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Affordable Care Act

Learn About the Affordable Care Act

The Affordable Care Act (ACA) was designed to give individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that they may not have been able to get on their own or through an employer. Under the ACA:

- You may be able to purchase health care through a state or federal marketplace that offers a choice of plans.
- Insurers can't refuse coverage based on gender or a pre-existing condition.
- Lifetime and annual limits on coverage are eliminated.
- Young adults can stay on their family's insurance plan until age 26.
- Seniors who hit the Medicare Prescription Drug Plan coverage gap or "donut hole" can get a discount on medications.

When to Enroll

Open enrollment is the part of each year that citizens can freely make changes to their health care coverage purchased through the ACA's Health Insurance Marketplace.

The next open enrollment period is expected to begin on November 1, 2017, and end on January 31, 2018. During the open enrollment period, you will be able to:

- Re-enroll in your current plan
- Choose a plan for the first time
- Choose a new plan to replace your current plan
- Make changes to your existing insurance plan

You can enroll or change your plan year-round if you have certain life changes:

- Getting married or divorced
- Having a baby or adding a dependent to your family
- Losing other coverage
- Moving to a new state
- Qualifying for Medicaid or CHIP

How to Enroll and Get Answers to Your Questions

You can learn more about and apply for ACA health care coverage in several ways.

- Go to HealthCare.gov. Depending on where you live, you'll apply for benefits there through the ACA Health Insurance Marketplace or you'll be directed to your state's health insurance marketplace website. Marketplaces, prices, subsidies, programs, and plans vary by state.
- Contact the Marketplace Call Center at 1-800-318-2596 or TTY at 1-855-889-4325.
- Find a local center to apply or ask questions in person.
- Download an application form to apply by mail

Using Your Coverage

If you have questions about specific parts of your insurance plan, you must contact your insurance company to get answers. Only your insurance company can answer specific questions about doctors, medications, treatments, medical equipment, and what is and is not covered under your plan.

- Find contact information for your insurance company on your insurance card or bill.
- If you can't find out how to contact your insurance company, contact the Marketplace Call Center.
- If you need help appealing a dispute with your insurance company, contact the Marketplace Call Center.

Small Businesses

Businesses with 50 employees or fewer can offer Small Business Health Options Program (SHOP) plans to employees, starting any month of the year. Learn about small business tax credits to help companies with the equivalent of fewer than 25 full-time employees provide insurance coverage to their workers.

Health Insurance Plans

Learn About Health Coverage

Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses--usually a certain dollar amount or percentage of the expenses.

How to get Health Coverage

You can get health care coverage through:

- A group coverage plan at your job or your spouse or partner's job
- Your parents' insurance plan, if you are under 26 years old
- A plan you purchase on your own directly from a health insurance company or through the Health Insurance Marketplace
- Government programs such as Medicare, Medicaid, or Children's Health Insurance Program (CHIP)
- The Veterans Administration or TRICARE for military personnel
- Your state, if it provides a health insurance plan
- Continuing employer coverage from your former employer, on a temporary basis under the Consolidated Omnibus Budget Reconciliation Act (COBRA)

Types of Health Insurance Plans

When purchasing health insurance, your choices typically fall into one of three categories:

- Traditional fee-for-service health insurance plans are usually the most expensive choice, but they offer you the most flexibility in choosing health care providers.
- Health maintenance organizations (HMOs) offer lower co-payments and cover the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan.
- provider organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility in selecting a provider.

Choosing a Health Insurance Plan

Read the fine print when choosing among different health care plans. Also ask a lot of questions, such as:

- Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
- Are specialists, such as eye doctors and dentists, covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician may prescribe?
- What are the deductibles? Are there any co-payments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, which are the amount of money you pay when you receive medical services or a prescription.
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled?