Individual & Family Health Plans

Affordable Healthcare Act - ACA - Advantages

The ACA has helped millions of Americans gain insurance coverage, saved thousands of lives, and strengthened the health care system. The law has been life-changing for people who were previously uninsured, have lower incomes, or have preexisting conditions, among other groups.

The ACA protects people with preexisting conditions from discrimination by insurers denying coverage or raising prices. The ACA also established guaranteed issue, meaning that insurers must issue policies to anyone and can no longer turn away people based on health status.
ACA requires that plans include categories of essential health benefits, including prescription drugs, maternity care, and behavioral health.
The law also banned insurers from setting annual and lifetime limits on benefits, which had previously prevented some of the sickest people from accessing necessary care and left Americans without adequate financial protection from catastrophic medical episodes.
ACA eliminated copayments and other forms of cost sharing for preventive services. This provision allows beneficiaries to seek contraception; screenings for cancers, blood pressure, cholesterol, and other illnesses; and immunizations without out-of-pocket payments.
ACA holds private insurance companies accountable for charging fair premiums, whether for individual market policies or for employer-sponsored coverage. The medical loss ratio (MLR) rules require insurance companies to return money to policyholders and employers if their health plans spend less than 80 percent to 85 percent of premium funds on medical care. In 2019, insurers returned $1.37 billion in MLR rebates to consumers for overpricing premiums relative to actual medical care.
The ACA outlawed gender rating and prohibited insurers from discriminating against people with preexisting conditions. Prior to the ACA, women faced unique barriers to adequate care. Insurers in the individual market could charge women up to 1.5 times more than men for health insurance, a discriminatory practice known as gender rating, and insurers treated pregnancy as a preexisting condition. The ACA mandates that plans include maternity coverage and makes key preventive services available without cost sharing, including breastfeeding support services and supplies; annual well-woman visits; and screenings for cervical cancer, HIV, and interpersonal and domestic violence. Thanks to the ACA, about 61 million women nationwide can access contraception without any out-of-pocket cost.
ACA guarantees young adults the right to stay on a parent’s insurance until age 26. About 2.3 million young adults—a group that is less likely to have an offer of employer-sponsored insurance than their older counterparts—gained coverage under the ACA’s dependent coverage provision.
The ACA also defined pediatric dental and vision care as part of essential health benefits, ensuring that kids covered through both the marketplace and Medicaid have coverage for those services.
The ACA expanded drug coverage by requiring marketplace plans to “cover at least one drug in each drug class” and to count out-of-pocket drug expenses toward a beneficiary’s deductible. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers.
ACA requires the Secretary of Health and Human Services (HHS) to provide an accurate summary of benefits and coverage explanation to the applicant at the time of application; prior to the time of enrollment or re-enrollment, and at the time of issuance of the policy or delivery of the certificate.