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How the Affordable Care Act Affects Everyone’s Health—No Matter What Kind of Insurance You Have

Kells McPhillips

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Last year, the Associated Press found that 26 percent of Americans named health care as “the most important issue facing the country.” Yet when it comes to legislation, most of us prefer a summary to, say, the full text of a dense (but critically important) 974-page document known as the Affordable Care Act. Now, however, it’s more vital than ever to understand the nuances of the Obama-era law. A federal judge in Texas declared the law unconstitutional in late 2018. And now that the Justice Department has agreed with that ruling, Democrats in the House of Representatives are strategizing to defend it.

Even if you don’t have an “Obamacare” health plan, it’s important to remember that the ACA isn’t just about safeguarding the health-care plans of nearly 20 million Americans. The bill also protects countless well-being initiatives that aren’t as general as “covered” or “not covered.” This is how the Affordable Care Act affects your life and the lives of all Americans:

The Affordable Care Act allows those under 26 years of age to stay on their family’s health care plan

The Affordable Care Act allows individuals ages 25 and younger to stay on their parents’ healthcare plan—even if they’re married, no longer living under their parents’ roof, still in school, no longer financially dependent on their parents, and even if they’re eligible to enroll in their own plan through work. Once they turn 26, they’re eligible to sign onto their own coverage through a special enrollment period. An estimated two million young adults receive coverage this way, according to an estimate provided by the government.

It requires businesses to pay for workers’ contraceptives, without copays

All plans in the Health Insurance Marketplace (a government-run service that helps citizens find healthcare coverage depending on their state of residency) or sponsored by employers must cover the 30 contraceptive methods approved by the FDA without charging a copayment. This includes hormonal birth control, tubal ligations, IUDs, and emergency contraceptives. Special exceptions are made for certain organizations, like churches, non-profit religious hospitals, or colleges with religious affiliations.

It requires insurers to cover preventative screenings (like colonoscopies and mammograms)

A huge part of the Affordable Care Act is preventative care. For plans within the Health Insurance Marketplace, the full cost of shots and certain tests are covered for women, men, and children alike. Examples include HIV screenings, the influenza vaccine, breast cancer genetic counseling, and well-women visits. This rule applies to company-sponsored insurance, packages in the marketplace, and for those on Medicare. Although, it’s important to note that the type of preventative tests fully covered varies by plan.

The Affordable Care Act keeps employers from over-charging workers with pre-existing conditions.

Up to 133 million Americans live with pre-existing conditions, reports The New York Times. The ACA states that no one can be denied coverage because of pre-existing conditions (with the exception of those on grandfathered plans). Meaning, once you’re in network, the provider can’t adjust your rates at will depending on the state of your health. It also protects you from being rejected based on pregnancy.

It provides breastfeeding benefits to countless women.

“Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding,” reads the government’s official health care website, healthcare.gov. “These services may be provided before and after birth.” That means insurance plans within the marketplace—and most other plans—are required to cover the cost of breast pumps and accommodate your doctor’s other recommendations.

It gives you the right to appeal a coverage decision.

Should your health insurance company either refuse to pay a claim or drop you, you have the right to appeal the decision within 6 months if you’re on a plan created after March 23, 2010, or another plan that has changed since that date. You can appeal a denied claim internally (by speaking directly to the provider) or externally (by taking the issue to a third party). Before the ACA, your insurance provider didn’t have to tell you the reason your claim was denied, but it does now.

The Affordable Care Act deems mental health and substance abuse services essential

Under the ACA, plans in the Health Insurance Marketplace (and most individual and small group plans) must provide coverage for psychotherapy, counseling, impatient services for mental and behavioral health, and substance abuse treatment. Plus, insurance companies can’t place yearly or lifetime limits on any of the services falling under this category.

For a personal take on the American health care system, learn how one woman is fighting an uphill battle for the coverage she needs.

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