How the Health Care Law Benefits You
Because of the Affordable Care Act, the 85 percent of Americans who have insurance have more choices and stronger coverage than ever before. And for the 15 percent of Americans who don’t have insurance, or families and small businesses who buy their coverage but aren’t happy with it, a new day is just around the corner.
Soon, we take a critical step forward when a new online Health Insurance Marketplace will provide millions of families and small businesses who currently don’t have insurance, or are looking for a better deal, a new way to find health coverage that fits their needs and their budgets.
Open enrollment in the Marketplace starts October 1, with coverage starting as soon as January 1, 2014. But families and small business can visit HealthCare.gov right now to find the information they need prepare for open enrollment.
As the law’s implementation continues, we’re ensuring that all Americans have access to affordable, quality health coverage that leads to better value, better health, and better choices.
- Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund. In 2012, 8.5 million consumers received half a billion dollars in refunds – with the average consumer receiving a refund of around $100 per family. Moreover, 77.8 million consumers saved $3.4 billion up front on their premiums as insurance companies operated more efficiently as compared to 2011.
- For the first time ever, insurance companies in every state must publicly justify any rate increase of 10 percent or more. Since implementing the law, the fraction of requests for insurance premium increases of 10 percent or more has dropped dramatically, from 75 percent to 14 percent. To date, the rate review program has helped save Americans an estimated $1 billion.
- Insurance companies can no longer rescind your coverage because you get sick or because you made a mistake on an application. And they can no longer limit lifetime coverage to a fixed dollar amount. Already 105 million Americans no longer have a lifetime limit on essential health benefits, thanks to the law.
- 129 million non-elderly Americans have some type of pre-existing health condition, including 17.6 million children. Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition. The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition. Over 110,000 Americans with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program’s inception.
- The health care law has allowed 3.1 million young adults who would otherwise have been uninsured to stay on their parents’ health insurance plans until age 26.
A Stronger Medicare Program
- The Affordable Care Act is closing the gap in drug coverage known as the "donut hole." Since the enactment of the law, over 6.6 million Americans with Medicare who reached the donut hole have saved a total of over $7 billion on prescription drugs, or an average of $1,061 per person. The average person with Medicare will save approximately $5,000 from 2010 to 2022, while those with high prescription drug costs will save much more – as much as $18,000 over the same period.
- The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology. Over the last four years, the administration’s fraud enforcement efforts have recovered $14.9 billion from fraudsters. For every dollar spent on health care-related fraud and abuse activities in the last three years the administration has returned $7.90.
- The health care law extends the life of the Medicare Trust Fund by ten years. From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy.
- Every year, about 2.6 million seniors – or nearly one in five hospitalized Medicare enrollees – are readmitted within 30 days of discharge, at a cost of more than $26 billion to the Medicare program. The health care law ties Medicare reimbursement for hospitals to their readmission rates. In 2012, an estimated 70,000 readmissions were avoided.
- The health care law focuses on driving a smarter health care system focused on the quality, not quantity of care. Already, more than 250 organizations are participating in one of Medicare’s Accountable Care Organization programs, which encourage quality and care coordination through the use of health information technology. Together, these initiatives are improving primary care for nearly 4 million people with Medicare and are expected to save up to $940 million in the first four years.
- The health care law requires most insurance plans to cover recommended preventive care without cost-sharing. Already, 71 million Americans with private health insurance have gained preventive service coverage without cost-sharing, including nearly 27 million women. In 2012 alone, an estimated 34 million people with Medicare received one or more preventive services with no cost-sharing, including those who took advantage of the new Annual Wellness Visit.
- Beginning in 2014, the Affordable Care Act requires most health plans in the individual and small group markets to cover ten essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance use disorder services. In the individual market alone, 8.7 million Americans will gain maternity coverage because of the health care law. And the Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans.
