Snapshot of the aca

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  Provides coverage to Americans including children with pre-existing conditions.
  
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  Protects your choice of primary care doctor from you plan’s network
  
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  Permits young adults under age 26 to remain covered by parent’s plan
  
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  Phases out annual limits and ends lifetime limits on health care
  
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  Ends arbitrary withdrawals of insurance coverage
  
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  Reviews premium increases and requires insurers to justify unreasonable rate hikes
  
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  Requires insurers to spend premiums primarily on health care, not administrative costs
  
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  Allows emergency services care outside your health plan’s network.
  
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  Covers some recommended preventive care with no co-pays
  
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  Guarantees your right to appeal denial of coverage
  
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  Requires uninsured individuals to obtain health insurance, a provision under review by the US Supreme Court, and creates a variety of alternatives to the private insurance market.
  
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  Expands the Medicaid Program and provides subsidies or tax credits to help those who cannot afford insurance
  

“Health Care Law and You” at www.healthcare.gov provides a summary of the law, its full text, and timeline for its implementation. The outline below corresponds to information on this site. At the Kaiser Family Foundation, www.kff.org, ”Health Reform” describes how the law will work, summarizes its provisions and gives another implementation timeline.

KEY PROVISIONS

I. RIGHTS & PROTECTIONS

The Affordable Care Act is designed to put you back in charge of your health care. Consumer Assistance Program State Consumer Assistance Programs help you file complaints and appeals, enroll in health coverage, and learn about your rights and responsibilities as a consumer. Appealing Health Plan Decisions You have the right to ask your plan to reconsider a denial of payment for services. Preventive Care You may be eligible to receive recommended preventive health services at no cost. Patient’s Bill of Rights The “Patient’s Bill of Rights” outlines consumer protections and gives you the knowledge you need to make informed choices about your health. Children’s Pre-Existing Conditions Insurance companies can no longer limit or deny benefits to children under age 19 due to a pre-existing health condition. Doctor Choice & ER Access You have the right to choose the doctor you want from your plan’s network or seek emergency care at a hospital outside of your health plan’s network. Grandfathered Health Plans You have the right to keep your “grandfathered” health plan if you were covered before the health care law was enacted if it is continued by your insurer or employer. Grandfathered plans do not have to provide some of the rights and protections under the Affordable Care Act. Curbing Insurance Cancellations Insurance companies can no longer cancel your coverage just because you made an honest mistake on your application.

II. INSURANCE

The ACA gives you alternatives to the individual private insurance market if you are uninsured. Pre-Existing Condition Insurance Plan (PCIP) If you have been rejected for insurance due to a health condition or disability, you may be eligible for coverage through the Pre-Existing Condition Insurance Plan. Affordable Insurance Exchanges Starting in 2014, you will be able to shop for insurance and compare health plans in new state-based Affordable Insurance Exchanges. CO-OP Insurance Plans Also starting in 2014, you or your small business may be able to buy insurance from a new type of non-profit, consumer-run health insurer, called a Consumer Operated and Oriented Plan (CO-OP).

III. INSURANCE COSTS

The ACA gives you new ways to hold insurance companies accountable and keep your costs down.  It limits how insurance companies may spend health insurance premiums that do not improve your health care, bans lifetime limits on new insurance plans, and phases out annual limits on health benefits by 2014. Flexible Spending Account Changes Significant changes were made to “flexible spending,” “health savings”, or “health reimbursement” accounts. Rate Review Rate Review helps protect families and small businesses by requiring insurance companies to justify any rate increase of 10% or more.

IV. SERVICES FOR THOSE 65 OR OLDER

The Affordable Care Act contains provisions expressly for seniors. Medicare Preventive Services If you have Medicare, you are eligible for a number of cost-free preventive services. Medicare Drug Discounts Eligible seniors who are in the coverage gap known as the “donut hole” automatically receive a discount on prescription drugs in 2011 and beyond. If you were in this coverage gap in 2010 you may have qualified for a rebate. Strengthens Medicare The health care law cracks down on waste, fraud, and abuse while providing new protections for seniors.

V. TAX CREDITS/PROGRAMS FOR EMPLOYERS

The law helps make health care affordable for employers, employees, and early retirees. Small Employer Tax Credits Tax credits for small businesses and non-profits help you bring down the cost of providing insurance. Early Retiree Reinsurance Program (ERRP) If your company provides health insurance to retirees ages 55 to 64, it may be eligible for financial help through the Early Retiree Reinsurance Program.

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