Fact Checked

What Does the Affordable Care Act Cover?

The passing of the Patient Protection and Affordable Care Act, also called the Affordable Care Act (ACA) or ‘Obamacare’, was accompanied with much fanfare, namely about it being a step toward universal healthcare. What is the Affordable Care Act? The exact wording that President Obama frequently fell back on was that the ACA was for “everybody.” It was very much not for everyone—but it was progress, right? That’s exactly how President Obama described it: 

“As messy as it’s [the Affordable Care Act] been sometimes, as contentious as it’s been sometimes, it is progress. It is making sure that we are not the only advanced country on Earth that doesn’t make sure everybody has basic health care.”

In truth the ACA both was and wasn’t what was promised. Enrollment was largely a success, many states expanded Medicaid, and millions of Americans were insured. But, at least initially, many states resisted the effects of the Affordable Care Act’s Medicaid provisions, and were legally enabled to, leaving more millions of people in the ACA’s dreaded coverage gaps. Businesses have found ways to avoid paying for their employees’ insurance coverage, and prescription drug prices have accelerated their climb with impunity. Perhaps most conspicuously, many Americans don’t even know who will be affected by the Affordable Care Act if they were to enroll, or cannot afford their insurance premiums or prescription drugs even when factoring in their subsidies. We’ll go over who’s covered and who isn’t, what that might mean for you, and how USARx can help you if you aren’t covered. 

First of all, if you live in a state that did not expand Medicaid and you make below 100% of the Federal Poverty Level (FPL) but above 48% of the FPL, you are not covered. This is called ‘the Medicaid Gap’ and it mainly affects adults, as children are covered by the Children’s Health Insurance Program (CHIP) in most states. It’s a “gap” because you only qualify for Medicare Marketplace Subsidies starting at 100% of the FPL in non-expanded states. In states that did expand Medicaid, qualification now extends up to 138% of the FPL. And if you qualify for Medicaid you do not qualify for Medicare. Furthermore, if you and your family are even a little over 400% of the FPL, you may face the ‘Subsidy Cliff.’ Going over that cliff means you can’t receive cost-assistance, which can easily make the difference when it comes to healthcare affordability for low-income families. If you don’t qualify it’s possible to shop outside of the HealthCare.Gov website for better options, as long as you find a trusted broker. But this can greatly complicate what was intended to be a relatively simple process, and you’ll still need to participate in enrollment in the individual market to put your plan into effect. 

If you’re a full-time employee currently receiving insurance from your employer, not much necessarily needs to change. All ACA provisions will apply to your old plan, including the option to extend coverage to your dependents until they’re 26. You may want to shop on the marketplace anyway; some extant employer plans don’t offer benefits covering the Ten Essential Health Benefits that all plans instated after the ACA must provide. It is also possible for employers to charge the full insurance premium (devoid of the subsidies they are required to provide to the actual employee) for any dependents you may want to bring onto your plan. This can be incredibly expensive and may lead to family members going without needed health. If either of these is the case for you, you may be better off shopping on the marketplace website for your dependents and/or yourself. Shopping for a dependent can have catches though—namely that they may not qualify for subsidies. This can cause many middle-class families to become stuck between unfavorable plans with no good way out when acquiring insurance for their families. Unless your premium from your employer is over 9.5% of your earnings (classifying you as ‘uncovered’) there is no simple solution to this issue. But if you’re employed by a small business, just these fees aren’t the end of potential problems you should be wary of.

There is a trend of employers reducing workers’ hours to reclassify them as part-time, thus evading the mandatory coverage they need to offer to full-time employees. There’s also a growing number of small business owners who consciously keep their employee numbers under 50 to dodge some of the heavier insurance requirements placed on larger small businesses by the ACA. If you’re one of those “part-time” employees being shortchanged, your recourse would be the marketplace at HealthCare.Gov. But this may not be tenable, depending on your income and state of residence (refer to the discussion on the ‘Medicaid Gap’ above). 

If you’re retired or disabled, your rights are protected and expanded. You cannot be dropped or charged more in the event of a catastrophe. You get yearly wellness visits and preventative treatments at no cost to you, including cancer screenings and immunizations. You will also receive significant discounts on prescription and generic drugs. But due to the spiking costs of prescriptions these discounts are not necessarily as good as they sound on paper. 

If you pay for your own insurance then you will probably benefit the most from the ACA. Prior to the passing of the ACA, insurance companies could happily charge high premiums on health plans with severely limited benefits. (The overplayed punchline—“Does it come with dental?”—comes to mind.) Many of these limited, non-employer dependent, plans may no longer be available. Depending on your income, an ACA approved plan may cost you more money, but you will almost certainly be better covered and better off overall, both financially and physiologically. A law instated by the ACA compels insurance companies to spend at least 80% of the premiums they receive on health benefits for their customers, and, if they don’t, to pay their customers the difference. The only bias insurers are allowed to let affect their decisions are age and your status as a smoker, so really there hasn’t ever been a better time to purchase your own insurance, if you can afford it. In some states, New York, for example, not even age is allowed to factor into premium prices, and these premium prices must be the same as they would be in an employer’s insurance package for a full-time employee of the same age. 

If you’re uninsured, you no longer have a tax penalty in 2020 as you did in the early years of the ACA. If you’ve chosen to go without insurance, there’s technically no reason you can’t continue to remain so indefinitely. But you may want to consider long-term care. Regular physicals, vaccinations, and specialized preventive care is a crucial safety net for all Americans, at-risk for disease or not. And the full price of some prescription drugs is nothing to sneeze at. In addition to those who choose not to buy a policy or cannot afford one, undocumented immigrants cannot receive coverage under the ACA. Neither Medicare nor Medicaid have any means to provide aid for you. In this case, a USA Rx card could be an absolutely necessary resource. 

USA Rx is entirely free to use, and requires no interfacing with an insurance policy, ensuring that it’s available for anyone at all who may need help making ends meet. The registration process is unintrusive and quick and results are immediate. By simply signing up, printing a savings card, and then presenting said card when checking out drugs, users will instantly save up to 75% of their purchase’s price. In addition to your USA Rx card, there are numerous potential avenues of saving, all of which are worth exploring. Firstly, USA Rx provides a free coupon service that allows users to search by their medication’s name, presenting an arrangement of discounts for any drug that can be reprinted as many times as you need. Many brand-name drugs can be purchased for cheaper than the initial valuation a pharmacist might give you. Tricks such as searching out (or requesting) the generic name of a brand-name drug, or scouting out different pharmacies (which, along with drugs, tend to present different prices for the same deal), can potentially save you from making hugely wasteful purchases, so shopping around is always recommended. You can also ask your prescriber where they recommend going to get the most savings. They’ll often have surprising and effective means for patients to scrimp. However, a USA Rx discount card is by far the quickest and most reliable way to avoid the incredible prices of most prescription drugs and out-of-pocket expenses. 

USA Rx remains crucial for the 30 million Americans who are without insurance—a number that is estimated to remain relatively constant despite the ACA’s implementation, at least for as long as it remains relatively unchanged from its current state. And, yes, those dissolute collectives, of immigrants, low-income families, and the willfully uninsured, do add up to tens of millions. USA Rx is in a unique position to provide exclusively for a market that ideally will continue to shrink, and it will continue to do so under the ACA, and whatever changes it goes through, for years to come.