The Affordable Care Act and you
The Patient Protection and Affordable Care Act or, simply, the Affordable Care Act (ACA), was designed to improve access to affordable health care for everyone. With the ACA, you cannot be denied coverage, or pay a higher rate, based on a pre-existing condition. If you currently don't have coverage through an employer plan, Medicare or Medicaid, you will have to buy it on your own. Also known as Obamacare, the ACA affects you and the type of health plan you can buy.
Our ACA toolkit has valuable information on how to get a lower cost health plan, the types of plans that you can purchase and what they cover, as well as how to prepare for enrollment. There are also answers to common questions.
Benefits available through the ACA
Qualified Health Plans (QHPs) offer specific coverage benefits. Here are some key points to keep in mind:
- Young adults can remain on a parent’s health plan until the end of the year they turn 26, even if they live away from home, attend school or are married
- Preventive care and women’s preventive care services available without copays, coinsurance or deductibles
- Children and adults with pre-existing conditions can't be denied coverage
- No set lifetime dollar limits on coverage
- All health insurance companies must use the same standard form (Summary of Benefits and Coverage or SBC) to help you compare plans
- Health insurance companies must spend at least 80 to 85 cents out of every premium dollar on medical claims and activities that improve the quality of care for members
You can buy a Qualified Health Plan directly through insurance companies like HAP, through the Health Insurance Marketplace or through an agent.
The Health Insurance Marketplace (the Marketplace) is a place where you can compare and select Qualified Health Plans. You can either shop online or by phone.
In Michigan, the Marketplace is operated by the federal government.
The government sets strict guidelines on when people can enroll in a health plan each year.
For 2017 coverage, the open enrollment period is November 1, 2016 to January 31, 2017.
Outside of these dates, you can only purchase a health plan or change your current plan if you have a qualifying life event - for example, you get married, have a baby or lose your job (this is called a special enrollment period).
Special Enrollment Period
You can change your health plan whenever life happens.
If you have a qualifying life event (birth, marriage, job loss, etc.) any time during the year, you can enroll in a new health plan or change existing coverage within 60 days of the event. This is called a special enrollment period. Written proof of the life event must be included with a new application or member change form.
We’ve got you covered. Guaranteed!
Health plans cannot deny coverage or charge a higher premium to someone with a pre-existing medical condition. These protections are commonly referred to as guaranteed issue.
Essential health benefits
What is covered?
Qualified Health Plans are required to cover Essential Health Benefits, or EHBs, which include at least the following 10 categories of health care services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance abuse services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services including vision and dental care
Lower cost eligibility
There may be help available.
If you buy coverage through the Health Insurance Marketplace, you may be eligible for cost savings based on your family size and how much your family earns. The lower your income, the higher your savings may be. If you are eligible, you will receive a cost savings that can be applied directly to your monthly premiums. You may also be eligible for lower copays, coinsurance and deductibles. To learn if you may qualify for these savings, get a quote now.
The metal tiers: Bronze, Silver, Gold and Platinum
Qualified Health Plans are ranked using metal tiers: Bronze, Silver, Gold and Platinum*. The idea behind metal tiers is to allow you to compare health plans with similar coverage value (the technical term is actuarial value).
What this means is that health plans offered to individuals and families through HAP or the Health Insurance Marketplace are grouped in different metal tiers. These tiers are based on the percentage of health care costs covered by the plan. There are also catastrophic health plans that have much lower premiums, but only cover you if something catastrophic were to happen.
Coverage for everyone
Avoid paying the tax penalty.
Everyone is now required to have health insurance. As part of the ACA requirements, people without coverage face tax penalties. These penalties started with the 2014 tax year and will increase over the next several years.