Definition and Examples
The Patient Protection and Affordable Care Act is a law that contains comprehensive health insurance reforms aimed at achieving near-universal and affordable health coverage. The law aims to improve access to affordable health insurance for everyone by reducing cost-sharing and providing tax credits for premiums. It also provides rights and protections against exploitative insurance company practices.
How the Patient Protection and Affordable Care Act Works
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, which implements reforms to ensure access to comprehensive, affordable health insurance coverage from birth through retirement. More than 10 years after its implementation, the Patient Protection and Affordable Care Act has reduced the number of uninsured Americans by 20 million and expanded vital consumer protections for over 100 million citizens.
Strong Consumer Rights and Protections
The Patient Protection and Affordable Care Act ended medical underwriting and the exclusion of pre-existing conditions, so insurance companies cannot deny coverage or charge you more based on your health or medical condition. The law also eliminates financial limits on essential health benefits and annual limits on what insurance providers spend on your coverage.
More Affordable Health Coverage
The Patient Protection and Affordable Care Act provides more affordable health coverage by reducing healthcare costs and requiring accountability for healthcare dollars spent. The 80/20 rule typically requires insurance companies to spend at least 80% of your premium dollar on healthcare and improvements in quality; otherwise, they must issue a rebate.
Better Access to Healthcare
The Patient Protection and Affordable Care Act provides better access to healthcare and offers a range of health insurance options. For example, the law gives you access to many recommended preventive health services, including diabetes and cancer screenings, at no additional cost in the form of out-of-pocket maximums or coinsurance percentages. Additionally, young people who do not obtain health coverage through their jobs can stay on their parents’ health insurance plans until age 26.
Strengthening the Medicare Program
The Patient Protection and Affordable Care Act strengthens the Medicare program for over 61 million Americans who depend on it by combating fraud and adding benefits and improving patient care. The law provides relief to seniors who face a coverage gap in prescription drug costs. Seniors can receive recommended preventive services like diabetes screenings and flu vaccinations at no charge.
How to Obtain Health Coverage Through the Patient Protection and Affordable Care Act
You can apply for health insurance under the Patient Protection and Affordable Care Act for 2022 during the open enrollment period, which runs until January 15, 2022. If you do not enroll in a health plan by that date, you will not receive coverage unless you have a qualifying life event that allows for enrollment.
You can apply for health coverage under the Patient Protection and Affordable Care Act in any of the following ways:
- Apply online. Visit HealthCare.gov to find benefits through the health insurance marketplace under the Patient Protection and Affordable Care Act. You may be redirected to your state marketplace website.
- Use a certified partner website to enroll. You can use a certified enrollment partner website, such as an insurance company, to apply and enroll in a marketplace plan.
- Call
- You can contact the market call center. A representative at the market call center (800-318-2596) can assist you in filling out the application and enrolling.
- Send your paper application by mail. You can send your paper application by mail and wait to receive your eligibility results within two weeks.
Notable Events
The Patient Protection and Affordable Care Act has made significant changes to the health insurance landscape with many reforms, but it has undergone numerous changes since then. In 2017, legislation was passed that eliminated the mandate for most people to have health insurance or pay a tax penalty. The repeal of the mandate took effect in 2019.
Short-term plans were reintroduced in 2018 under the Trump administration, allowing policies that provide coverage for periods ranging from a few months up to 364 days. While these policies offer lower premiums than plans compliant with the Patient Protection and Affordable Care Act, they are not subject to the rules of the Patient Protection and Affordable Care Act; thus, insurance companies can be more selective in the coverage offerings they provide.
For example, these plans are not subject to prohibitions against excluding pre-existing medical conditions or annual and lifetime financial limits. Many of these plans also exclude benefits for prescription drugs, maternity care, preventive care, mental health services, and substance abuse treatment.
The Patient Protection and Affordable Care Act also placed limits on the amounts that families and individuals can pay annually for care. The law now imposes limits on the maximum annual out-of-pocket expenses that plans in the market can charge, with lower limits for plans that offer cost-sharing reductions. In 2022, the maximum out-of-pocket expenses are $8,700 for individuals and $17,400 for families.
In 2022, individuals with incomes up to 150% of the federal poverty level will not contribute to their premium. Meanwhile, a contribution of up to 8.5% of household income is required for those with incomes exceeding 400% of the federal poverty level. Prior to July 2021, consumers earning 150% of the federal poverty level had to contribute more than 4% of their income.
Source: https://www.thebalancemoney.com/what-is-the-patient-protection-and-affordable-care-act-5215153
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