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ACA (Affordable Care Act) - Health Insurance

Resources for library users about the Affordable Care Act and insurance choices

Official Information

What is the Affordable Care Act?

The Affordable Care Act (ACA) was passed by Congress and signed into law on March 23, 2010. The Affordable Care Act (ACA) has ten sections or Titles.

A brief outline of each Title, as well as the full text of the ACA can be found at The Affordable Care Act, Section by Section. On October 1, 2013, open enrollment in the Health Insurance Marketplace through HealthCare.gov began coverage starting January 2014.

If you previously purchased a plan through Healthcare.gov, your insurance company should have sent you information on renewing that plan.

The open enrollment period begins November 1, 2022 and ends January 15, 2023.

Policies purchased between November 1, 2022 and December 15, 2022 will become effective January 1, 2023.

After the initial open enrollment period, new policies purchased before the 15th of the month will be effective the first of the next month. Policies purchased after the 15th of the month will be effective on the first of the 2nd following month. For example, if you purchase your policy on February 20, your policy will be effective April 1, but if you purchase your policy on February 14, the policy will be effective March 1.

Each year there is an annual open enrollment, just like there is for Medicare Part D or for an employer's health plan.

The official web site is Healthcare.gov.

Federal Poverty Guidelines

Poverty, poverty levels, or the poverty rate is calculated several ways by the federal government. The Census Bureau caluclates poverty levels for determining the number of people living in poverty. That information is here.

The Department of Health and Human Services calculates US Federal Poverty Guidelines. The full explanation and charts for the most recently available year are here. The US Federal Poverty Guidelines for each year are published in the Federal Register, usually in January of the year covered.

Special Enrollment Period - Life changes

Did you know that life changes like moving, having a child, turning 26, losing your coverage, or getting married may qualify you for a Special Enrollment Period?

After the open enrollment period ends, you may still be able to current year coverage if you’ve experienced a life change recently.

Important: If you qualify for a Special Enrollment Period, you’ll have 60 days from the time the life event occurs to enroll.

Check here to see if you qualify.

If you have employer provided insurance

If you have job-based health insurance you like, you can keep it. You may be able to change to Marketplace coverage if you wish, but you probably won't qualify for a premium tax credit or other savings.

You can ask your employer if it plans to offer health insurance. If not, you may need to get insurance through the Marketplace or from other sources. 

What is Included

There are four levels of coverage  — Bronze, Silver, Gold, or Platinum — based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you'll likely spend for essential health benefits during the year. The percentages the plans will spend, on average, are:

  • 60% (Bronze),
  • 70% (Silver),
  • 80% (Gold), and
  • 90% (Platinum).

This isn't the same as coinsurance, in which you pay a specific percentage of the cost of a specific service.

Dental and Vision insurance is automatically included for anyone under the age of 18. (If you are over 18, you will need to pay for dental and vision coverage.)

Who is in charge?

There are three levels involved:

  • US Department of Health and Human Services

The HHS does two main things: It provides a minimum threshold those policies must meet in terms of what they cover, and a maximum threshold those policies will cost anyone out of pocket who enrolls in them. (They have annual caps of a sort, but they're to protect the consumer, not the insurance company bottom line.)

  • State-run Insurance Exchanges

Individual states only have to do one main thing: create and maintain a mega-website where residents of that state can find details on various insurance policies listed. This portion of the ACA is typically handled by the state's insurance regulation department. The exchange is where you will actually shop and compare policy features and choose the one best for you.

Louisiana does not have plans for a state exchange. Louisiana residents will participate in a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions.

  • Insurance providers

The policies from private insurance companies come in various shapes and sizes, but all must meet the HHS-state mandated requirements. The out pocket premium cost for lower income people is not affected by age or preexisting conditions, it's a function of income and tobacco use. As you earn more, your age does become a factor, but the rates are still a big improvement and are calibrated to remain affordable for all tax brackets. Anyone earning less than federal poverty wages will be covered under the Medicaid expansion side of the Act.

Additional Information