Enacted in 2010, the Affordable Care Act marked a significant milestone in American Medical Association (AMA) policies and healthcare reform. ACA’s primary goal is to improve health insurance coverage while reshaping the healthcare system simultaneously. Through the state marketplaces, ACA provides affordable health packages for the uninsured, those with financial struggles, and preexisting health conditions.
What Are the Goals and Objectives of ACA?
The Affordable Care Act (ACA) has a set of goals and objectives to be achieved to revolutionize the U.S. healthcare system:
- 1. It expands health coverage to uninsured families and individuals through State marketplaces and Medicaid.
- 2. The ACA boosts accessibility to healthcare by establishing essential benefits and removing existing barriers to critical services such as maternity and child care.
- 3. Individuals with preexisting conditions are protected from insurance companies who charge premiums and offer them coverage.
- 4. The ACA offers financial assistance through cost-sharing and premium tax credits, making health insurance affordable to families and individuals in the low-income bracket.
- 5. The ACA addresses existing healthcare disparities and seeks to improve the quality of care, promote innovations, and control costs.
Key Provisions of the Affordable Care Act
The Affordable Care Act is guided by provisions focused on improving and reforming the U.S. healthcare system.
- Individual mandate: It requires every American, besides the exempted, to obtain health insurance or be liable for a financial penalty.
- Medicaid expansion: All ACA participating states are eligible for Medicaid, providing coverage for low-income individuals.
- Health insurance marketplaces: The state and federal level centralized platforms where individuals can research, compare, and purchase health insurance, promoting competition and transparency.
- Essential health benefits: ACA declares compulsory health benefits that must be included in every insurance plan, ensuring all individuals have access to maternity care, preventive care, prescription drugs, and mental health services.
- Protection for preexisting conditions: Prevents insurance companies from charging higher premiums or even denying coverage to individuals with preexisting conditions.
- Coverage extension: ACA ensures coverage is extended to young adults up to 26 by remaining in their parent’s insurance plans.
- Employer mandate: Requires big employers to accord their employees affordable health insurance, and non-compliance leads to penalties.
- Financial assistance: ACA provides cost-sharing reductions and premium tax credits to low-income families and individuals.
The ACA Health Insurance Marketplace
According to the ACA, online health insurance marketplaces are established at the state and federal levels. The platform helps streamline the purchase of health insurance coverage and the enrollment process for businesses and individuals.
The ACA enrollment period, ending December 15 every year, allows individuals and businesses to browse the different insurance plans available on the marketplaces. If one misses the enrollment deadline due to allowable circumstances, they can take advantage of the Special Enrollment Period.
The ACA provides four insurance plans, Platinum, Silver, Bronze, and Gold, and each has a different level of coverage for medical costs. The bronze and silver plans are ideal for young people, while gold and platinum are recommended for people with frequent medical needs.
How to Apply for Affordable Care
Once you have chosen the coverage plan that best suits your needs, the next step is to apply. Irrespective of how you get your health plan, you will need to provide the following information to complete the required application fully:
- The size of your household
- Birth dates of all individuals to be covered
- Mailing address
- Social security number
- Earning and employment details
- Estimated household income for the current year
- If an individual(s) receives an employer-sponsored health coverage plan, they should provide the Employer Coverage form
ACA Subsidies and Financial Assistance
The Affordable Care Act provides financial assistance to low-income individuals through premium tax credits and cost-sharing reductions.
Premium tax credit limits the amount an individual must pay for the premium “benchmark” health plan, the market’s second-lowest silver plan cost-wise. It is also called the mandatory individual contribution, determined by one’s income scale. For example, in 2024, all individuals whose income was up to 150% of the Federal Poverty Level (FPL) were exempted from this contribution, while the ones with above 400% FPL must pay 8.5% of their household income.
To receive a premium tax credit, individuals must submit a complete application via the marketplace by providing information about their age, citizenship status, estimated income, and address for the coming year. Only after submitting this application can the premium tax credit be determined.
Moreover, as of the beginning of 2024, there is a criterion used to determine if the enrollee, via the marketplace, qualifies for the premium tax credit. One must meet the following requirements:
• They do not qualify for Medicaid, Children’s Health Insurance Program (CHIP) coverage, or Medicare.
• At least have an income (household) equivalent to the Federal Poverty Level (FPL)
• Not having insurance coverage through an employer.
• Have proof of being a U.S citizen and resident
In addition to the premium tax credit, low-income individuals and families can receive financial assistance through cost-sharing reductions. With cost-sharing reductions, the marketplace enrollee pays fewer out-of-pocket fees (coinsurance, deductibles, and copayments). To obtain the cost-sharing reduction, the individuals must qualify for the premium tax credit, and their household income must be between 100% and 250% FPL.
Notably, cost-sharing reductions are only given to the silver plan, unlike premium tax credits, which can be applied across all four plans or metal levels. Moreover, individuals whose income is between 100 and 250 percent of FPL can apply for a premium tax credit at any mental level. Still, they can only be eligible for cost-sharing reductions if they opt for the silver plan.
Conclusion
Affordable Care Act has reformed the U.S. health system by ensuring the underprivileged are well covered. With its comprehensive provisions, this act has helped low-income individuals and families receive quality health care affordably. Thanks to the Affordable Care Act, essential services such as maternity care, mental health, and child care are available to everyone, irrespective of their income level or coverage plan. Moreover, financial assistance in the form of premium tax credits and cost-sharing reductions is accorded to individuals and families that have low incomes. The importance of good health cannot be emphasized enough, and ACA has taken the strategic step to ensure all American citizens receive quality health care.
