The Affordable Care Act: Your health care reformed
The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive health care reform law that President Barack Obama signed on March 23, 2010.
The law was designed to make health insurance more affordable — by making more people eligible for Medicaid, and also by making major changes to reduce costs in individual insurance markets.
The ACA also guarantees that you can›t be denied health insurance even if you›re already sick. It requires every health plan to provide ten essential health benefits. And, depending on your income, age, and household size, you may also be eligible for financial assistance (tax credits or subsidies
New Jersey residents who want to enroll in an ACA health plan can apply using the State of New Jersey›s health insurance marketplace, Get Covered New Jersey.
Here’s what you should know about the ACA and what it means for you.
During the Open Enrollment Period, anyone can sign up for new health insurance through the ACA, or switch plans, regardless of their situation. In New Jersey, Open Enrollment begins on November 1 and ends on January 31 each year. New insurance plans go into effect on January 1 of the following year if you apply before December 31, assuming your first month’s premium has been paid. If you apply between January 1–31, plans go into effect on February 1.
Enrolling Outside of the Open Enrollment Period
You cannot switch health insurance plans outside of the Open Enrollment Period unless you have a Qualifying Life Event (QLE). Below are examples of QLEs:
- Loss of existing health coverage — For reasons like losing a job or turning 26 and no longer being covered by your parent’s insurance
- Changes in household — Such as getting married or divorced, having a new baby or adopting a child, or a death in the family
- Changes in residence — For instance, moving to a new zip code, county, or state
- Other qualifying events — Including a change in your income, becoming a U.S. citizen, or leaving jail or prison
Five key parts of the Affordable Care Act
The ACA has had a major effect on the types of health plans you can qualify for, how much you are asked to pay, and what benefits you receive. Here’s why:
- Individual mandate
The State of New Jersey has an individual health insurance coverage mandate, which requires New Jersey residents to have health insurance or possibly pay a fine. This helps keep insurance premiums lower for individuals because it pools together all the health care consumers in a given area — both those who are likely to have very few medical issues and those who are likely to have very many.
- Help with costs
If you have difficulty paying for health care, the government may help you pay for some or all of your health care expenses. Those who qualify could either receive tax credits or be able to pay a lesser amount for a plan that meets their needs. That includes many people who don't already get help from the government. Beginning in 2021, the State of New Jersey also has an additional subsidy that residents can qualify for through the NJ Health Plan Savings (NJHPS) state subsidy.
- Full-time hours
Employers with more than 50 employees are required to either provide health insurance coverage to their full-time employees or become ineligible for a subsidy.
- Guaranteed coverage
You can enroll in a health plan even if you already have serious and expensive health problems. And you will not pay more because of your health problems.
- Ten essential health benefits
Health insurance plans are required to offer these ten essential health benefits in all their individual and small group health plans:
- Preventive, wellness, and disease management services
This includes annual physical exams, flu shots, gynecological exams, and birth control
- Emergency care
Treatment for broken bones, heart attacks, and other urgent health problems at a hospital emergency room
- Ambulatory services
Minor surgeries, blood tests, and X-rays
Treatment at a hospital for a condition that requires you to stay overnight or multiple days
- Maternity and newborn services
Care through the course of a pregnancy, delivery of the baby, and checkups after the baby is born
- Pediatric services, including dental and vision
Children’s well visits, vaccinations, teeth cleanings, braces, exams, glasses, and contact lenses
- Prescription drugs
Medications prescribed by a doctor, including high blood pressure medicines, insulin, antibiotics, and birth control pills
- Laboratory services
Blood tests, urinalysis, and other kinds of lab tests
- Mental health, substance use disorder services, and behavioral health treatment
Getting treatment for conditions like depression, alcohol abuse, and drug abuse
- Rehabilitation and habilitation services
For example, physical therapy, speech therapy, and occupational therapy
- Preventive, wellness, and disease management services
In addition, most health insurance plans fully cover preventive services that help you stay healthy. That means you may not have to pay anything extra for preventive services such as well visits (annual check-ups), immunizations, and screenings for cancer and other diseases.
How the Health Care Law Protects You
Because of the ACA, health insurance companies that serve the people of New Jersey are required to provide certain benefits that they didn’t have to offer before. For example:
|Before the ACA||Now|
|You could be denied health insurance if you had a pre-existing medical condition like diabetes, kidney failure, heart disease, or cancer.||You cannot be denied coverage because of having a pre-existing condition, and you can’t be charged a higher premium because you have one.|
|Young adults stopped being covered by a parent’s health insurance plan once they turned 18.||Young adults can stay on a parent’s plans until age 26.|
|Health plans weren’t required to cover all the same basic health services.||All health plans now must cover specific health services like regular doctor check-ups and screenings, emergency room visits, prescription medications, and hospital stays.|
Additional Rights and Benefits
Before the ACA, health insurance plans were not required to cover the same types of services and products. Under the ACA, all insurers must cover certain services and products, such as:
- Breastfeeding equipment
Health insurance plans must cover breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.
- Birth control
All plans must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. When these services are provided by an in-network health care provider, plans may not charge a copayment or coinsurance, even if you haven’t met your deductible.
- Treatment of mental health and substance use disorders
All plans must cover mental health and substance use disorder services, which include behavioral health treatments like psychotherapy and counseling and inpatient mental and behavioral health services.
For more information, visit healthcare.gov.
The ACA’s impact on health insurance plans provided by employers
The ACA has also affected health insurance plans provided by employers. It requires businesses with more than 50 employees to either provide health insurance coverage to its full-time employees or pay a fine.
To learn more about what options you and your family have, visit Affordable Health Insurance in New Jersey.
For more details on how the Affordable Care Act affects you, visit GetCovered.NJ.gov.