Five Things You May Have Forgotten Were Included In The ACA

Jan. 03--If you say "Obamacare," most people think of the Marketplace insurance plans -- and the penalty for not carrying insurance. But the Affordable Care Act was a broad-reaching piece of legislation, intended to reform multiple aspects of the health-care system; some of its tenets are still taking effect. With talk of repealing or reforming all or parts of the ACA, here are some changes people may have forgotten were part of it.

Coverage even with pre-existing conditions.

As of 2014, insurance plans can no longer deny you or your child, or charge you more, because of pre-existing health problems. Nor can they refuse to pay for treatment for conditions you had before you had insurance, or raise your rates based on your health.

Before the Affordable Care Act, insurers could, and did, deny coverage or charge higher rates to people with asthma, diabetes, cancer or other chronic health conditions, rendering some "uninsurable." Since the CDC estimates about half of Americans now have a "pre-existing" chronic health condition, this was a big deal.

This applies only to policies that meet the ACA's "minimum essential benefits" package. Some policies that do not qualify still exclude pre-existing conditions. You can buy them, but you may still owe a penalty, since they don't meet ACA requirements. However, certain people who don't qualify for subsidies for Marketplace plans may find that option more affordable.

Children can stay on parents' policies until age 26.

In 2010, the ACA required new health insurance plans to allow adult children to remain on their parents' insurance plans until age 26, regardless of whether the child lives with the parent, is financially dependent on the parent, has other coverage options, is a student or is married. For the first four years, existing plans could deny this benefit to adult children if they had access to other coverage, but that changed in 2014.

The goal was to reduce the number -- 30 percent -- of Americans ages 19-29 who were uninsured. The government said 3 million young adults have stayed on their parents' plan.

However, the government says 6 in 10 young adults qualify for subsidies that allow them to have Marketplace insurance for less than $100 a month, which may be a more affordable option for some families.

The ACA requires large group plans to offer dependent coverage to full-time employees. Small group health plans aren't required to offer dependent coverage.

Preventive care covered with no co-pay.

Insurance is now required to cover certain preventive services without a co-pay or co-insurance, and without cost even if you haven't met your deductible, as long as the provider is in-network.

This includes 15 services for all adults who meet age/risk requirements: screenings for blood pressure, cholesterol, colorectal cancer, type 2 diabetes, depression screening, abdominal aortic aneurysm, HIV, obesity and syphilis; counseling for alcohol, sexually transmitted diseases or diet; aspirin use; tobacco use intervention; and certain immunizations.

For women, it covers 22 services, including pregnancy-related tests and services, breastfeeding support and supplies, breast and cervical cancer screenings and genetic counseling, osteoporosis screenings, and contraception (but not abortion).

It covers 26 preventive services for children, including autism and developmental screenings, behavioral assessment, vaccinations, hearing and vision tests, screenings for a variety of chronic childhood problems, alcohol/drug use assessments for adolescents, and fluoride treatments for children whose water source is not fluoridated.

For those on Medicare, the ACA added an annual "wellness visit" and eliminated co-pays for seniors for flu, pneumonia and hepitatis B shots; screenings for colorectal cancer, cervical cancer, breast cancer, cholestoral, cardiovascular health, diabetes, prostate cancer, abdominal aortic aneurysm and HIV; bone mass measurement; and medical nutrition therapy for those managing diabetes or kidney disease.

Phasing out the 'donut hole.'

Senior citizens with Medicare Part D, which covers prescription drugs, have long dealt with the gap known as the "donut hole." When seniors hit an annual limit on their drug costs, Medicare would stop paying for prescription drugs until seniors spent quite a bit more money and coverage kicked back in. While in the gap, seniors were responsible for the full cost of their drugs.

The ACA hasn't eliminated the gap, but it pays a portion of prescription drug costs during the donut hole period. And it plans for the gap to shrink each year until 2020, when it will effectively be gone. More than 9 million seniors have saved more than $15 billion in drug costs since the donut hole assistance began in 2010.

Mental health and addiction services required.

The ACA made mental health and substance abuse treatment one of 10 "essential benefits" that all Marketplace and Medicaid plans must include. Before, many carriers did not include any mental-health benefits in health insurance plans. It also expanded a 2008 "parity" law requiring insurers to cover behavioral health services the same way they would other types of medical treatment -- and made sure insurers could not deny coverage for pre-existing mental illness and addiction.

Other tenets of the ACA encourage "wholistic" programs that integrate behavioral health with primary care. Even so, stigma, cost and too few providers still prevent many Americans from getting the mental health care or addiction treatment they need.

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