Health Insurance and the Affordable Care Act (ACA)

Major medical health insurance policies changed when the Patient Protection and Affordable Care Act (PPACA) (often referred to as ACA or Obamacare) was enacted March 23, 2010. The bill itself is 2,700 pages. It is estimated that Congress will generate over 1 million pages of laws to enforce the Affordable Care Act. Needless to say, there is much confusion associated with the Affordable Care Act.

Individual Mandate

Beginning with ACA plan year 2019, the Individual Mandate no longer applies. You are no longer subject to the Shared Responsibility Payment penalty beginning plan year 2019.

A key provision of the ACA was the Individual Mandate. The Individual Mandate "required" individuals to purchase health insurance whether they wanted it or not. If they did not purchase an ACA Qualified Health Plan for each member of their family during 2014–2018, they were subject to a fine each year by the Internal Revenue Service (IRS). The fine increased each year through 2018.

Key components of the ACA policies are:

  • Essential Health Benefits (EHB)
  • Qualified Health Plan (QHP)
  • Guaranteed Issue—Medical history is not considered
  • No annual or lifetime limits on how much the insurance company pays in benefits
  • Medical Loss Ration (MLR)
  • Metallic level plans—Bronze, Silver, Gold, and Platinum
  • Maximum Out-of-Pocket expense (2023) for an individual is $8,200 and $16,400 for a family
  • Young Adult Coverage—Children can stay on parents' plan until 26th birthday
  • Premiums will be the same for males and females (Unisex premiums).
  • Premiums will be the same regardless of you health status (preexisting conditions do not matter)

See the menu on the left for more information.