The Affordable Care Act (ACA)

By Joan KestonNewsComments are off

The Affordable Care Act (ACA), often referred to as ‘Obamacare,’ will have a positive effect on planning for seniors, and individuals with disabilities and special needs.  The new legislation is generally applicable to individual and group plans beginning on January 1, 2014, and beginning on September 23, 2010 for individuals under age 19 with a pre-existing condition.

The Health Insurance Marketplace will launch on October 1, 2013.  This is a new competitive private health insurance market, providing individuals and small businesses with a one-stop-shop to find and compare affordable, quality private health insurance options.  The ACA authorized State Planning and Establishment Grants to help states establish Health Insurance Marketplaces, or Exchanges. This funding will give states the resources to conduct the research and planning needed to build a better health insurance marketplace and determine how their marketplace will be operated and governed.  For more information, go to to apply for coverage, compare plans and enroll.

Pre-existing Condition Exclusion:  The ACA prohibits any pre-existing condition exclusion form being imposed by group health plans or group health insurance coverage and extends this protection to individual health insurance coverage.

Lifetime and Annual Limits:  The ACA prohibits health plans from putting a lifetime dollar limit on most benefits you receive.  The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits and entirely eliminates these limits in 2014.  (Plans can limit care services that are not considered “essential” and a “grandfathered” individual health insurance policy is not required to follow the new rules on annual limits.)

Young Adult Coverage:  Under the ACA, if your plan covers children, you can now add or keep your children on your health insurance policy until they are 26 years old, even if they are married, not living with you, attending school, not financially dependent on you, eligible to enroll in their employer’s plan.

Stronger Medicare Program:  Under the ACA, seniors and people with disabilities on Medicare will benefit from coverage of preventive services with no cost sharing, i.e., no deductibles or co-pays.  In addition coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.

Long-Term Care and Special Needs Planning Post ACA

Although insurance coverage will now be available to those individuals who previously relied solely on Medicaid or self-insured, and conditions will now generally be covered without annual or lifetime limits, planning is still necessary.  Insurance coverage is not the only or primary purpose of long-term care planning or special needs planning.