Key Facts as Affordable Care Act Begins

What it means for an individual or a family
By Mary Silver, Epoch Times
January 2, 2014 Updated: January 2, 2014

After a long gestation period, the Affordable Care Act took effect on Jan. 1. 

Here are some practical facts about the law, which has been phased in gradually since President Obama signed it on March 23, 2010.

Open Enrollment

Open enrollment continues until March 31. People without health insurance have until March 31 to pay their first premiums in order to avoid a tax penalty for being uninsured.

Ghosts and Orphans

Some drugstore chains have offered to be flexible for newly enrolled people who find themselves to be “ghosts and orphans,” meaning people who thought they had bought insurance on the troubled federal health exchange, but have no record of it, or whose records are flawed. 

CVS and Walgreens, for example, will wait for payment for medicines while their ghost and orphan customers sort out their insurance woes.

People who have enrolled, want to see a doctor or fill a prescription, but do not have an insurance card, should either contact their insurers directly or call the Marketplace Call Center at 1-800-318-2596, according to the Department of Health and Human Services.

No Coverage Caps

Insurance companies cannot limit the annual or lifetime dollar amount of benefits they cover for an individual. Insurers cannot turn away or charge more to an individual who has an illness or a history of illness. They cannot charge women more than they charge men, or drop customers who develop an expensive illness.

Free With an Asterisk

Feel like getting a raft of preventive screenings and immunizations? Now is a great time to do it. From mammograms to prostate cancer screenings, from blood pressure to HIV tests, flu shots to diabetes screening, many preventive tests and shots must be covered with no cost sharing by the patient. That’s a governmental way to say it’s free, with a big asterisk: free if you get the service from an in-network provider.

Preventive Care for Children and Teens

Children and teens have their own laundry list of preventive care, immunizations, and screenings covered for free. Autism, vision, hearing, oral health, and developmental screenings are covered. Recommended shots are covered. 

Certain screenings for adolescents are covered: depression and substance abuse assessments for all teens, and sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk.

Diet and Weight

Screening for obesity and dietary counseling are covered for children and adults.

Location and the Medicaid Gap

For some people who are poor or nearly poor the value of the new law depends on where they live. Expanding Medicaid was an essential part of the ACA’s intent to increase the number of people with health insurance. When the Supreme Court made the federally funded Medicaid expansion optional for states, about half of states chose not to accept the money.

“There are big differences in eligibility for coverage depending on whether a state expands Medicaid or not,” according to the Kaiser Family Foundation (KFF). 

In the 25 states that did not, “nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a ‘coverage gap’ of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits,” KFF reported.