Health insurance Your Coverage Options

Eight things you should know about the Affordable Care Act

Written by Diane Archer

Thanks to the Affordable Care Act (“ACA”), 16.4 million more people in the United States have health insurance, though 13.2 percent of the population is still uninsured. Here’s eight other interesting facts about the ACA in 2015, post King v. Burwell.

  1. The ACA guarantees Americans and permanent legal residents the right to buy health insurance, regardless of whether they have a pre-existing condition; and it forbids insurers from cutting people’s coverage off if they get sick. Undocumented immigrants and legal immigrants in the US for 5 years or less are not eligible for coverage.
  2. The ACA requires insurers to offer “minimum essential health insurance coverage” to everyone who they insure, including mental health care, prescription drugs, having a baby, as well as a range of preventive services with no copay or deductible.
  3. The ACA requires insurers to charge everyone the same rate for the same policy based on their age, regardless of their health status. Also, your out-of-pocket costs must be capped. And, it limits the amount that insurers can profit off the premiums they charge.
  4. The ACA requires everyone eligible for coverage to have coverage, although people can go without coverage if they pay a penalty (2% of income or $325, whichever is higher, 2015).
  5. The ACA requires every state to have a health insurance exchange, a marketplace through which people without insurance from their jobs and small businesses can buy insurance. Either the state can establish the exchange itself or the federal government can establish the exchange for the state. The exchange, which can be accessed online, allows people to compare the costs and benefits of the health plans available to them.
  6. The ACA provides a subsidy—help paying for coverage through a state’s health insurance exchange—for anyone with income up to 400 percent of the federal poverty level, $47,080 for an individual. If you’d like to know whether you’re eligible for a subsidy and the amount, click here. In the 30 states (including Washington DC) that opted to expand Medicaid, people with incomes under 138 percent of the federal poverty level are eligible for it, $16,242 for an individual and $27,724 for a family of three. About 3.7 million nonelderly adults in states that opted not to expand Medicaid fall into a coverage gap.
  7. The ACA allows parents with health care coverage through their jobs to include coverage for their children until they turn 26.
  8. The ACA requires chain restaurants to list calories on their menus.

If you still have questions, you can call the government at 1-800-318-2596.



  • I have MEDICARE, and get a small pension from the State of California for working 23 years as a high school teacher in Los Angeles. I am 78 and have serious arthritis, which incapacitates me and gives me agonizing pain 24/7. (I take morphine, which helps only a little). MY QUESTION IS– how can I access affordable home care? My doctors give me a run around and gobbledygook and tell me to call some agency that is never available anyway. I have tried for years to get answers, and every year I am closer to zero hour. I don’t know how much longer I can function on my own, that is, washing dishes, shopping, taking out garbage, etc. This is a serious matter and I would like to know if ACA has any stake in it.

    • I wish there were a good answer. But,uUnless a family member or friend provides home care, the unfortunate reality is that most Americans struggle to get it. It’s so costly. Sometimes Medicaid, or MediCal in California, pays for home care. As you know, Medicare only pays for home care in limited situations. Click on this link to learn more:
      I would urge you to contact your local area agency on aging to learn about other resources in your community, including home-delivered meals. You can find the number at or call 1-800-677-1116. You can check out other free resources here:

      • Perhaps important to point out the distinction between “Home Health” prescribed for medical necessity vs help with activities of daily living, which is characterized more as “custodial care”. These really are two separate and distinct services. As we know Medicare does not cover custodial care, which is typically a private-pay service. Your suggestion is a good one! Contacting the local aging office is always a great idea.

  • Forrest hopping comment shows beyond a shadow of a doubt the need for a single payer system of health care in this country. The cost of health care in this country is out of control. An health insurance is a major part of the problem. We will have to be able to accept wage and price controls in the delivery of our health care. Plus the most balanced and fair way to pay for it would be a tax on all earnings. An realize that we must be willing to wait for non life threatening care. Plus those delivering the care must be willing to accept wage and price controls. That pay for the service plus a small modest profit.

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