Health Care Reform
Affordable Care Act 101
The Affordable Care Act (ACA) offers better health insurance choices, broader eligibility for Medicaid and stronger customer protections.
Better health insurance choices
You can now buy good, affordable private insurance through the online Health Insurance Marketplace. Every health insurance plan offered through the Marketplace must cover mental health and substance abuse treatment, doctor visits, hospital care, prescriptions and emergency room visits.
To compare options before you purchase, health insurance plans are required to show prices and what they cover in simple language so you can compare options before you make a choice. If you need help choosing a plan or help in another language, the Marketplace will give options for free telephone, in person or online assistance.
Use this tool to see the plans and pricing information in your area before you apply. Most people will be eligible for a tax credit that lowers your monthly premium right away. You can use this calculator created by Kaiser Family Foundation (not associated with Kaiser Permanente) to find out if you qualify for a tax credit or Medicaid in the Health Insurance Marketplace.
Broader eligibility for Medicaid
Medicaid is a program that provides health coverage to millions of lower-income Americans. Under the ACA, many states will broaden eligibility for Medicaid to people with incomes between 0 and 138 percent of the federal poverty level (FPL).
If your state expands Medicaid, will you qualify?
|Household Size||Annual Income* (138% FPL)||Monthly Income* (138% FPL)|
If your state expands eligibility for Medicaid, you may qualify if you are a household of one and your yearly income is $15,856 or less. If you are a household of three, you may be eligible for Medicaid if your yearly household income is under $26,951.
All Medicaid plans will cover mental health and substance abuse treatment, doctor visits, hospital care, prescriptions and emergency room visits. Medicaid plans have low costs, but your choice of providers may be more limited than in private health insurance plans.
Stronger customer protections
Under the ACA, stronger customer protections will help you and your family.
- Starting in 2014, health insurance plans offered through Marketplaces must cover mental health and substance use services at parity, or on fair and equal terms compared to services for other medical conditions. Managed care Medicaid plans must also cover mental health and substance use services at parity.
- Parents can choose to keep young adult children who donít have job-based insurance on their plan until age 26 even if the young adult is working or living independently.
- Plans cannot put lifetime limits on basic health and mental health care. Starting in 2014, annual limits on basic health and mental health care will not be allowed.
- Plans cannot turn you down, limit coverage or charge more because you live with mental illness. Plans are not allowed to cancel your coverage when you get sick or use more services.