RX for Affordable Care Act

Major Reforms of the Affordable Care Act

The focus of the Affordable Care Act is to broaden insurance coverage to those who previously did not have it and to lower the overall costs associated with healthcare spending. To accomplish these goals, the law introduces several new reforms to the American healthcare system. Many of these reforms are designed to give direct help to individuals, while some regulate what types of health insurance business are required to offer. Some of the most high-profile reforms include the following:

  • State-specific health exchanges have been created as marketplaces where those who do not have employer-based or government-sponsored health coverage can browse, compare, and purchase insurance plans. This reform gives the average consumer easier access to their health insurance options.
  • Insurance plans will now cover all out-of-pocket costs associated with preventive care and screening services, regardless of whether or not you’ve met your yearly deductible. Examples of these services include mammograms, well-woman visits, oscilloscopes, and more. This change could save you hundreds of dollars each year.
  • Insurers will no longer be able to vary insurance premiums based upon gender. Women, you no longer have to worry about paying more!
  • Those who have disabilities or pre-existing conditions, which includes people with histories of asthma and cancer, are no longer allowed to be refused coverage. Also, people who fall into these categories are not allowed to have their premiums raised by insurance companies. .
  • Along those same lines, insurance companies also aren’t allowed to cap the amount that they will pay in a patient’s lifetime, so patients with chronic or terminal illnesses, like asthma or cancer no longer have to worry about running out of coverage.
  • Young adults who have not reached the age of 26 may continue to remain on their parent's health plans, including if they are married and no longer rely upon their parents for financial support, even if they are eligible for health insurance coverage through their employer.
  • Small business owners with fewer than 25 workers may now receive tax credits to help in offsetting the costs associated with providing health insurance. Small businesses with fewer than 50 workers are excluded from the penalty for not offering health insurance and employees are eligible to purchase insurance from the marketplace. Businesses with more than 50 employees, however, are now required to offer insurance to full time employees or pay the penalty.
  • Medicare participants who fall under the Part D coverage gap now receive discounts on brand named and generic prescriptions until the gap is closed in 2020.
Last Updated: October 10, 2016