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