The Basics of the Affordable Care Act

health-care-reformblogIs Health Care Reform just what the doctor ordered?

The Affordable Care Act includes many provisions designed to help consumers obtain health insurance either through the exchange or free market. The law is meant to give access to health insurance while at the same time control costs. Here are the key provisions that will impact all residents.

1. Extensions of health insurance coverage to children up to age 26.

While this was a very useful provision of the law, in 2014 these young adults will be able to purchase a policy through the exchange or outside the exchange with no underwriting. So a parent may actually be better off taking the adult child off their employer plan and purchasing a individual policy.

2. Guaranteed Issue requires all insurers to no longer be able to decline coverage based on health status.

This is one of the biggest provisions of the health care law. In the past, all health plans have been subject to some type of underwriting. In 2014, you will not have to answer any medical questions to get a health policy. For Hoosiers with ongoing conditions, this will have a huge positive impact.

3. Insurance Companies will be prohibited from charging consumers more for gender.

In the past, women have always had higher insurance rates. This will no longer be the case.

4. Elimination of annual and lifetime coverage limits.

Very few Hoosiers will be impacted by this provision unless you are obtaining a lot of health care. There have been situations in the past where people have maxed out plans, but this will no longer happen.

5. Prohibition of Coverage limitation or exclusions based on Pre-Existing Conditions.

In the past, we have seen Insurance companies place riders on certain conditions or put a waiting period in before the condition would be covered. Now any on going condition will covered under the policy.

6. Approved clinical trials have to be covered by the insurance policy.

This is a huge provision! In the past, an insurance policy would never cover any clinical trials. Now they do. So if you have a terminal condition, you can participate in a clinical trial.

7. The Medical Loss Ratio.

80% of  your premium dollars must go towards medical claims. If a portion of the 80% does not go towards medical, then you could be eligible for a rebate.


These new provisions will have a huge impact on the entire state. Some people will be very happy because they will now have access to coverage. Others are going to be upset because they will see their premium go up.

In any case, there are going to be options for coverage. You will be able to look at a policy through the health insurance exchange and outside the exchange. Inside the exchange, you’ll have the option of applying for subsidies to help lower your costs. Outside of the exchange, you’ll have the option of the free market, where you can purchase a plan that has greater access to doctors.

Need help sorting it all out? Contact us and we can help find the best plan option for you!



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