The Affordable Care Act
After much debate, the Affordable Care Act remains the law of the land. It seeks to increase the quality and affordability of health insurance, reduce the number of uninsured people and reduce the costs of health care.
- Makes health insurance companies cover all applicants and offer the same rates – regardless of their sex or their health. This means that under the current law health insurance companies can not charge women differently than men. They also can not deny you coverage or charge you more because of a “pre-existing condition” – a current or past health issue. (Note: Your premium amount can only be based on age, location, tobacco use, individual vs. a family plan, and the coverage level of the plan.
- Requires all health plans to cover the Essential Health Benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services (for free) and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
This has made it easier for consumers to compare plans, knowing that each one has to cover these items at a minimum. It has also prevented health insurance companies from selling “skimpy” plans that were cheap, but didn’t cover many services – often leaving consumers with big bills when they needed care.
Any provider, including (but not limited to) Doctors of Chiropractic, can provide care for those Essential Health Benefits that are within his/her scope of practice under Colorado law. More information about provider non-discrimination and chiropractic services is available in a bulletin issued by the Division of Insurance.
- Requires ALL plans to include preventive services for FREE, even before the deductible is met. A sample of these include:
- Blood pressure screening
- Breast cancer screening and mammography
- Cervical cancer screening (pap test)
- Cholesterol screening
- Colorectal cancer screening
- Depression screening
- Obesity screening and counseling
- Adult immunizations (flu shots, Hepatitis A and B, and pneumonia vaccines)
Financial Help for Individuals
Under the Affordable Care Act, a tax credit called a Premium Tax Credit is available, if you qualify, that can help you afford coverage purchased through Connect for Health Colorado. Unlike tax credits that you claim when you file your taxes, these credits can be used right away to lower your monthly premium costs. If you qualify, you may choose how much to apply to your premiums each month and whether you want to leave some unclaimed until you file your taxes.
You may also be eligible for savings, called Cost-Sharing Reductions, when you access care to help reduce things like copays, deductibles and coinsurance. The amount that you qualify for will depend on factors including your household income and family size. Lower income families and individuals get the most help.
You will learn exactly how much you can receive when you enroll. Individuals can get an estimate of their potential financial help using our Quick Cost & Plan Finder tool.See if You Might Qualify for Financial Help - You May Be Surprised!
Small Business Savings
An employer with fewer than 25 full-time equivalent employees making an average of about $51,600 a year or less (not counting the business owner or family members) can qualify for a tax credit for sponsoring employee health coverage.
To qualify for the Small Business Tax Credit, an employer must pay at least 50 percent of full-time employees’ premium costs. Employers do not need to offer coverage to part-time employees or to dependents.
The tax credit is worth up to 50 percent of your contribution toward your employees’ premiums (up to 35 percent for tax-exempt employers). Small Businesses can use our Small Business Tax Credit Calculator to get an estimate of their potential financial help.See if Your Small Business Might Qualify for Financial Help