Coverage Changes in Effect

Coverage changes and consumer protections are among the biggest provisions of the Affordable Care Act (ACA). Here is a snapshot of the provisions in place today.

No lifetime limits and restriction on annual limits

Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage.

Restricts annual limits on the dollar value of coverage.

100% coverage for preventive care

Plans must cover, without cost-sharing, a variety of preventive services as determined by organizations such as the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention.

Over-age dependent coverage

Group and individual market health plans providing coverage for dependent children must continue to make coverage available for an adult child until the child turns 26 years of age.

No pre-existing conditions exclusions for children

Plans are prohibited from denying coverage to children with pre-existing conditions who are under 19 years of age.

Emergency services

For all ACA-compliant plans, emergency services are covered:

• With no prior authorization.
• For any provider, whether in- or out-of-network.
• At the same copayment or other cost-sharing, whether in- or out-of-network.
• Without difference in coverage, whether in- or out-of-network.

Rescinding coverage

Insurers and group health plans may not rescind an enrollee’s coverage unless the individual has performed an act that constitutes fraud against the plan or has intentionally misrepresented a material fact to the plan.