The Affordable Care Act (ACA) was designed to give individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that they may not have been able to get on their own or through an employer. Under the ACA:
Find the answers to common ACA questions about submitting documents, getting and changing coverage, your total costs for health care, tax options, and more.
Using Your Coverage
If you have questions about specific parts of your insurance plan, you must contact your insurance company to get answers. Only your insurance company can answer specific questions about doctors, medications, treatments, medical equipment, and what is and is not covered under your plan.
Find contact information for your insurance company on your insurance card or bill.
Health insurance helps you pay for medical services and sometimes prescription drugs. Once you purchase insurance coverage, you and your health insurer each agree to pay a part of your medical expenses--usually a certain dollar amount or percentage of the expenses.
How to get Health Coverage
You can get health care coverage through:
A group coverage plan at your job or your spouse or partner's job
Read the fine print when choosing among different health care plans. Also ask a lot of questions, such as:
Do I have the right to go to any doctor, hospital, clinic, or pharmacy I choose?
Are specialists, such as eye doctors and dentists, covered?
Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
Does the plan cover home care or nursing home care?
Will the plan cover all medications my physician may prescribe?
What are the deductibles? Are there any co-payments? Deductibles are the amount you must pay before your insurance company will pay a claim. These differ from co-payments, which are the amount of money you pay when you receive medical services or a prescription.
What is the most I will have to pay out of my own pocket to cover expenses?
If there is a dispute about a bill or service, how is it handled?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families the right to choose to continue group health coverage provided by their group health plan for limited periods of time.
There are three basic requirements that must be met for you to be entitled to elect COBRA continuation coverage:
Your group health plan must be covered by COBRA
A qualifying event must occur (for example, voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, or divorce)
You must be a qualified beneficiary for that event
If you are entitled to elect COBRA continuation coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage.
How to Get COBRA
Under COBRA, group health plans must provide covered employees and their families with a notice explaining their COBRA rights. Plans must also have rules for how COBRA continuation coverage is offered, how qualified beneficiaries may elect continuation coverage, and when it can be terminated.
Most health insurance plans and Medicare severely limit or exclude long-term care. If you want coverage, you may need a separate long-term care insurance policy. Read the Guide to Long-term Care Insurance. You should consider the cost of long-term care insurance as you plan for retirement.
These questions can help you evaluate long-term care insurance policies.
What qualifies you for benefits? Some insurers say you must be unable to perform a specific number of the following activities of daily living: eating, walking, getting from bed to a chair, dressing, bathing, using a toilet, and remaining continent.
What type of care is covered? Does the policy cover nursing home care? What about coverage for assisted living facilities that provide less client care than a nursing home? If you want to stay in your home, will it pay for care provided by visiting nurses and therapists? What about help with food preparation and housecleaning?
What will the benefits amount be? Most plans are written to provide a specific dollar benefit per day. The benefit for home care is usually about half the nursing-home benefit. But some policies pay the same for both forms of care. Other plans pay only for your actual expenses.
What is the benefits period? It is possible to get a policy with lifetime benefits but this can be very expensive. Other options for coverage are from one to six years. The average nursing home stay is about 2.5 years.
Is the benefit adjusted for inflation? If you buy a policy prior to age 60, you face the risk that a fixed daily benefit will not be enough by the time you need it.
Is there a waiting period before benefits begin? A 20 to 100 day period is not unusual.
Complaints about Long-Term Care
To report an emergency where there is immediate danger, call 911 or contact your local authorities.
If you have a complaint about a long-term-care facility, read about the long-term care ombudsman program, which investigates complaints.
If you have an elder abuse complaint, contact your long-term ombudsman or local elder abuse resources.
Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Learn about eligibility, how to apply and coverage.