Affordable Care Act: What Changes Can You Expect?

For the first installment on healthcare reform, click here.

Healthcare reform, or the Affordable Care Act (ACA), implements requirements and limitations on health insurance companies to protect patients, especially the ability to drop or deny coverage to individuals due to pre-existing conditions. It also includes changes to Medicare and Medicaid, following a highlight of changes that may affect you.

Insurance Changes

More coverage. Individuals and families will have additional insurance coverage choices through alternatives to the individual private insurance market, such as pre-existing condition insurance plans and young adult coverage.

More options. The ACA creates Affordable Insurance Exchanges so consumers may select a plan that fits their individual or family needs. Consumers can also participate in CO-OPs (Consumer Operated and Oriented Plans), nonprofit insurance plans run by customers—which must use profits to lower premiums, improve benefits, or improve quality of members' healthcare.

More clarity. Healthcare reform requires insurance companies to provide consumers with an easy-to-understand Summary of Benefits and Coverage (SBC) and a Uniform Glossary that defines commonly used terms, such as deductible and copayment. All insurance companies must also use the same standard form. These changes will make it easier for consumers to easily compare options across companies before choosing a plan.

More consumer protections. The law also protects patients by preventing insurance companies from canceling coverage, instituting lifetime limits on benefits, or retroactively canceling insurance coverage because the patient or his employer made an honest mistake on the application. Consumers will now have the right to appeal unfavorable coverage decisions. Consumer Assistance Programs will help individuals file complaints and appeals, enroll in health coverage, and educate consumers on their rights and responsibilities.

More transparency. Furthermore, insurance companies must publicly justify their actions if they want to raise rates by 10 percent or more, and are required to spend at least 80 percent of premiums on medical care and quality improvement—or else provide rebates to consumers.

And Grandfathered Health Plans. The ACA exempts most plans that existed on March 23, 2012 from some of the law's consumer protections, and preserves consumers' rights to keep the coverage they had before healthcare reform passed.

Medicare and Medicaid

More Americans will be eligible for Medicaid, the government's program for disabled or low-income citizens, or to receive federal subsidies to buy insurance. Between now and 2020, the ACA will gradually close the coverage gap for prescription drugs, or the famed "doughnut hole."

Seniors will still be responsible for 25 percent of their prescription drug costs. Seniors will also be eligible for annual checkups with no co-insurance payments.

For more information, you can view state-by-state updates on health reform at


Sources: "Understanding Reform." Web. "Consumer Operated and Oriented Plans (CO-OPs)." Web. 21 February 2012. "Get the Facts: Busting the Top 10 Myths on the Affordable Care Act." Web.

Howard, Beth. "11 Myths About Health Care Reform." AARP The Magazine. September 2012. Web.

Nordstrom, Shawn. "Affordable Care Act Has Some Little-known Tricks Up Its Sleeve." Web. 14 May 2012.

Carey, Mary Agnes, and Gold, Jenny. "After the Election: A Consumer's Guide To The Health Law." Web. 8 November 2012. "Myths and Facts." "Summary of Benefits and Coverage (SBC) and Uniform Glossary." Web. 23 September 2012. "Consumer Assistance Program." Web. 24 August 2012 "Appealing Health Plan Decisions." Web. 12 July 2012 "Grandfathered Health Plans." Web. 20 August 2012 "Patient's Bill of Rights." Web. 6 February  2012. "Children's Pre-Existing Conditions." Web. 2 August 2012 "Doctor Choice & ER Access." Web. 6 February 2012 "Curbing Insurance Cancellations." Web. 27 January 2012 "Insurance Choices." Web "What is the Affordable Care Act?" Web