The Affordable Care Act (ACA), enacted in 2010, is a comprehensive health care reform that provides rights and protections for consumers. The goals of the ACA are:
- Make affordable health insurance available to more people.
- Expand the Medicare program to cover all adults with income below 138% of the Federal poverty level.
- Support innovative medical care delivery methods designed to lower the cost of health care.
The ACA provides options for individuals, families, small employers, and their employees to enroll in health care coverage. Protections are in place to cover consumers with preexisting conditions/illnesses.
Health Insurance Marketplaces were established through the ACA to provide qualifying health coverage. Through the Marketplace consumers complete a streamlined application to determine their qualification for coverage under different health care plans.
The Open Enrollment Period (OEP) for Qualified Health Plans (QHP) occurs November 1st – December 15th. During that time, consumers can change their coverage or enroll for the first time. Consumers who experience certain life events are eligible to make a change to their QHP during a Special Enrollment Period (SEP). If you miss the OEP you will have to wait until the next enrollment period unless you qualify for SEP.
Consumer Protections Under the ACA
Qualified consumers are able to:
- Get affordable health coverage regardless of pre-existing conditions.
- Access health coverage through the Marketplace in their state.
- Keep existing health coverage for young adults under a parent’s health plan.
- Receive certain preventative services included in their health coverage without cost sharing.
Cost Saving Options through the Health Insurance Marketplace
The Marketplace allows consumers to determine if they qualify for tax credit subsidies to save money on their monthly insurance premium. The amount of a subsidy is based on tax household size, gross annual taxable income for everyone in the household, age, county of residence, an whether there are smokers in the household. Consumer can review plans and prices before enrolling.
To enroll, visit healthcare.gov to create an account and complete the application. For assistance, call the Marketplace Call Center at 1-800-318-2596. A local insurance agent and Certified Application Counselors at Community Health Centers can assist with enrollment.
Resources for more information:
- HHS Health Care
- Health Insurance Marketplace: 1-800-318-2596
- Community Health Centers in South Dakota