The Affordable Care Act included many provisions designed to help ensure that consumers have access to effective health care coverage, and to limit their costs. Key provisions that you need to understand include:

  • Extension of health insurance coverage to children up to age 26

  • Expansion of the “guaranteed issue” requirement to ensure that health insurance issuers offer group and individual market policies to any eligible individual in a state, regardless of health status

  • Prohibition on charging consumers a higher premium based on health status or gender

  • Elimination of annual and lifetime coverage limits

  • Prohibition on coverage limitations or exclusions based on pre-existing conditions

  • Prohibition on precluding a qualified individual’s participation in an approved clinical trial, or discriminating against that individual based on such participation

  • Introduction of an 80/20 MLR rule to ensure that at least 80 percent of the premium dollars paid to a health insurance issuer are spent on providing health care

Under the Affordable Care Act, health plans that cover children must make coverage available to children up to age 26. Young adults can join or remain on a parent’s plan even if they are:

  • Married (coverage does not extend to married child’s spouse)

  • Not living with a parent

  • Not attending school

  • Not financially dependent on a parent
  • Eligible to enroll into their employers plan (started in 2014)