Understanding ACA Compliant Health Insurance

The Affordable Care Act or ACA is a landmark legislation passed in 2010 that aims to make health care more accessible and affordable for all Americans. The ACA introduced a number of reforms to the health insurance industry, including new standards for health insurance plans sold in the individual and small group markets. These standards are known as ACA compliant health insurance plans.

What is ACA Compliant Health Insurance?

An ACA compliant health insurance plan is a health insurance policy that meets the minimum standards set by the Affordable Care Act. These standards include a number of consumer protections and benefits, such as coverage for essential health benefits, no lifetime or annual benefit limits, and guaranteed issue and renewability of coverage.

Essential health benefits are a set of ten categories of benefits that all ACA compliant health insurance plans must cover. These include:

Who Needs ACA Compliant Health Insurance?

Under the Affordable Care Act, most Americans are required to have health insurance or pay a penalty. This requirement is known as the individual mandate. The individual mandate applies to adults who are not eligible for Medicare or Medicaid and do not have access to affordable employer-sponsored health insurance.

Individuals who are exempt from the individual mandate include those who:

• Have a religious objection to health insurance
• Cannot afford health insurance based on their income
• Have experienced a hardship, such as homelessness or bankruptcy

Employers with 50 or more full-time employees are required to offer affordable health insurance to their employees or pay a penalty. This requirement is known as the employer mandate.

How Do I Choose an ACA Compliant Health Insurance Plan?

If you are shopping for health insurance, there are a number of factors to consider. Here are some tips to help you choose an ACA compliant health insurance plan:

Consider Your Health Care Needs

Think about your health care needs and the services you use most often. Do you have any chronic conditions or take any medications regularly? Do you see a specialist on a regular basis? Look for a plan that covers the services you need most.

Compare Costs

Compare the premiums, deductibles, copayments, and coinsurance for different plans. Consider how much you can afford to pay out-of-pocket in case of an emergency.

Check the Provider Network

Make sure the plan you choose includes your preferred doctors, hospitals, and other health care providers. If you have a preferred doctor, check to see if they are in the plan’s provider network.

Read the Plan Details

Read the plan details carefully to understand what is covered and what is not. Make sure you understand any exclusions or limitations in the plan.

FAQs

What is the difference between an ACA compliant health insurance plan and a non-compliant plan?

An ACA compliant health insurance plan meets the minimum standards set by the Affordable Care Act, including coverage for essential health benefits and no lifetime or annual benefit limits. Non-compliant plans may not offer these protections and benefits, and may be subject to different rules and regulations.

Can I buy an ACA compliant health insurance plan outside of open enrollment?

You can only buy an ACA compliant health insurance plan outside of open enrollment if you experience a qualifying life event, such as getting married, having a baby, or losing your job. Otherwise, you must wait until the next open enrollment period to buy coverage.

What happens if I don’t have ACA compliant health insurance?

If you don’t have health insurance, you may have to pay a penalty when you file your taxes. The penalty for 2020 is $695 per adult and $347.50 per child, up to a maximum of $2,085 per family, or 2.5% of your household income, whichever is greater.

Can I get financial assistance to help pay for an ACA compliant health insurance plan?

If you meet certain income requirements, you may be eligible for financial assistance to help pay for an ACA compliant health insurance plan. This assistance is available in the form of tax credits and subsidies, and can be applied to the premiums and out-of-pocket costs of your plan.

What is the future of ACA compliant health insurance?

The future of ACA compliant health insurance is uncertain, as the Affordable Care Act has been the subject of ongoing political debate and legal challenges. However, as of 2020, the ACA remains in effect, and individuals and employers are still required to have or offer health insurance that meets the minimum standards set by the law.