What the Affordable Care Act Means for You

Be Aware Your doctor's office may not know about the free checkups. You may need to offer a reminder.

What We're Getting

Greater access to health insurance If you get health insurance through your employer, send your CEO a thank-you note, because today, companies like yours have no obligation to provide it and face no penalties if they don't. That changes in 2015, however, when employers with 50 or more "equivalent" employees (who work 30 hours or more a week) must provide "affordable" health insurance. That means the portion that you pay can't be more than 9.5% of your household income. (If your household income is $60,000, that makes your monthly premium about $475.) If employers don't offer insurance, they face substantial fines; unlike health insurance premiums, however, the fines are not tax deductible, so employers will take major financial hits for not complying. In addition, small businesses with fewer than 25 full-time employees who make $50,000 or less a year may be eligible for tax credits to help owners purchase health insurance for their employees. Small businesses will also have access to specialized marketplaces called the Small Business Health Options Program (SHOP) that will help them compare the costs and benefits of insurance options for their employees.

Better Coverage

The law requires that all individual and commercial plans cover at least 10 categories of benefits, known as essential health benefits. These include:

All outpatient medical care

Mental health and substance abuse services

Emergency services


Prescription drugs (For natural remedies that work, check out these 10 Alternatives To The Leading Prescription Drugs)

Pediatric services, including dental and vision care

Rehabilitative (including devices) and "habilitative" care, including autism treatment

Laboratory services

Preventive, wellness, and chronic disease services

Prenatal, maternity, and newborn care

Even if you're not in the baby-making demographic, it's good to know that your daughter or niece is protected. Today, few states require coverage for maternity care in the individual market, leaving millions of women uninsured when they have a baby. Nearly 7.5 million women are expected to gain maternity coverage on the individual market.

Between state Medicaid expansions, health insurance exchanges, and employer mandates, it's estimated that about 19 million women will gain health insurance, with slightly more than half of them eligible for subsidized coverage through the marketplaces. Many are between ages 50 and 64--too young to qualify for Medicare but possibly burdened with significant medical bills.

Visit our ACA Resource Center, packed with links and information and be sure to check out the November issue of Prevention, where we'll run part two of our story about ACA changes coming in January. Our ACA expert, Prevention's editor-at-large Debra Gordon, will host online chats to answer your questions.

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