Does Your Health Insurance Plan Cover Your Basic Needs? Find Out If It Is ACA-Compliant

When former President Obama came into office, one of his top priorities was to make sure all Americans were insured, and thus the Affordable Care Act (ACA), or Obamacare, was enacted in March 2010. The ACA has not only made health insurance easier to get for millions of Americans, but it has also meant that now all health insurance plans must cover certain basic needs, as long as they are ACA-compliant. Knowing if your plan is ACA-compliant or non-compliant will help you to get the most out of your health insurance plan, and to know if you need to switch your plan to one that is compliant.

What Does ACA-Compliant Mean?

ACA-compliant health insurance plans are known as qualified Major Medical health plans, and  cover the 10 essential health benefits with no annual or lifetime coverage maximums. These essential benefits include: illustration of a man laying in a hospital bed with a doctor standing next to him

  1. Hospitalization
  2. Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
  3. Emergency services
  4. Maternity and newborn care
  5. Services to treat mental health disorders and problems with substance abuse
  6. Prescription drugs
  7. Lab tests
  8. Preventive services, including things like contraception, blood pressure screening, breast cancer screening, colorectal cancer screening, obesity screening and counseling, tobacco use counseling and interventions, and breastfeeding counseling
  9. Pediatric services for children, including dental and vision care
  10. Rehabilitative and habilitative services

ACA-compliant plans are also guaranteed issue during the open enrollment period, which means that any pre-existing conditions will not play a role in your eligibility for a health insurance plan.

Non-Compliant Plans

illustration of a gray clock without numbers
Short term plans are not ACA-compliant, but are cheaper and temporary for when you can sign up for an ACA-compliant plan.

Other types of health plans that do not cover the 10 essential benefits, sometimes called traditional plans, are considered non-compliant with the ACA. Non-compliant plans include short-term health insurance, fixed indemnity plans, and healthcare sharing ministry plans. These types of plans do not have to abide by the ACA’s consumer protections and are exempt from federal regulations.

Of non-compliant plans, short-term health plans are probably the most commonly purchased, because they are generally much cheaper than ACA-compliant plans. They provide temporary coverage when you are not eligible for a major medical plan or are waiting for coverage to start. Unlike ACA-compliant health insurance plans, these plans can use your pre-existing conditions against you; short-term policies were created for healthier individuals who need some sort of emergency coverage for a short amount of time, so they only cover the basics. Therefore, people with pre-existing conditions, or who are in need of medical care should not consider a short-term health plan.

Looking For More Coverage?

ACA-compliant plans offer more coverage, and thanks to Biden’s American Rescue Plan Act, premium subsidies have been extended to more people, so everyone can save money on health insurance. Before you start doing the work of comparing plans on your own, come to EZ: we will make the process quicker and easier by comparing available plans in your area in minutes. Our licensed agents work with all the top-rated insurance companies in the nation and can go over your budget and needs, and find the best plan for you and your family. We compare plans and offer guidance at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with an agent, call 888-350-1890.

About The Author:
Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.

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