Affordable Care Act Basics & Benefits

The Affordable Care Act (ACA), signed into law in 2010, consists of nearly 11,000 pages. While the law accomplished many things, its signature achievement was the complete regulatory overhaul of the the United States’ healthcare system—with specific emphasis on the health insurance industry.

Here are the most important new regulations for individual health plans enacted by the ACA:

1. All plans must be Guaranteed Issue. In other words, no person can be denied coverage or priced at a higher rate due to medical history or pre-existing conditions.
2. All plans must cover ten Essential Health Benefits. The intention behind these benefits was to elevate the quality of coverage for all individuals and families, eliminating plans that were too limited.
3. New federal subsidies were created to help people afford a health insurance plan. These subsidies, which function as discounts, arrive in the form of an Advanced Premium Tax Credit in which the Internal Revenue Service sends money to the insurance company as a tax credit paid from the beginning of the plan and later reconciled on your tax return.
4. The Individual Mandate, or penalty for most people who do not acquire and maintain a health insurance plan, was enforced. This mandate is a necessity in order for the plans to be Guaranteed Issue. The basic premise is that you need a base of healthy consumers purchasing insurance in order to help pay for new, sicker individuals who can finally afford comprehensive coverage.

You must actively manage your health insurance plan.

For those who qualify for the federal subsidies, it is essential to actively manage the plan. Each year’s renewal process involves a virtually new application. All your information must be kept up to date with the Marketplace. Without active management, it’s possible to lose a subsidy mid-year or face a large repayment of the subsidy on the next tax return as a result of outdated information or a lack of proper documentation. 

That’s where we come in. As your advocate, we fully understand these Marketplace requirements and will help you each step of the way. Osborne Insurance Services has nearly twenty years of experience in helping individuals and families find health insurance plans that best suit their needs—and at affordable rates.