What is covered under the Affordable Care Act?
Asked by: Amaya Wintheiser | Last update: October 29, 2025Score: 4.4/5 (59 votes)
What did the Affordable Care Act cover?
The ACA expanded Medicaid eligibility, created a Health Insurance Marketplace, and prevented insurance companies from denying coverage due to preexisting conditions. The Affordable Care Act requires insurers to cover a list of essential health benefits.
What are 5 mandated benefits under the ACA?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
What is protected under the Affordable Care Act?
If you get sick, an insurance company cannot cancel your policy. Health insurance companies cannot turn down your application because of your health status. Women can no longer be charged more for insurance than men. In fact, insurance rates cannot be based on gender or gender identity at all.
What is not covered under the Affordable Care Act?
What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.
5 Things About The Affordable Care Act (ACA)
What conditions are covered under the ACA?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
What are the 10 essential health benefits under the ACA?
- Ambulatory patient services (outpatient services)
- Emergency services.
- Hospitalization.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
Who is not eligible for Obamacare?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
What is the 9.5 rule in Obamacare?
The 9.5% threshold for health insurance costs
The Health Reform bill established 9.5% as the amount of income used for health insurance beyond which, it would not be an affordable. This means that if you make $40K annually, the bill subsidizes health insurance premiums beyond just short of $4K.
Does Obamacare cover surgery?
All plans offered in the Marketplace cover these 10 essential health benefits: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services. Hospitalization (like surgery and overnight stays)
Who is eligible for ACA benefits?
To be eligible to enroll in health coverage through the Marketplace, you must: Live in the United States (U.S). Be a U.S. citizen or national, or be lawfully present non-citizen in the U.S. Learn about eligible immigration statuses. Not be incarcerated.
How much is Obamacare a month for a single person?
Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.
Is ACA the same as Obamacare?
“Obamacare” and the “Affordable Care Act” are the SAME thing. A recent article in the New York Times reported survey results showing that one-third of the people surveyed did not know that “Obamacare” and the “Affordable Care Act” refer to the same law.
What does cobra status allow you to do?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, ...
Does ACA cover prescriptions?
Under the Affordable Care Act (ACA), certain preventive medicines are covered at 100 percent with no member out-of-pocket cost. These medicines include: low-dose aspirin. breast cancer prevention medicines.
Which of the following is not an essential benefit under the ACA?
Pursuant to 45 CFR 156.115(d), the following benefits are excluded from EHB even though an EHB-benchmark plan may cover them: routine non-pediatric dental services (for plan years beginning on or before January 1, 2026), routine non-pediatric dental services, routine non-pediatric eye exam services, long-term/custodial ...
Does Obamacare cover an ambulance?
Emergency services: Generally, this includes trips to the emergency room that are made necessary by an accident or sudden illness. Any transportation by ambulance must also be covered. Under the ACA, you cannot be penalized for going out of network or for not getting prior authorization for emergency care.
Is the Affordable Care Act expensive?
Affordable Care Act (ACA) health plans require you to pay a monthly premium, which may be reduced by a premium subsidy — also called a premium tax credit. New legislation means that 4 out of 5 people in the 2025 coverage year will be able to find a plan on the marketplace for $10 or less per month.
Which is considered the most controversial issue related to the Affordable Care Act?
Individual mandate. The most legally and politically controversial aspect of the ACA, the individual mandate requires Americans to purchase health insurance or face a government penalty, with some exceptions—particularly for low-income individuals who cannot afford to buy insurance [3].
What are two major benefits of the Affordable Care Act?
Among other things, the ACA made it easier for many people to get coverage, removed annual and lifetime limits on essential health benefits and put in place requirements that individuals have medical coverage or pay a tax penalty.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.
What disqualifies you from the premium tax credit?
For tax years other than 2021 and 2022, if your household income on your tax return is more than 400 percent of the federal poverty line for your family size, you are not allowed a premium tax credit and will have to repay all of the advance credit payments made on behalf of you and your tax family members.
Does social security count as income for Obamacare?
Include both taxable and non-taxable Social Security income. Enter the full amount before any deductions. Include all unemployment compensation that you get from your state.