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Health Care Reform

The Affordable Care Act

The Affordable Care Act (ACA) was passed by Congress and signed into law by the president in March 2010. On June 28, 2012, the Supreme Court rendered a final decision (PDF) to uphold the health care law.

One key feature of the law was that affordable health insurance exchanges or marketplaces (like MNsure) would be set up in every state. They allow residents to compare health plans, get their questions answered, find out if they qualify for tax credits or health programs, and enroll in a health plan.

More about the ACA.

What Marketplace Health Plans Cover

Essential Health Benefits

Under the Affordable Care Act (ACA), individual and small group health plans must cover 10 essential health benefits regardless if the plan is purchased inside or outside of MNsure.

Every health plan must cover the following:

  • Outpatient care you get without being admitted to a hospital, including doctor's office visits
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (examples: physical and occupational therapy, speech-language pathology, psychiatric rehabilitation)
  • Lab tests
  • Preventive and wellness services and chronic disease management (examples: blood pressure and diabetes screenings, mammograms and colonoscopies, vaccinations and flu shots)
  • Pediatric services, including dental and vision care

Consumer Protections

All plans offered in the MNsure marketplace include consumer protections.

  • No discrimination based on pre-existing conditions or gender
  • No annual dollar limit on coverage
  • No lifetime limit on coverage
  • A cap on out-of-pocket costs
  • Allows young adults to stay on their parent's health insurance plan until age 26, unless they have access to coverage through their employer
  • Requires that 80-85 cents of every dollar you pay for health insurance is spent on delivering or improving health care-or you get a refund from your insurance company
  • Provides consumers a standard, plain language summary of your plan called a summary of benefits and coverage.

Health Care Coverage Requirement

The ACA requires that all individuals have health insurance beginning January 1, 2014. In addition, insurers are required to cover everyone, regardless of health status or history.

The purpose of the requirement is to make sure people don't wait until they have a health issue to purchase insurance. By bringing healthy people into the covered group, there is a better balance of sick and healthy individuals, and average costs are kept down.

Through the MNsure marketplace, individuals and families can find out if they qualify for public health programs, or for tax credits that will lower the cost of coverage. Small employers with fewer than 25 employees who provide health insurance may qualify for a federal tax credit of up to 50%.

Although employers are not required to offer health insurance to employees, most who employ more than 50 employees will pay an assessment if they don't offer affordable coverage that covers minimum essential health benefits.

Exemptions from the Individual Mandate

You may qualify for an exemption from the requirement to maintain health insurance coverage.

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