Affordable Care Act ACA

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What Is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA), known colloquially as “Obamacare”, is a comprehensive health care reform law enacted in 2010 that has expanded health insurance coverage for the uninsured, aimed to control health care costs, and implemented significant changes to the health insurance market.

The Affordable Care Act (ACA) Has Undergone Many Changes

Perhaps the most significant change made to the Affordable Care Act (ACA) was the elimination of what was known as the individual mandate. Prior to 2019, you could face large tax penalties if you were uninsured. The federal tax penalty no longer exists.

Under the ACA, patients who may have been uninsured due to pre-existing conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state.

Pros and Cons of the Affordable Care Act (ACA)

To help you make the best decisions for your healthcare, it is important to weigh both sides of the ongoing Affordable Care Act (ACA) debate. Here are a few of the often debated pros and cons of the ACA.

Pros of the Affordable Care Act:

Carrier selection is expanding and adding additional networks

In most markets, carrier selection has been expanding over the past few years. As an independent agency, we at Griffin Insurance Solutions always keep up with the changing marketplace and add new insurance companies to our extensive portfolio of options. 

Government incentives offer financial help

Government incentives make purchasing health insurance less expensive for those who qualify for subsidies. Generally, subsidies are available for households making less than 400% of the Federal Poverty Level (FPL). Additionally, the Inflation Reduction Act, which was recently passed in August of 2022, extends the enhanced subsidies for people buying health insurance through the Marketplace through 2025. Also, the implementation of the 80/20 rule means 80% of your premium dollars is spent on healthcare instead of administrative costs.

In addition to subsidies offered to households making less than 400% FPL, households making less than 250% FPL can qualify for a Cost Sharing Reduction (CSR). A CSR is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance.

Lowest eligible income for ACA Expanded Medicaid Min. Income CSR Tier 1 limit CSR Tier 2 limit CSR Tier 3 limit

Family Size

100% FPL

138% FPL

150% FPL

200% FPL

250% FPL

1

$14,580

$20,120

$21,870 $29,160

$36,450

2

$19,720

$27,214

$29,580 $39,440

$49,300

3

$24,860

$34,307

$37,290 $49,720 $62,150

4

$30,000

$41,400

$45,000 $60,000 $75,000

5

$35,140

$48,493

$52,710 $70,280 $87,850

6

$40,280

$55,586

$60,420 $80,560 $100,700

Each Additional

$5,140

$7,093 $7,710 $10,280 $12,850

Preventive care

All qualified health insurance plans must provide 10 essential health benefits. These benefits include preventive care and wellness visits with no copay, deductible, or coinsurance.

No pre-existing condition denials

Insurance companies also cannot deny coverage for a pre-existing condition.

Medicaid is more inclusive for many

For states that have chosen to expand their program, Medicaid coverage now includes uninsured Americans under 138% of the federal poverty level (FPL).

Dependents can stay on their parents’ ACA plan longer

Your children can be insured under your health plan until they are 26 years old.

Stable ACA Networks

Originally, many insurance companies made their provider networks smaller to cut costs while implementing ACA requirements.

However, this trend is stabilizing as we are starting to see some doctors re-enter the ACA Networks now that they have been around for over 12 years. This trend is also improving due to additional Carriers entering the Marketplace and bringing along more networks as well.

No more ACA limits

Limits on lifetime benefits have been completely banned and annual limits phased out. (This does not include grandfathered plans).

Cons of the Affordable Care Act:

The cost has not decreased for everyone

Those who do not qualify for subsidies or make over the 400% FPL may find marketplace health insurance plans unaffordable. Customers may end up paying more for a plan that includes benefits, such as maternity care, that they may not need. Due to these increases in price, these individuals may need to discuss other “Off-Market” Health Insurance options with us. The term “Off -Market” just means these plans are not available for subsidies, but also don’t have to abide by all of the ACA rules. These off-market plans will sometimes lower premiums by asking health questions or not always covering pre-existing conditions. However, if you don’t have pre-existing conditions and qualify, these plans can sometimes be more affordable.

Loss of company-sponsored health plans

Some businesses may find it more cost-effective to let their employees purchase their own individual insurance on the exchanges rather than provide employer-sponsored coverage.

Shopping for Coverage Can Be Complicated

Shopping for coverage can be complicated with limited enrollment periods, difficulties with insurance websites, and a wide variety of coverage options. Additionally, with so many new carriers entering the Marketplace, it is important to shop your options with a reputable Independent Broker such as Griffin Insurance Solutions since we stay up to date with all the new plans and changes.

Regardless of the Affordable Care Act pros and cons, Griffin Insurance Solutions can be your helping hand in figuring out your health insurance options.

Call us today at 919-704-6147 or 800-774-1434 to talk with a licensed insurance agent.

We have been helping people across North Carolina and beyond with their ACA and Medicare needs for almost 10 years. Nobody knows more about health insurance than Griffin Insurance Solutions. Our expert services cost you nothing.

  • We get you the same price you would get even after you spend hours researching your choices.
  • We often save you money, because we make sure you get the right plan for your individual needs.
  • We provide proof that you actually enrolled.
  • We take the time to make sure you really understand the plan you are signing up for.
What is ACA insurance?

The Affordable Care Act (ACA) is the name for the comprehensive health care reform law and its amendments. The law addresses health insurance coverage, health care costs, and preventive care.

Who qualifies for the ACA?

Individuals at all income levels can sign up for health insurance under the Affordable Care Act. If you have a household income between 100% and 400% of the federal poverty level (FPL), you probably qualify for a premium tax credit or special subsidies that will reduce health insurance costs as long as you don’t qualify for any other affordable Health Insurance options.

Is the ACA the same as Obamacare?

No. Since its inception way back in 2010 there have been many material changes to the Affordable Care Act (ACA). Today’s ACA has matured into a coverage benefiting millions of Americans without fear of penalties or exclusions.

Is the ACA the same as Medicare?

In the simplest terms, the main difference between understanding Medicare and Affordable Care Act (ACA) is that the ACA refers to private health plans available through the Health Insurance Marketplace mainly for those under 65 years of age. While Original Medicare is provided through the federal government and is mainly for those over 65, those on Medicare Disability, or those receiving dialysis.

Can I have both Medicare and ACA?

No. The Marketplace doesn’t affect your Medicare choices or benefits, so if you have Medicare coverage, you don’t need to do anything. This means no matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO), you don’t have to make any changes.

Do you lose the Affordable Care Act (ACA) when you turn 65?

No, technically you just lose the subsidy, and the ACA plans don’t cancel automatically. Medicare is the better choice for anyone who qualifies for free Medicare Part A (40 working quarters).

If you don’t qualify for Free Medicare Part A, then you still have the option to apply for ACA and subsidy.

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