General Questions
What is ACA?
The ACA, or Affordable Care Act, is a health care reform law enacted in March 2010. It includes provisions to expand insurance coverage, control healthcare costs, and improve the healthcare delivery system.
Who needs to have health insurance under the ACA?
The ACA mandates that most Americans have health insurance. However, there are exemptions for certain groups, such as those with very low incomes and members of certain religious groups. More information can be found on the U.S. Department of Health & Human Services website.
How does the ACA benefit me?
The ACA provides numerous benefits, including access to affordable health insurance, protections for people with pre-existing conditions, and the expansion of Medicaid in some states to cover more low-income individuals and families. It also includes provisions for free preventive services such as annual wellness exams, screenings for cancer and diabetes, immunizations, and counseling for smoking cessation and weight management.
About Enrollment & Coverage Plans
What information do I need to provide when I apply for coverage?
To apply for coverage, you'll need the following information:
- Social Security numbers for all applicants
- Employer and income information (e.g., pay stubs, W-2 forms)
- Policy numbers for current health insurance plans (if applicable)
- Information about any health coverage available through your employer or a family member’s employer
Am I able to keep my current doctor if I enroll in a new plan?
Whether you can keep your doctor depends on whether they are included in your plan's network. Each plan has a list of covered providers, so it's important to check the network when selecting a plan to ensure your doctor is included. You can do this by calling the number on the back of your insurance card or using the network's app to find doctors and offices near you that are in your network.
When can I enroll in an ACA plan?
You can enroll in an ACA plan during the Open Enrollment Period, which typically runs from November 1 to December 15 each year. You may also be able to enroll at other times of the year if you qualify for a Special Enrollment Period. That could include certain life events, such as losing other health coverage, moving, getting married, or having a baby.
Benefits & Protection Questions
What are the benefits I can receive with ACA?
ACA health insurance plans cover a set of essential health benefits (EHBs). These benefits ensure that every individual has access to comprehensive healthcare services, including:
- Ambulatory patient services (outpatient care)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
Are preventive services covered under the ACA?
Yes, the ACA requires that all ACA-compliant health insurance plans cover preventive services without charging a copayment or coinsurance, even if you haven’t met your yearly deductible. This includes screenings, vaccines, and counseling!
Additional Questions
Are dental and vision coverage included under the ACA?
Dental and vision coverage for adults is not considered an essential health benefit under the ACA. However, dental and vision care for children is included in the ten essential health benefits. Some health plans may offer adult dental and vision coverage as a separate benefit.
How does the ACA address mental health and substance use disorders?
The ACA requires that all ACA-compliant health insurance plans cover mental health and substance use disorder services as part of the essential health benefits. This includes behavioral health treatment, counseling, and psychotherapy.