Rights and Protections under the Affordable Care Act
- Young adults may remain on their parent’s coverage until age 26 (effective plan years on or after 9-23-2010).
- No pre-existing condition exclusions are allowed for children (effective plan years 9-23-2010; for adults effective 1-1-2014).
- Health insurance consumers have expanded appeal rights (effective for new plans beginning on or after 9-23-2010).
- No rescissions or policy cancellations are allowed due to illness (effective for plan years beginning on or after 9-23-2010).
- No lifetime limits on benefits are allowed (effective for plan years beginning on or after 9-23-2010).
- Annual limits on benefits are being phased out (from $750,000 in 2010/2011 to $1.75 million in 2011/2012 to $2 million in 2012/2014).
- No-cost preventive services are available before deductible is met (effective 1-1-2011).
- Medicare Part D Prescription Plan coverage gap (donut hole) is being phased out (50% reduction in gap effective 2011).
- Private insurance companies must provide a Standardized Summary of Benefits & Coverage (SBC) with clear, consistent and comparable information about the health plan benefits and coverage (effective 9-23-2012).
- Small employer tax credits are available (effective 2010, increasing in 2014).
- Twenty-three states, including Maine, now offer federally funded Consumer Assistance Programs to provide help to consumers with health coverage options and enrollment (2011).
- Insurance companies are required to provide rebates to enrollees if they spend less than 85% of their premium dollars on health care as opposed to administrative costs and profits (effective 1-1-2011).
- States have the option to expand Medicaid eligibility to cover a new population with 100% federal funds (2014-2016).
- Each state has a Health Insurance Marketplace through which tax credits are available for people in certain income ranges.
- The Minimum Essential Coverage Requirement requires most people to have creditable health insurance or face a penalty, though there are exceptions.
- All plans sold on and off the Marketplace must cover certain Essential Health Benefits (EHBs).
- No pre-existing condition exclusions will be allowed for anyone of any age.
- Plans can no longer vary rates based on gender (note: Maine already prohibited gender rating).
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