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Consumer Protections

In 2010, Congress enacted the Patient Protection and Affordable Care Act, known as the “ACA” or “Obamacare.” Here are some changes that might impact you.

  • If you have a pre-existing health condition, you can no longer be denied coverage or charged more based on your condition starting in 2014.
  • Insurance companies are required to spend at least 80% of the monthly premiums you pay on health care services. If you got a refund check in the mail from your insurance company, they are paying you back for spending too much of your premium payments on other items, such as administrative costs or profits. This is known as the Medical Loss Ratio (MLR) requirement.
  • If you currently have a health insurance plan that meets the legal requirements for Minimum Essential Coverage (MEC), you can likely keep it.
  • Many insurance plans are now required to cover specific categories of basic health services, known as Essential Health Benefits (EHBs).
  • Many preventive services must now be provided at no additional cost, including certain vaccines, cancer and disease screenings, services for pregnant women, and contraceptive methods like birth control pills.
  • Insurance companies can no longer put yearly or lifetime limits on the amount of health care services they will cover if you get really sick.