An Overview of the Affordable Care Act

An Overview of the Affordable Care Act

The Affordable Care Act (ACA) provides health insurance options for patients with preexisting conditions and many health insurance market reforms. It is committed to working with the Obama Administration to ensure that these provisions are strengthened and that more can be done to improve our healthcare system in the future.

Coverage for Individuals

With Medicaid expansion, state and multistate health insurance exchanges, premium tax credits, cost-sharing reductions, and other initiatives, the Affordable Care Act offers millions of people coverage. Additionally, it provides complimentary coverage for many preventive services like immunizations and screenings.

Maternity and mental health care are among the essential medical benefits that all individuals and small groups with health insurance must have under the Affordable Care Act in Western PA. Insurance companies are prohibited from increasing prices in response to risk or denying coverage due to preexisting conditions.

The law also provides subsidies to help individuals and families afford health insurance, with premiums allocated on a sliding scale based on income. Consumers who earn less than 400% of the federal poverty level (approximately $48,000 for an individual and $98,000 for a family) qualify for these subsidies.

Coverage for Small Businesses

The ACA has helped reduce the uninsured rate for small businesses and their employees, allowing them affordable coverage. However, attempts to repeal and replace the law under the Trump administration have yet to progress.

The law also provides tax credits to help small businesses and self-employed individuals purchase health insurance through the ACA Marketplace. These credits are available for two years and increase as firm size and average wage increase.

Coverage for Children

Health coverage for children is often a critical factor in their development and well-being. It has been shown to reduce the risk of illness and injury, promote school success, improve social and emotional outcomes, and prevent the development of costly conditions.

The ACA requires plans and issuers to offer dependent child coverage until an adult child reaches age 26. It is a significant change for many parents worried about losing health insurance when their children leave home for college.

Coverage for Individuals with Disabilities

Under the ACA, states can expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level. It has helped millions of people who previously did not qualify for Medicaid, many with disabilities and complex healthcare needs, gain coverage.

The ACA also provides a legal safeguard for the disability community by prohibiting discrimination against individuals with disabilities, including in employment and other areas. It also allows young adults with disabilities to remain on their parent’s insurance until age 26 — a massive win for families worried about losing their children’s insurance when they move out or graduate from college.

Coverage for Employers

The ACA requires employers to offer affordable health insurance to their full-time employees or face penalties. These rules are the employer shared responsibility provision or “pay or play.”

Whether an employer is subject to the ACA’s employer mandate depends on the number of full-time employees the previous year.

Employers with over 50 full-time employees or full-time equivalents must offer affordable minimum value coverage to 95% of their employees. These employers are called applicable large employers, or ALEs.

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