The Affordable Care Act, which people also refer to as ACA, PPACA, or Obamacare, is a federal law concerning health care coverage. The act stems from the Obama Administration’s desire to expand healthcare coverage and Medicaid, as well as encourage innovation. Obama’s signature goes on the ACA in 2010, and the states implement changes by 2014. Last week, we reviewed key Affordable Care Act basics, such as what the Federal Poverty Level is as well as the main purposes of the ACA. This week, we are looking at more Affordable Care Act basics key protections the ACA affords as well as federal provisions that help achieve the ACA’s goals.

Rights & Protections

The ACA affords Americans some very specific rights and privileges. If you get a new insurance plan, these things should be on there. But there are a handful of plans that insurance companies grandfather in, so check your plan for coverage today. So here are some things that plans must do.

• Cover individuals with pre-existing conditions, as well as not charging more for it.
• Offer free preventative care.
• Provide young adults with more options.
• Abolish lifetime and annual limits on coverage of essential health benefits.
• Assist customers understand what type of coverage they get.
• Protect your choice of healthcare provider as well as protect you from retaliation from your employer.
• Give mothers breastfeeding support and equipment.
• Birth control counseling and cost coverage.
• Include mental health and substance abuse services in the category of essential health benefits.
• Allow people to appeal health plan decisions and have an outside party review them.

The ACA also holds insurance companies accountable for rate increases and prohibits them from dropping a client when that client gets sick.

Federal Provisions

The three main purposes of the ACA are to improve the availability of coverage, expand Medicaid, and support cost saving innovations in health care delivery. There are quite a few steps the federal government takes to achieve those goals. We only have space for some of the provisions on this page, for a full list, check out the National Conference of State Legislatures website. In addition, there are exceptions to a few of these provisions, consult with your local health insurance company to find out further details.

Availability Of Coverage

• Make employers help their workers get coverage. However, some small businesses are exempt.
• Give small businesses that help cover employee health insurance costs with tax credits.
• Insurance plans must cover young adults on parents’ plans.

Medicaid Expansion

• Give Medicaid coverage to people with incomes below 133% FPL.
• Improve care coordination between Medicare and Medicaid.
• Medicaid must cover services to help pregnant individuals on Medicaid stop smoking.

Innovation

• Comparative studies to research the difference in effectiveness of different treatments. Then, implement that research.
• Collect and report data to analyze health disparities between populations of different demographics.
• Invest in health information technology.

The Affordable Care Act, also known as ACA or Obamacare, is a health care coverage act from the Obama Administration. President Barack Obama signed the act in March of 2010. Since then, the ACA is a hotly debated topic in homes and on news stations. However few people understand the purpose and the full extent of the bill. This week and next week we are breaking down Affordable Care Act basics. Read on to learn what the federal poverty level is, the purpose of the Affordable Care Act, and other basics.

Federal Poverty Level

When it comes to the Affordable Care Act, there are many references to the “federal poverty level” (FPL). But what is that really? The FPL is an exact dollar amount that the Department of Health and Human Services calculates every year. FPL represents the minimum amount of income that an individual or family needs to cover the necessities of life, including shelter, food, clothing, and transportation.

The government uses FPL to determine your eligibility for government benefits. For example, take Tom. Tom is a single man who lives alone, and his annual income is only $17,000.  For a single person, 138% FPL is $17,609. Tom makes below 138% FPL so he qualifies for Medicaid if his state has wider Medicaid coverage.

Income Under 100% FPL

You likely do not qualify for Medicaid from income, nor do you qualify for a Marketplace insurance plan.

Income Under 138% FPL

If your state expands Medicare coverage, you qualify for Medicaid from your income.

Income 100% to 400% FPL

You qualify for government subsidies that lower your monthly premium so you can access a Marketplace insurance plan.

The Big Picture

The Affordable Care Act has three primary purposes that the entire act revolves around. All of the provisions and the design of the act exist to meet those purposes. If you want to understand the ACA, it is essential to understand these big picture goals.

Availability

Firstly, the ACA addresses an issue that gives much cause for concern in America – how many people have no health insurance coverage. At the time of the signing, over 46 million Americans are without health insurance.

The focus is especially heavy on families who are at or just above the poverty level. The government provides subsidies that keep costs as low as possible.

Expand Medicaid

Medicaid provides health insurance coverage for low income people, including families. Both the state and federal government fund Medicaid, which causes some issues when the federal government tries to expand it.

Nevertheless, expanding Medicaid is one of the big goals of the ACA. Ultimately, they want Medicaid to cover all adults with income under 138% of the federal poverty level. Find out more about those exact numbers here.

Support Innovation

Finally, the ACA strive to support innovative ways to deliver medical care. Especially those innovations that lower the cost of health care.

Come Back

Come back next week to learn more about the ACA, including key federal provisions as well as how the law protects you.