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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.

The AHCA retains this requirement.

 

Essential Health Benefits

Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits.

The AHCA retains this requirement.

 

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.

The AHCA retains this requirement.

 

Preventive Services

Under the ACA, plans must cover a specified set of preventive services – like vaccines and screening tests – at no cost to you.

The AHCA retains this requirement.

 

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.

The AHCA retains this requirement.

 

Dependent Coverage

Under the ACA, dependent children can stay on their parent’s health insurance plan until they are 26 years old.

The AHCA retains this requirement.

 

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.

The AHCA retains this requirement.

 

Rating Rules for Age Classes

Under the ACA, older adults may be charged no more than three times the premium as younger adults.

The AHCA changes this requirement to allow older adults to be charged no more than five times the premium as younger adults

 

Metal Tiers

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.

The AHCA repeals this requirement.

 

Continuous Coverage Penalty

To encourage you to get and keep continuous health coverage, the AHCA adds an additional rule that will allow insurance companies to charge you more if you do not keep coverage. Under the rule, when applying for health coverage, the insurance company will look back to see how many days out of the last year you were uninsured. If you were uninsured for more than 63 days, the insurance company can charge you a flat 30% surcharge on top of your base premium. The next year, assuming you have remained covered, the surcharge would go away.