Top ten facts on healthcare reform

2 min read · 7 years ago


Helping Individuals Navigate the Turbulent Waters of a Changing System

Wondering what the Affordable Care Act, commonly known as the ACA or health care reform, means for you? Many of the changes help to expand access to health care coverage and will likely affect you and your health care benefits. To help you prepare we’ve compiled a simple list of the top 10 facts you need to pay attention to in order to better understand and meet the requirements of the law.

1. Required coverage: Most people are now required to obtain Qualified Health Coverage (QHC) or to pay a penalty. Compliant coverage may include, but is not limited to, employer-provided insurance, coverage you buy on your own or coverage under Medicare or Medicaid.

2. Health insurance marketplaces: You can buy health insurance directly through the health insurance marketplace in your state, which can be accessed at Keep in mind if you purchase health insurance through these marketplaces you will lose any contribution your employer provides towards equivalent health insurance benefits offered at your workplace.

3. Summary of benefits and coverage: Health insurance issuers and group health plans are now required to provide you with an easy-to-understand summary about your health plan’s benefits and coverage. For an even deeper understanding of your health plan, be sure to take advantage of opportunities to meet with a benefits advisor or broker if offered by your employer.

4. Dependent coverage: Private insurers must continue dependent coverage of children until age 26. If you have children under age 26, you can insure them even if they are married, are no longer living with you, are not dependents on your tax return or are no longer students. The only exception applies prior to 2014 for employees covered under certain grandfathered plans. In this case, if your children can get their own job-based coverage, your plan may not extend coverage to them. Additionally, private insurers aren’t required to offer spouse coverage.

5. Pre-existing conditions: Major medical plans cannot exclude you from coverage or charge a higher premium for a pre-existing condition, including a disability. Additionally, the law provides protections for children with pre-existing conditions. As of September 23, 2010, insurers cannot deny coverage to any child under age 19 based on health conditions, including babies born with health problems.

6. Preventive care: Except for certain grandfathered plans, you will not have to pay a copayment, co-insurance or deductible to receive certain recommended preventive health care. These services may include screenings, vaccinations, and counseling such as:

  • Blood pressure, diabetes, and cholesterol tests.
  • Many cancer screenings, including mammograms and colonoscopies.
  • Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use.
  • Regular well-baby and well-child visits, from birth to age 21.
  • Routine vaccinations against diseases such as measles, polio or meningitis.
  • Counseling, screenings and vaccines to ensure healthy pregnancies.
  • Women’s wellness visits.
  • Flu and pneumonia shots.

For the other four tips, please see the original article here.

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