Top 14 Questions Answered On the Affordable Care Act

Updated: May 10

The Affordable Care Act has left a lot of Americans questioning how the program works and what the minimum coverage requirements are. Read our Frequently Asked Questions (FAQ) guide for a quick look at some of the answers to the most common questions on this program.

Q1: What programs meet the Minimum Coverage Requirements?

A1: There are several plans that meet these requirements. They include:

  • Plans purchased through Federal or State Exchanges

  • Veteran benefits, employer plans, and public programs such as Medicare and Medicaid

  • Grandfathered plans through employers

  • Self-insured plans

Contact your insurance provider or your human resources department to find out if your program meets the Minimum Coverage Requirements.

Q2: What will determine the price of insurance through the exchanges?

A2: There are four factors that will be used to determine the cost of your health coverage:

  • Age

  • Premium Rating Area

  • The number of family members covered

  • Tobacco use

Q3: Are there different insurance plans available?

A3: There are four levels of coverage (Platinum, Gold, Silver, and Bronze). Each level has a different amount of insurance premium and out-of-pocket expense. However, there is a maximum out-of-pocket expense determined by your income with each program. There are also catastrophic plans available that would cover you after you have reached your calculated annual limit.

Q4: What are Essential Health Benefits?

A4: Essential Health Benefits are items that are required to be covered by all health care plans. They include:

  • Ambulatory patient services

  • Emergency services

  • Hospitalization

  • Maternity and newborn care

  • Mental health and substance use disorder services

  • Prescription drugs

  • Rehabilitative and habilitative services

  • Laboratory Services

  • Preventive Services

  • Wellness Services

  • Pediatric Services

Q5: What is the penalty for remaining uninsured?

A5: The penalties will increase each year. Please see the chart below:

Q6: Is there any method to avoid paying the penalty?

A6: There are exemptions from the penalty. They include:

  • Exempt non-citizens (illegal aliens)

  • Incarcerated individuals

  • Members of recognized religious sects (must have opted out of Medicare and Social Security)

  • Members of recognized healthcare sharing ministries

  • Low income taxpayers (be