Affordable Insurance

The Affordable Care Act

The primary goal of the Affordable Care Act is to help millions of Americans obtain health insurance coverage. To achieve that goal, the Affordable Care Act provides new coverage options, gives consumers the tools they need to make informed choices about their health care coverage, and puts in place strong consumer protections. Agents and brokers will play an integral role in helping individuals understand and act on the coverage choices that the Affordable Care Act offers through Marketplaces.

The Affordable Care Act includes many provisions to make health insurance coverage more accessible and affordable. Key components of the Affordable Care Act that will affect you and the consumer include:

  • Health law changes
  • Major consumer protections

The Affordable Care Act included many provisions designed to help ensure that consumers have access to effective health care coverage, and to limit their costs. Key provisions that you need to understand in order to best serve the consumer include:

  • Extension of health insurance coverage to children up to age 26
  • Expansion of the “guaranteed issue” requirement to ensure that health insurance issuers offer group and individual market policies to any eligible individual in a state, regardless of health status
  • Prohibition on charging consumers a higher premium based on health status or gender
  • Elimination of annual and lifetime coverage limits
  • Prohibition on coverage limitations or exclusions based on pre-existing conditions
  • Prohibition on precluding a qualified individual’s participation in an approved clinical trial, or discriminating against that individual based on such participation
  • Introduction of an 80/20 MLR rule to ensure that at least 80 percent of the premium dollars paid to a health insurance issuer are spent on providing health care