Contact CHC at 412-456-1877

Affordable Care Act & Medicaid Expansion

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (ACA) is a bipartisan law that established a set of rules and regulations for the health insurance industry.  It is commonly known as the ACA or “Obamacare.” The law was passed on March 23, 2010.

The ACA created new coverage options for U.S. residents who aren’t offered health insurance by employers or any their way. The law created a Health Insurance Marketplace where people can compare plans from multiple private insurance companies side-by-side for the first time. They can also apply for financial assistance to pay for their plans. This is available online (Healthcare.gov) or by phone (1-800-318-2596).

 

How is Consumer Health Coalition involved?

The ACA created Navigators, unbiased assisters who provide free, in-person assistance to learn about your health insurance options and enroll in coverage. Consumer Health Coalition oversees a Pennsylvania statewide network of Certified Marketplace Navigators. Contact our Navigators today.

 

Financial assistance is available.

The ACA created financial assistance called tax credits to make health coverage more affordable. Based on income, age, and household size, the ACA gives monthly subsidies called tax credits to lower the monthly cost of health insurance plans.

The ACA also provides cost-sharing reductions to people who qualify. These lower the cost of out-of-pocket expenses like co-payments, deductibles, and coinsurance. People who qualify can get these extra cost savings if they select Silver level Marketplace plans.

In Pennsylvania, over 77% of enrolled consumers receive tax credits to lower the cost of their Marketplace insurance, and over 50% receive cost sharing reductions, according to CMS.

 

Medicaid Expansion is part of the Affordable Care Act.

The ACA gave the states the option to expand their Medicaid health insurance to all adults under age 65 and offered federal matching funds for this. See which states have expanded Medicaid.

In January 2015, Pennsylvania expanded Medicaid to income-eligible adults. People with incomes too low to qualify for financial assistance on the Marketplace can now often qualify for Medicaid. This health insurance is available at no cost through the Pennsylvania Department of Human Services.

Eligibility for Medicaid Expansion is based on current income, household size, and citizenship status. It does not look at savings or assets. Read more eligibility guidelines.

Before Pennsylvania expanded Medicaid, it was only available to people who fit into restrictive categories, like having a disability or being pregnant. Since Pennsylvania expanded Medicaid, over 600,000 adults in the state gained access to this health coverage.

 

Open Enrollment

Open Enrollment has been shortened for enrolling in 2018 health insurance. People will only be able to enroll in plans from November 1 – December 15, 2017 to get a Marketplace health insurance plan for 2018. This is when anyone can buy or change health insurance plans on the Health Insurance Marketplace. One exception: you can apply for Medical Assistance or CHIP anytime, all year.

If you do not enroll in a Marketplace plan health coverage during Open Enrollment, you can not sign up for health insurance during the year until the next Open Enrollment period unless you qualify for Special Enrollment.

 

Special Enrollment

There are several life changes that make you eligible to sign up for a new health plan or change your health plan outside of Open Enrollment. Special Enrollment gives you 60 days before or after a qualifying life change to enroll in health coverage.

You can get a Special Enrollment Period for life changes, including:

• Changing family size by getting married, having a child, adopting.
• Becoming a U.S. citizen
• Leaving jail or prison
• Losing eligibility for Medicaid or CHIP
• AmeriCorps service members starting or ending their service
• Moving to a new state or region (with some exceptions)
• Losing health insurance for reasons including:

• Losing a job where you had coverage
• No longer qualifying for Medical Assistance
• Turning 26 and losing coverage through a parent’s health plan
• Graduating from a university where you had coverage
• COBRA running out
• Your coverage plan is discontinued by no fault of your own

Find the full detailed list of SEPs here.
You can apply for Medicaid or CHIP anytime, all year.

The ACA Helps You.

Even if you are not enrolled in a Marketplace health plan, most people benefit from the ACA.

How the Affordable Care Act benefits us:

• Over 20 million gained health coverage, including 1.1 million Pennsylvanians.
• Medicaid Expansion provides health care to hundreds of thousands of previously uninsured Pennsylvanians.
• Over 120 million in the country are no longer denied for pre-existing conditions.
• All health plans cover preventative care at no cost.
• There are no longer lifetime caps that cut off benefits, protecting over 100 million of the sickest people in the country.

How the ACA improves health care access:

• Young adults can stay on their parents’ health insurance until age 26.
• Insurance companies can no longer discriminate against people with pre-existing conditions.
• It bans annual limits on coverage, even if you get a serious illness like cancer.
• Free preventive care is included in health insurance plans.
• Mammograms, colonoscopy, and other cancer screenings.
• Birth control is offered with no out-of-pocket payments.
• See a complete list of preventative care here.
• It requires plans to a list of 10 Essential Health Benefits to make coverage more comprehensive. This includes maternity coverage, prescription, and emergency/hospital care.
• No more getting sick and then finding out your plan won’t cover your hospital care!
•  Provides prescription help in the Medicare “donut hole,” with savings on track to close the gap completely by 2020.

Learn more about what Marketplace plans cover.
Meet Pennsylvanians who have gained coverage because of the Affordable Care Act.

Now that you know how Obamacare has helped you, let us know why having access to care matters, and how your life would change if the ACA were taken away. Share your story!

We are here to help with your specific circumstances.

Call our Help Line at 412-456-1877.
CHC’s Certified Marketplace Navigators are available year-round to assist you determine if you qualify for Special Enrollment and to help you enroll. Get in touch with us.

We offer enrollment assistance at our office on the North Side of Pittsburgh as well as sites around the community. Check out our event calendar.

Additional Helpful links

What is health insurance, anyway? The YouToons Have It Covered.

Watch other videos about health coverage from the Kaiser Health Foundation.