The Patient Protection and Affordable Care Act: What Health Care Reform Means to You

The Patient Protection and Affordable Care Act: What Health Care Reform Means to You

By Social Security Administration

On March 23rd, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), designed to reduce health care costs for American families and small businesses, expand coverage to millions of Americans, and end certain negative practices of insurance companies.

 While some parts of the act will not go into effect for several years, a lot of the changes will improve access to healthcare now.  Here is a list of some of the key changes made by the PPACA:


  • If you have a pre-existing condition and have been uninsured for 6 months, you will now have access to health insurance.  This insurance coverage will be subsidized by the government until 2014, at which time insurance companies can no longer deny coverage based on your health.
  • The law prohibits new health plans from denying coverage to children with pre‐existing conditions.
  • Insurance companies are banned from dropping people from coverage when they become sick.
  • New health plans must allow children up to age 26 to remain on their parents’ insurance policy (at their parents’ choice).
  • Health insurance companies are prohibited from placing lifetime caps on coverage.  The PPACA will also restrict annual limits and prohibit them all together by 2014.
  • New private plans must cover preventative services free of co-payments.  Also, preventive services must be exempt from deductibles.
  • New plans must ensure customers have access to an effective internal and external appeals process to appeal decisions by their health insurance plan.
  • New group health plans are prohibited from establishing eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees.
  • The act provides a $250 rebate to Medicare Beneficiaries who hit the “donut hole” (the gap in Medicare prescription drug coverage). Beginning 2011, there will be a 50% discount on prescription drugs for those who fall in this gap.  By 2020, this gap will be eliminated.
  • A temporary re-insurance program will help early retirees (ages 55-64) offset insurance premiums (until the new Health Insurance Exchanges become available).
  • States will be provided aid to establish offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals.
  • Copayments for preventive services under the Medicare program are eliminated, and preventive services are exempt from deductibles.
  • Individual and small group plans are required to spend 80 percent of premium dollars on medical services (85% for larger group plans). Insurers who do not meet this threshold must give rebates to policyholders.
  • Increased funding for community health centers will allow for nearly double the number patients served by the centers over the next 5 years.
  • New investments will be implemented to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants.
  • Health insurance companies will be required to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges.

To find out more, visit Social Security Administration.