The Affordable Care Act’s Annual Open Enrollment Period

America’s largest health policy reform, titled the federal Patient Protection and Affordable Care Act (ACA), was signed on March 23, 2010.[1] Since then, millions of Americans have signed up for affordable and comprehensive health insurance.  Today, it is difficult to see healthcare without this essential law.  The ACA has rooted itself in American culture.  A law signed more than a decade ago is still discussed each morning as the news comes on the morning radio and coffee is brewed in many American households.  Politicians still advocate or dismiss the law in campaign articles and commercials.  Courts still litigate the constitutionality and applicability of the law.  Regardless of the constant conversation, it is indisputable that the ACA is entrenched in the American healthcare system in ways that promote accessibility and decrease the coverage gap.

The ACA established protections to consumers in ways not seen before the law’s inception.  Specifically, the ACA:

Prohibits Preexisting Conditions.  All Marketplace plans must cover treatment for pre-existing medical conditions.[2] Insurance companies cannot prohibit coverage or refuse to pay for benefits for any condition an individual had before their coverage begins.[3]

Provides Preventative Care.  Most health plans must cover a set of preventative services at no cost to the individual when provided by a doctor or provider within your network.[4]  This can include, but is not limited to; immunizations, screening tests, diet counseling, and fall prevention.[5]

Provides Prescription Drug Coverage.  Prior to the ACA, around 20% of health plans did not include prescription medication coverage.[6] The ACA mandates that prescription drug coverage is considered an essential health benefit.[7]  Meaning, prescription drug coverage is in the set of 10 categories of services that health insurance plans must cover.[8]

Provides Maternity Care and Preventative Care Benefits for Women.  Many women’s health services are provided free of charge when delivered within an individual’s network.  These services can include birth control, breastfeeding support, certain supplements while pregnant, depression screenings at well-baby visits, preeclampsia prevention and screening for pregnant women with high blood pressure, bone density screening, cervical cancer screening, and much more.[9]

Allows young adults to remain on their parent’s policy until 26.  Before the enactment of the ACA, young people could be removed from their parent’s health insurance policies when they reached a specific age.  The ACA increased the time that young adults may stay on their parent’s policy to the age of 26, leaving college-aged adults with coverage.[10]

Provides Financial Assistance for Coverage.  For individuals who qualify, tax credits may be used to help pay for health care coverage.  Qualification is based on an individual’s income and if approved, individuals may take the tax credits and apply them to their premium to make their monthly payment lower.[11]   Additionally, individuals might qualify for cost-sharing reductions, which allows individuals to pay less out-of-pocket costs when they get medical services.[12]

Caps Out-of-Pocket Costs.  The ACA mandates that plans must cap the cost individuals pay for covered services in a plan year.[13]  Meaning, after an individual spends the set amount on deductibles, copayments, and coinsurance for in-network services, covered benefits will be covered at 100% by the health plan.  Out-of-pocket cost caps for plans vary, but are prohibited to go over a set amount each year.[14]   For the 2022 plan year, the out-of-pocket cap for an ACA plan can not exceed $8,700 for an individual and $17,400 for a family.  This cap protects individuals from large, unexpected costs.[15]  For example, the average cost for complex inpatient treatment for COVID-19 in Illinois averages $102, 207!  Health insurance can protect individuals and families from these large costs. 

The ACA’s popularity remains high, with more than 12.2 million people currently enrolled through the Marketplace.[16]  The past 20 months could not highlight a more opportune time to get covered.  Obtaining health insurance is essential to maintaining good health.  With preventative services provided free of cost, as well as current reduced premiums and deductibles, there is no reason to not make one’s health and financial well-being a priority.[17] 

There are individuals at the ready to assist anyone needing help to obtain Marketplace coverage.  Individuals can go to getcoveredillinois.gov or healthcare.gov and will be connected to assisters willing to walk individuals through the process.   

Take the step today and GET COVERED!

[1] H.R. 3590 Patient Protection and Affordable Care Act; Text - H.R.3590 - 111th Congress (2009-2010): Patient Protection and Affordable Care Act | Congress.gov | Library of Congress; Congress.gov (Nov.10. 2021).

[2] Health Benefits and Coverage; Coverage for Pre-existing Conditions; Marketplace health plans cover pre-existing conditions | HealthCare.gov Healthcare.gov (Nov. 10, 2021).

[3] Id.

[4] Preventative Care Benefits for Adults; Healthcare.gov,  Preventive care benefits for adults | HealthCare.gov Healthcare.gov (Nov. 10, 2021).

[5] Id.

[6] An Overview of Prescription Drug Insurance; Health Insurance; Prescription Drug Insurance (verywellhealth.com) (Nov. 10, 2021).

[7] Health Benefits and Coverage; What Marketplace Plans Cover;  Find out what Marketplace health insurance plans cover | HealthCare.gov (Nov. 10, 2021).

[8]Essential Health Benefits;  Essential Health Benefits - HealthCare.gov Glossary | HealthCare.gov (Nov. 10, 2021).

[9] Preventative Care Benefits for Women; Preventive care benefits for women | HealthCare.gov (Nov. 10, 2021).

[10] Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses; Centers for Medicare and Medicaid Services; Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses | CMS (Nov. 10, 2021).

[11]How to Save on Your Monthly Insurance Bill with a Premium Tax Credit; Saving Money on Health Insurance;  How to Save Money on Monthly Health Insurance Premiums | HealthCare.gov (Nov. 20, 2021).

[12] Saving Money on Health Insurance; Cost-Sharing Reductions; Extra savings on out-of-pocket health care costs | HealthCare.gov (Nov. 10, 2021).

[13]Out-of-Pocket Maximum; Definitions; Out-of-pocket maximum/limit - HealthCare.gov Glossary | HealthCare.gov (Nov. 10, 2021).

[14] Id.

[15] COVID-19 Medical and Hospitalization Costs by State: Illinois; FAIR Health; PowerPoint Presentation (Nov.10, 2021).

[16] Biden-Harris Administration Announces Record Breaking 12.2 Million People Are Enrolled in Coverage Through the Health Care Marketplace; Biden-Harris Administration Announces Record-Breaking 12.2 Million People Are Enrolled in Coverage Through the Health Care Marketplaces | HHS.gov (Nov. 10, 2021).

[17] Id.