Highlights of the Affordable Care Act

Posted Sept. 07, 2013, at 5:29 a.m.

You have lots of questions about the Affordable Care Act, aka Obamacare. The Bangor Daily News and Lewiston Sun Journal want to help you understand what the ACA will mean for you and your family.

Through a 5-part series that begins this weekend and will run Mondays through Oct. 1, the day before ACA health insurance signups, the papers will explain the comprehensive health care plan and other reform items included in the act.

To view our full ACA coverage, visit bangordailynews.com/series/ACA, where you also can sign up to receive email notifications of stories that have been published.

Here are highlights of the law to get you started:

Coverage

  • Expands Medicaid to more low-income Americans (except in some states, including Maine, that opted out of the expansion).
  • Young adults up to age 26 can remain on their parents’ health plan.
  • Insurers may no longer deny coverage to people with pre-existing health conditions, or charge them more.
  • Requires employers to cover their workers or pay penalties, with exceptions for small businesses.
  • Requires individuals to have insurance, with few exceptions.
  • Prohibits insurers from applying lifetime monetary caps on insurance coverage and limits the use of yearly caps.
  • Prohibits insurance plans from arbitrarily cancelling coverage, except in cases of fraud.
  • Requires state reviews for “unreasonable” insurance premium increases.

Costs

  • Creates health insurance marketplaces where consumers and small businesses can shop for plans and apply for subsidies and tax credits to help them afford coverage.
  • Prescription drug discounts for seniors on Medicare.
  • All new plans must cover certain preventive health services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance.
  • More money dedicated to reduce fraud and waste in Medicaid, Medicare and CHIP.
  • Insurers must spend at least 80 cents of every premium dollar on benefits and quality improvements, rather than overhead costs and profits.

Care

  • Coverage for mental health and substance abuse treatment must be comparable to coverage for medical and surgical care.
  • Accountable Care Organizations and other programs designed to help doctors and health care providers work together to deliver better, less expensive care.
  • A new $15 billion fund will invest in prevention and public health programs, including smoking cessation and combating obesity.

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