- The health care law invests in training and support for thousands of new primary care doctors and nurses by providing bonus payments, scholarships and loan repayment, and new training opportunities. The number of primary care providers in the National Health Service Corps are at all-time highs, and have more than doubled since 2008.
- The Affordable Care Act makes an unprecedented investment in promoting wellness, preventing disease, and protecting against public health emergencies. Prevention and Public Health Fund initiatives like the Center for Disease Control and Prevention’s Community Transformation Grants advance health and wellness and empower communities to design and implement strategies to prevent chronic diseases.
- The Affordable Care Act dramatically increased funding for the operation, expansion and construction of health centers nationwide. Today, 1,200 health centers operate nearly 9,000 service delivery sites that provide primary care to more than 21 million patients annually.
- Beginning in 2014, 41.3 million uninsured Americans will have new opportunities for coverage through the Health Insurance Marketplace. The Marketplace will make it easy for you to compare qualified health plans, get answers to questions, find out if you are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage that meets your needs.
- In 2014, 49 states, the District of Columbia, and four territories will have received a total of nearly $4.2 billion in grants to establish their marketplaces. 17 states (including the District of Columbia), will fully run their own Marketplace. The Department of Health and Human Services (HHS) will fully run a Marketplace in 19 states. In 15 states, HHS will work with the state to run a Marketplace. But no matter what state a consumer lives in, he or she will be able to shop seamlessly for coverage through the Marketplace.
- To date, more than 120 issuers have applied to offer qualified health plans in the HHS-run Marketplace. In the states with early data, an estimated 80 percent of the people who are expected to enroll in a health plan through the Marketplace will be able to choose from five or more insurance companies. In many states today, the health insurance marketplace is highly concentrated and only one or two issuers control a majority of market share. On average, issuers plan to offer more than 15 qualified health plans per state.
- Small employers will be able to choose from a range of coverage options for their employees through the Small Business Health Options Program, or SHOP. Eligible employers may qualify for a tax credit worth up to 50 percent of the employer’s premium contribution to a SHOP plan. In 2014, SHOPs will have the flexibility to decide whether employers can let their employees choose from a number of plans, or can offer their employees one plan that the employer chooses.
- New member-run, non-profit health insurers, called Consumer Operated and Oriented Plans (CO-OPs) will offer coverage inside and outside the Marketplace. To date, 24 non-profits that plan to offer coverage in 24 states have been awarded nearly $2 billion to set up CO-OPs.
- States have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $31,322 for a family of four in 2013). This expansion includes non-elderly adults without dependent children, who have not previously been eligible in most states.
- Consumers will be able to fill out one application to see if they qualify for a range of health coverage options - including plans in the Marketplace, Medicaid and CHIP - or lower costs on monthly premiums based on their income. For many, the three-page application for individual market Marketplace coverage can be completed, on average, in just 10 minutes, which is much shorter than the industry standard today. You can fill out the application online, in person, over the phone or via mail. The SHOP employee and employer paper applications are two and three pages, respectively.
- Consumers will have access to a number of resources to learn about the Marketplace and navigate their coverage options. They can get in-person assistance from Navigators, non-Navigator assistance personnel, certified application counselors, and/or agents and brokers. Community Health Centers in all 50 states have also received a total of $150 million in federal grants to help enroll uninsured Americans.
- The newly remodeled HealthCare.gov is the destination for consumers to prepare for open enrollment and ultimately sign up for health coverage. It includes a 24/7 live chat function, and the newly launched Marketplace call center is open 24 hours a day, seven days a week (1-800-318-2596 toll free, or 1-855-889-4325 for the hearing impaired). Spanish-speaking consumers can go to CuidadoDeSalud.gov.
Learn more about how the Affordable Care Act is improving health care where you live: Interactive Map: The Affordable Care Act in Your State
Visit HealthCare.gov to get ready for open enrollment in the Health Insurance Marketplace on Oct. 1.
Posted on: September 20, 2012
Last updated: July 29, 2013