An important goal of the law is ensuring that individuals and families have access to affordable, high-quality health coverage. It will also make it much easier for people to shop for private health coverage, to get help with financial assistance to help pay for private insurance, and to apply for Medicaid.
The District of Columbia has established DC Health Link to help people find, compare, and enroll in the health coverage that meets their needs and budget. Below is a summary of the major parts of the law that affect individuals and families.
Putting You in the Driver's Seat
Before the Affordable Care Act, the private health insurance market did not work well for many people. You may have been unable to find affordable coverage, been denied coverage, charged a much higher premium if you had medical needs, or learned your health insurance did not cover treatment for your pre-existing medical condition.
Insurance policies were allowed to place annual or lifetime caps on your benefits that may have left you without enough insurance coverage when you were sick. Women of child-bearing age were charged more than men. And some people paid more for coverage if they worked in construction and other high-risk jobs.
The Affordable Care Act changed all that.
- Insurance companies are not allowed to turn you down or charge you more because of a current or past medical condition like diabetes, heart disease, or cancer. They must pay for care related to your condition.
- Insurance companies are not allowed to charge you more because you are a woman of child-bearing age or because of your occupation. There are limits on how much more insurers can charge older people.
- Insurance companies are not allowed to cap your benefits annually or have lifetime dollar caps.
All private health plans available through DC Health Link must cover essential health benefits that include:
- Doctor visits
- Hospital stays
- Emergency room care
- Maternity and newborn care
- Prescription drugs
- Lab tests
- Preventive tests and services
- Rehabilitative and habilitative services and devices
- Chronic disease management
- Mental health care
- Substance use disorder services
- Dental care for children
- Vision care for children
There are no out-of-pocket costs for most preventive services like cancer screenings, immunizations, smoking cessation, and well-baby and well-child visits. For a list of preventive care that must be provided, visit the Healthcare.gov website. Also, there can be no limits on the number of mental health or substance abuse treatment visits. View the available health plans on DC Health Link.
Most people are required to have health insurance or pay a penalty to the federal government. In 2015, the yearly penalty is $325 per adult and $162.50 per child under 18 (up to $975 per family), or 2% of your yearly income, whichever is higher. The penalty for not having coverage in 2016 is $695 per adult and $347.50 per child under 18 (up to $2,085), or 2.5% of your income, whichever is higher.