Healthcare Reform Overview

Last updated: February 1, 2016

Affordable Care Act

What Is the Affordable Care Act?

It is Legislation signed by President Obama on March 23, 2010. It changed the availability and delivery of health insurance, Medicaid, and health policy nationwide. It is commonly referred to as the health reform law, Patient Protection and Affordable Care Act (PPACA), and Obamacare.

What Changes Took Place?

  • Lifetime dollar limits on essential health benefits aren’t allowed.

  • The appeal procedures available to you are different.

  • Insurers can’t deny coverage because of a pre-existing condition.

  • Nearly all adult children (up to age 26) are eligible to remain on a parent’s health insurance policy.

    • This does not depend on the child’s marital status, financial dependency, enrollment in school, or place of residence.

  • In-network and participating providers must cover preventive services.

    • There can be no cost-sharing for preventative services.

  • You have more access to information about proposed rate changes.

  • Medical loss ratio standards limit how much of premium dollars insurers can spend on administrative expenses.

  • All insurers must use a standardized Summary of Benefits and Coverage (SBC), which makes it easier to compare plans.

  • Small businesses that provide health care for employees can apply for a tax credit.

  • Persons with Medicare prescription drug coverage receive a rebate to help cover the cost of the “donut hole.”

    • The “donut hole” should be phased out by 2020.

  • Plans must include the new consumer protections.

    • Health insurers can no longer deny or refuse to renew coverage because of a pre-existing condition.

    • They also can’t charge a higher premium due to a person’s gender or health condition.

  • Insurers must cover routine medical costs if a person participates in a clinical trial for cancer or other life-threatening diseases.

  • Insurance plans also can’t put annual dollar limits on essential health benefits.

  • Individuals who can afford it must have basic health insurance coverage, referred to as the ACA as “minimum essential coverage.”

  • Individuals and families who need help affording coverage may have access to financial assistance when they shop in the new health insurance exchanges.

Where Can a Person Find More Information About the ACA?

  • Call the department’s toll-free hotline at 800-432-2484.

For more detailed information about the ACA and its key provisions, visit the federal government’s website at www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325).

Click any of the following topics to learn more! 

Discrimination and the New Rules About Insurance Premiums 

"Accreditation Status” and “Consumer Experience” 

Your Appeal Rights and Complaints