The Affordable Care Act was signed into law on March 23, 2010. The law's main goal is to make affordable health insurance available to more people. To help you better understand what health care reform means for you, we've put together some tools and resources.
There is a lot to know about health care reform. Start by learning the basics.
Individuals and families with low to medium income, those making between 100 percent and 400 percent of the Federal Poverty Level (FPL), may be able to get help paying for health insurance costs. To get this help, you will need to purchase a plan through the Health Insurance Marketplace. Depending on your income, you may qualify for help paying monthly bills and/or out-of-pocket costs like deductibles and copays.
Individuals and families who make less than 400 percent of the FPL may qualify for Advance Premium Tax Credits (APTC). If you qualify, you may choose to use some or all your advance credit towards your bill each month. When you file your taxes, you'll determine if you used too much or too little credit. If you used too little, you'll be refunded the remainder on your federal tax return. If you used too much, you'll pay the difference back with your federal tax return.
Individuals and families who make less than 250 percent of the FPL may qualify for a cost share reduction (CSR). CSRs help lower the costs you pay when using your health insurance, such as deductibles, coinsurance and copays. If you qualify, you will be able to purchase a silver level plan through the Health Insurance Marketplace. These silver plans will have similar benefits to more expensive plans but at a lower price.
Advance Premium Tax Credit (APTC)
The Affordable Care Act provides a tax credit to help you afford health care insurance purchased through the Health Insurance Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. Learn more.
Your share of the costs of a covered health care service. It is calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.
For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. Your health plan pays the rest of the allowed amount.
Copayments (or Copays)
A fixed amount you pay for a covered health care service. It is usually paid at the time you get the service.
For example, if you have an office visit with your doctor, your copay may be a fixed amount such as $30. If you have a copay, this is usually the only fee you will have to pay when you visit your doctor (other services such as lab tests or x-rays may result in additional fees). Choosing a plan with a copay for services you receive often may help you minimize your out-of-pocket expenses.
Cost Share Reductions
If you qualify, these can help you with the cost of health care. Your out-of-pocket costs like deductibles, coinsurance, and copayments may be reduced, depending on your income. Those that qualify can pay the premium of a Silver plan but get the benefits of a Gold or Platinum plan. Learn more.
The amount you pay for covered health care services before your health insurance begins to pay. If your deductible is $1,000, your health plan won’t pay anything until you’ve paid $1,000. The deductible may not apply to all services.
Health Insurance Marketplace (Exchange)
The Health Insurance Marketplace (Exchange) is an open market for dental and health care insurance. You'll be able to compare types of health care insurance, check prices, find out if you qualify for subsidies and enroll in a health care insurance plan.
Health Plan Categories (Metal Levels)
All health insurance plans are divided into five categories – Catastrophic, Bronze, Silver, Gold and Platinum**. These are called the “metal levels.” The categories are based on the average total amount* your plan will pay for your covered medical costs: 60 percent for Bronze, 70 percent for Silver, 80 percent for Gold and 90 percent for Platinum (catastrophic plans will vary).
The most you will pay in calendar year for covered health care services. This does not include your monthly premium or out-of-pocket costs for benefits that are not essential health benefits.
Your costs for health care not paid by health insurance. These costs can include deductibles, coinsurance, and copayments. They also include costs for services that aren't covered by your health insurance.
A premium is the amount that you pay each month for your health insurance.
Help with paying for your health care and insurance plan costs based on your income level. You can get help with your monthly premium (Advance Premium Tax Credit) or help with your out-of-pocket expenses (Cost Share Reductions). Learn more.