The fourth Open Enrollment period for the Affordable Care Act (ACA) is underway and we certainly have a lot to be thankful for. As the ACA’s coverage provisions have taken effect, nearly 12.7 million Americans enrolled in Marketplace plans this year, and 5 million of them were new enrollees, showing consumers' strong desire for quality, affordable health coverage. Here are 6 reasons we can be thankful for the ACA:
One of the things we can be thankful for is that financial help is available through the Marketplace to help cover the cost of monthly health insurance premiums. This year in Florida, 85 percent of people eligible for coverage through the Marketplace can find a plan for $100 or less and 68 percent for $75 or less.
Young adult coverage
Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Before the health care law, insurance companies could remove enrolled children usually at age 19, sometimes older for full-time students. Now, most health plans that cover children must make coverage available to children up to age 26. By allowing children to stay on a parent's plan, the law makes it easier and more affordable for young adults to get health insurance coverage.
No lifetime limits
Thanks to the Affordable Care Act, lifetime limits on most benefits are prohibited in any health plan or insurance policy. Previously, many plans set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.
Holding insurance companies accountable
The health care law provides 2 ways to hold insurance companies accountable and help keep your costs down: Rate Review and the 80/20 rule. Rate Review helps protect you from unreasonable rate increases. Insurance companies must now publicly explain any rate increase of 10% or more before raising your premium. This does not apply to grandfathered plans. The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. Since the 80/20 rule was enacted in 2011, nearly $2.8 billion in total rebates have been paid to consumers, including rebates for 2015.
Under the Affordable Care Act, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.
Coverage for Women
Before the Affordable Care Act became law, most insurance companies selling individual policies could deny coverage to women or charge them more due to pre-existing conditions, such as cancer and having been pregnant. Under the law, insurance companies are already banned from denying coverage to children because of a pre-existing condition.
Now is the time for consumers to take advantage of renewing or buying an affordable health plan in the Healthcare Marketplace. Open Enrollment runs November 1, 2015, to January 31, 2016. Consumers who haven’t already enrolled, should take this opportunity to enroll by December 15, 2015 so their coverage is in place for the New Year! To make an appointment, call 786-708-0836 or text “ACA HELP” to 41411 or visit www.MiamiDadeMatters.org/ACA for FREE in-person assistance, close to their home, in their own language, at a time that fits their schedule.