Learn About the Affordable Care Act

I Am Under 30

Young adults have the highest rate of uninsurance among all age groups.[1] The Affordable Care Act (ACA) works to change this by making insurance more accessible and more affordable. It also aims to make the insurance young adults have better.

Already…

Changes marked with a * do not apply to ‘grandfathered’ health insurance plans until 2014, or until the plan is no longer grandfathered. Your plan is grandfathered if you had it in March 2010 and no big changes have been made to it since then. Big changes include increasing the plan’s costs or reducing what the plan covers. 

  • Young adults can stay on their parents’ family insurance plan until they turn age 26. It does not matter if they are a student, live in the same state, are employed, or are married.*
    • Until 2014, grandfathered plans only have to cover adult children who cannot get insurance through their own employer.
  • In Ohio, young adults can stay on their parents’ family insurance plan until age 28 if they are:
    • Single
    • An Ohio resident or full-time student
    • Not eligible for insurance through their own employer
    • Not eligible for Medicaid or Medicare
  • Insurers must cover 100% of the cost of preventive health care services. This includes services such as immunizations, certain prescriptions including birth control, annual exams and physicals.*
  • Insurers must tell you how much you paid and how much they paid for every service.*
  • Insurers cannot cancel your insurance if you get sick unless you lied to them when you applied for insurance.
  • You have the right to appeal your insurer’s decisions:
    • First, to an internal review board
    • Second, to an outside independent decision maker
  • If you have been denied insurance for six months or more due to a health problem you can purchase insurance through the Pre-existing Condition Insurance Plan (PCIP).

 Beginning in 2014…

Almost all citizens will be required to have insurance or pay a fine. This rule is called the individual mandate. There are many changes that will help young adults afford health insurance in order to meet this requirement.

  • Lower-cost, ‘catastrophic’ insurance plans will meet the requirement for young adults age 30 and younger. These plans will cover:
    • Three primary care visits
    • 100% of the cost of preventive care
    • 60% of the costs of essential health benefits after you reach your deductible (In 2010 dollars the maximum deductible is $5,950/individual).
  • Young adults who make less than 400% of the federal poverty level ($44,680 for one person, $92,200 for a family of four), and purchase their insurance on an exchange, will get help paying for insurance premiums. These subsidies will be based on how much you make, your family size, and where you live. It will be on a sliding scale but will make sure that you do not pay more than 9.5% of your income on insurance premiums.
  • You will be able to compare and purchase insurance on an exchange if you want. Exchanges will be online marketplaces where you can easily compare and buy the insurance based on coverage and price.
  • Insurers can no longer charge more based on gender or health status. Premiums can only vary based on:
    • Whether you are buying an individual or family plan,
    • Your age,
    • Whether you use tobacco, and
    • Where you live.
    • Insurers cannot deny anyone insurance due to health problems.  
    • All health insurance plans must cover essential health benefits. These are basic services such as emergency services, maternity care, mental health care, and prescription drugs.

[1] http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.shtml