Enacted in 2010, the Affordable Care Act marked a significant milestone in American Medical Association (AMA) policies and healthcare reform. ACA’s primary goal is to improve health insurance coverage while reshaping the healthcare system simultaneously. Through the state marketplaces, ACA provides affordable health packages for the uninsured, those with financial struggles, and preexisting health conditions.
What Are the Goals and Objectives of ACA?
The Affordable Care Act (ACA) has a set of goals and objectives to be achieved to revolutionize the U.S. healthcare system:
- 1. It expands health coverage to uninsured families and individuals through State marketplaces and Medicaid.
- 2. The ACA boosts accessibility to healthcare by establishing essential benefits and removing existing barriers to critical services such as maternity and child care.
- 3. Individuals with preexisting conditions are protected from insurance companies who charge premiums and offer them coverage.
- 4. The ACA offers financial assistance through cost-sharing and premium tax credits, making health insurance affordable to families and individuals in the low-income bracket.
- 5. The ACA addresses existing healthcare disparities and seeks to improve the quality of care, promote innovations, and control costs.
Key Provisions of the Affordable Care Act
The Affordable Care Act is guided by provisions focused on improving and reforming the U.S. healthcare system.
- Individual mandate: It requires every American, besides the exempted, to obtain health insurance or be liable for a financial penalty.
- Medicaid expansion: All ACA participating states are eligible for Medicaid, providing coverage for low-income individuals.
- Health insurance marketplaces: The state and federal level centralized platforms where individuals can research, compare, and purchase health insurance, promoting competition and transparency.
- Essential health benefits: ACA declares compulsory health benefits that must be included in every insurance plan, ensuring all individuals have access to maternity care, preventive care, prescription drugs, and mental health services.
- Protection for preexisting conditions: Prevents insurance companies from charging higher premiums or even denying coverage to individuals with preexisting conditions.
- Coverage extension: ACA ensures coverage is extended to young adults up to 26 by remaining in their parent’s insurance plans.
- Employer mandate: Requires big employers to accord their employees affordable health insurance, and non-compliance leads to penalties.
- Financial assistance: ACA provides cost-sharing reductions and premium tax credits to low-income families and individuals.
The ACA Health Insurance Marketplace
According to the ACA, online health insurance marketplaces are established at the state and federal levels. The platform helps streamline the purchase of health insurance coverage and the enrollment process for businesses and individuals.
The ACA enrollment period, ending December 15 every year, allows individuals and businesses to browse the different insurance plans available on the marketplaces. If one misses the enrollment deadline due to allowable circumstances, they can take advantage of the Special Enrollment Period.
The ACA provides four insurance plans, Platinum, Silver, Bronze, and Gold, and each has a different level of coverage for medical costs. The bronze and silver plans are ideal for young people, while gold and platinum are recommended for people with frequent medical needs.
How to Apply for Affordable Care
Once you have chosen the coverage plan that best suits your needs, the next step is to apply. Irrespective of how you get your health plan, you will need to provide the following information to complete the required application fully:
- The size of your household
- Birth dates of all individuals to be covered
- Mailing address
- Social security number
- Earning and employment details
- Estimated household income for the current year
- If an individual(s) receives an employer-sponsored health coverage plan, they should provide the Employer Coverage form
ACA Subsidies and Financial Assistance
The Affordable Care Act provides financial assistance to low-income individuals through premium tax credits and cost-sharing reductions.
Premium tax credit limits the amount an individual must pay for the premium “benchmark” health plan, the market’s second-lowest silver plan cost-wise. It is also called the mandatory individual contribution, determined by one’s income scale. For example, in 2024, all individuals whose income was up to 150% of the Federal Poverty Level (FPL) were exempted from this contribution, while the ones with above 400% FPL must pay 8.5% of their household income.
To receive a premium tax credit, individuals must submit a complete application via the marketplace by providing information about their age, citizenship status, estimated income, and address for the coming year. Only after submitting this application can the premium tax credit be determined.
Moreover, as of the beginning of 2024, there is a criterion used to determine if the enrollee, via the marketplace, qualifies for the premium tax credit. One must meet the following requirements:
• They do not qualify for Medicaid, Children’s Health Insurance Program (CHIP) coverage, or Medicare.
• At least have an income (household) equivalent to the Federal Poverty Level (FPL)
• Not having insurance coverage through an employer.
• Have proof of being a U.S citizen and resident
In addition to the premium tax credit, low-income individuals and families can receive financial assistance through cost-sharing reductions. With cost-sharing reductions, the marketplace enrollee pays fewer out-of-pocket fees (coinsurance, deductibles, and copayments). To obtain the cost-sharing reduction, the individuals must qualify for the premium tax credit, and their household income must be between 100% and 250% FPL.
Notably, cost-sharing reductions are only given to the silver plan, unlike premium tax credits, which can be applied across all four plans or metal levels. Moreover, individuals whose income is between 100 and 250 percent of FPL can apply for a premium tax credit at any mental level. Still, they can only be eligible for cost-sharing reductions if they opt for the silver plan.
Conclusion
Affordable Care Act has reformed the U.S. health system by ensuring the underprivileged are well covered. With its comprehensive provisions, this act has helped low-income individuals and families receive quality health care affordably. Thanks to the Affordable Care Act, essential services such as maternity care, mental health, and child care are available to everyone, irrespective of their income level or coverage plan. Moreover, financial assistance in the form of premium tax credits and cost-sharing reductions is accorded to individuals and families that have low incomes. The importance of good health cannot be emphasized enough, and ACA has taken the strategic step to ensure all American citizens receive quality health care.
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