The Affordable Care Act: What You Need to Know

Whether you are insured or planning on purchasing a plan, find the answers to your questions about the Affordable Care Act and learn how it may affect you and your family.

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The wealth of information about the Affordable Care Act can seem daunting and even confusing. With open enrollment for healthcare commencing October 1, 2013, and changes taking effect in 2014, you will need a firm grasp on how the ACA may affect you. Rather than slogging through a thousand pages of reforms, get the essentials from our Affordable Care Act FAQs.

What is the Affordable Care Act (ACA) in a nutshell? 

The ACA is a law that requires that all Americans have access to health insurance: either from their job, from the new national Health Insurance Marketplace, or through a government-funded program. The ACA also requires all insurance plans to provide essential health benefits, eliminates discrimination against pre-existing conditions and expands Medicaid eligibility to millions of low-income Americans who can’t afford insurance.

I don’t have insurance. What do I do?

You can enroll for a new plan through the Health Insurance Marketplace, which opens October 1, 2013. Or if you qualify for Medicaid (eligibility varies by state), you can get free or low-cost insurance.

What happens if I don’t get insurance?

With a few exceptions, if you don’t have insurance, you will have to pay a tax (1% in 2014; 2.5% in 2016).

Is dental and vision coverage also considered mandatory?

No, if you are an adult you do not need to have dental or vision coverage to avoid paying the penalty fee.

I already have insurance. What changes for me?

If you already have coverage, your plan will now provide new protections for you (with the exception of grandfathered plans*, outlined on the next page). 

The ACA is making these essential health benefits mandatory to most plans: 

  • ambulatory patient services 
  • emergency services 
  • hospitalization 
  • maternity and newborn care 
  • mental health and substance use disorder services 
  • prescription drugs 
  • rehabilitative and habilitative services 
  • laboratory services 
  • preventive and wellness services 
  • pediatric services 

How much will insurance cost me through Health Insurance Marketplace? 

That depends on a bunch of things: Where you live, your age, tobacco use, whether you want to pay a higher premium with a lower deductible (or vice versa), and whether or not you are eligible for a subsidy. When the Health Insurance Marketplace opens on October 1, 2013, you’ll be able to determine your actual costs. In the meantime, you can get an estimate with the Kaiser Family Foundation’s health insurance costs and savings calculator.

When does open enrollment start and end, and when does coverage go into effect?

Open enrollment begins October 1, 2013 and ends March 31, 2014. If you enroll before December 31, 2013, your coverage should begin on January 1, 2014. If you enroll in January, February or March of 2014, coverage should begin the following month. After the initial open enrollment period, there will be annual open enrollment from October 15 to December 7, with coverage beginning on January 1 of the following year. 

What if I already have insurance through my job? 

You can keep it! You can also consider switching to a Marketplace plan, but you may not qualify for lower costs than your company offers. 

Can I keep my doctor? 

Possibly. Much like any other insurance plan, there will be a network of doctors, specialists, hospitals and pharmacies. If keeping your doctor is a priority, you can see a list of providers in each plan’s network before you buy. 

Can I get dental and vision coverage? 

Many health plans will include dental and/or vision coverage, but if the one you want does not, you can buy a separate, stand-alone dental plan. Stand-alone vision plans may not be offered. 

I have a pre-existing condition. Will I be able to get insurance?

Starting January 1, 2014, you cannot be denied insurance because of pre-existing conditions. If you already have insurance, coverage for your pre-existing conditions will begin immediately. 

Will the Affordable Care Act cover children? 

As long as your plan covers children, they can stay on your insurance or be added to it until they turn 26. This applies even if they are attending school, not living at home, not financially dependent or married. 

*What is a grandfathered plan? 

A grandfathered plan is one that already existed on or before March 23, 2010 (it doesn’t matter if you enrolled before or after that date). Grandfathered plans still have to follow most new ACA guidelines, but they do not have to cover preventative care for free. To find out if your plan is being grandfathered, ask your employer or plan’s benefits administrator. 

 Where can I ask more questions? 

 Call 1-800-318-2596 (TTY: 1-855-889-4325), or chat online at Healthcare.gov. You can also read more about the ACA and find more healthcare reform FAQs on Sharecare.