The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010 to ensure that all Americans have access to affordable health insurance options. Since then comprehensive health insurance reforms have been implemented. Now that the ACA is underway, you may have questions about how this law will affect you:"What additional ACA changes are coming in the future?" "How can I access the ACA Marketplace in Virginia to compare health plans?" "Are there Virginia resources I need to know about?" ENROLL Virginia! provides free assistance with the new health insurance marketplace enrollment process.
The provisions of the Affordable Care Act can impact many people including older adults, the uninsured, people with disabilities, and families - all of whom have unique challenges accessing reliable and affordable health care services.
Most benefits of the ACA have already been implemented, with others continuing to be phased in over the next few years. There are three main areas of benefits and changes:
1. Improving Health Care Access and Quality
2. Making Health Care More Affordable and Expanding Benefits through Medicaid and Medicare
3. Reforming Health Insurance, Expanding Private Health Insurance Plan Benefits
Click on one of the three topics to see detailed information on current and future changes:
- Improving Access and Quality
- Making It More Affordable
- Reforming Health Insurance
Improving Health Care Access and Quality:
- The Affordable Care Act (ACA) 2016 Open Enrollment begins November 1, 2015 and ends January 31, 2016. During this time Virginians can sign up for Marketplace health insurance plans. If you bought a health insurance plan through the Marketplace in 2015, you can renew or change plans for 2016. It is also important to report changes to the information that you provided on your 2015 application. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events.
- Tools have been created to allow you to compare a variety of quality measures of health care and service providers at www.healthcare.gov.
- People with low or no income will have greater access through an expanded network of community health centers.
- People living in medically underserved areas have access to more primary care providers as a result of an expanded National Health Service.
- Virginia has new opportunities to expand and improve home and community based services for people with disabilities through Medicaid rather than institutional care in nursing homes. Virginia's Money Follows the Person (MFP) program is designed to create a system of long-term supports that assist individuals to transition from institutions into the community.
- Commonwealth Coordinated Care (CCC) ensures that services are provided for individuals who are dually eligible for Medicaid and Medicare.
Making Health Care More Affordable and Expanding Benefits through Medicaid and Medicare:
- Prescriptions: Medicare recipients in the part D "donut hole" receive a 50% discount on covered, brand name prescription drugs and a 7% discount on generic drugs.
- Preventive Care: Medicare and private insurance recipients are eligible for free preventive care such as annual wellness checkups and cancer screenings.
- Americans who earn less than 133% of the poverty guidelines may be eligible to enroll in Medicaid depending upon State action. Federal funding is available for this purpose should State's choose to expand Medicaid eligibility.
- The employer responsibility provision to provide insurance will generally apply to larger firms with 100 or more full-time employees as of 2015 and employers with 50 or more full-time employees starting in 2016.
- To avoid a payment for failing to offer health coverage, employers need to offer coverage to 70 percent of their full-time employees in 2015 and 95 percent in 2016. Read this fact sheet to learn more about the final rulings
- The "Donut Hole" will be closed.
Reforming Health Insurance, Expanding Private Health Insurance Plan Benefits:
- Insurers cannot cancel your coverage if you become sick.
- Insurers must get permission from the Federal government to cap the dollar amount they will pay in health care for a person over a lifetime.
- Insurers must phase out annual limits on certain services.
- Insurers cannot deny coverage to anyone under 19 years of age based on pre-existing conditions.
- Consumers have new appeal rights and procedures if insurers deny care or payment for services.
- States review large premium increases to ensure they are reasonable avoiding unjustifiable hikes.
- Young adults can remain on parent's insurance plans until age 26 (without regard to their educational or marriage status or residency).
- Insurers must spend 80-85% of premiums received on actual health care.
- Small employers with 25 or fewer employers and average annual wages of less than $50,000 receive a tax credit for providing employee health insurance.
- Private and group health plans must provide a uniform summary of benefits of coverage (SBC) to all applicants and enrollees.
- Insurers cannot cap the dollar amount they will pay in health care for a person over a lifetime.
- New health plans must sell policies to all new applicants regardless of health status.
- New health plans cannot charge higher premium rates based on gender or health status.
- Insurers cannot deny coverage based on pre-existing conditions.
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