The Affordable Care Act introduced a good number of regulations that controlled what plans insurance companies could offer, what those plans had to cover, who those plans had to cover, and what could be charged for those plans. Under the AHCA, many of these protections remain.
Guaranteed Issue (Pre-Existing Conditions)
Under the ACA, insurance companies are not allowed to refuse to sell you insurance because of a pre-existing medical condition you may have. Insurance companies must also cover treatment for any pre-existing medical conditions you may have.
Essential Health Benefits
Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits.
Lifetime and Annual Limits
Under the ACA, insurance companies are no allowed to set a dollar limit on what they will spend for your care during the entire time you are enrolled or during the entire year.
Under the ACA, plans must cover a specified set of preventive services – like vaccines and screening tests – at no cost to you.
Premium Rating Classes
Under the ACA, insurance companies can only base the price of plans offered on your age, location, and whether you use tobacco. They are not allowed to base the price on your gender, race, or health status.
Under the ACA, dependent children can stay on their parent’s health insurance plan until they are 26 years old.
Medical Loss Ration
Under the ACA, insurance companies are generally required to spend at least 80% of the money they take in from premiums on health care costs. The remaining 20% may be spent on administrative costs and profit. If insurance companies do not spend enough money on health care costs, they are required to issue a rebate check to all those they insure.
Rating Rules for Age Classes
Under the ACA, older adults may be charged no more than three times the premium as younger adults.
Under the ACA, insurance plans are divided into four major categories depending on what percentage of your total health care costs they will cover. These categories – Bronze, Silver, Gold, and Platinum – are designed to show you how you and your plan share costs. Bronze plans have the lowest monthly premiums, but the highest costs when you need care. Platinum plans have the highest monthly premiums, but have the lowest costs when you need care.