Health Care Reform

The Affordable Care Act

The Affordable Care Act (ACA) is the law that is commonly referred to as health care reform. It became law in 2010 and brings major improvements to our health care system. Quality health care coverage is now available to millions of Americans who would be unable to purchase health insurance on their own.

A comprehensive, concise summary of the Affordable Care Act is provided by the Kaiser Family Foundation.

ACA health care improvements

The Affordable Care Act (ACA) ensures that:

  • Parents can keep kids on their insurance until they are age 26.

  • There is no lifetime cap (or limit) to how much insurance will pay.

  • There is no annual cap (or limit) to how much insurance will pay.

  • You cannot be denied coverage if you have a pre-existing condition.

  • You cannot be dropped from your insurance if you get sick.

Washington Healthplanfinder

One of the factors in the new law is that almost everyone is required to have health insurance.

In Washington, everyone who needs to get health insurance can use the Washington Healthplanfinder — our state’s “exchange” or “marketplace.” During open enrollment, Washingtonians use it to shop for and enroll in quality, affordable health care plans.

It’s also where, if you are a Washington citizen with low income, you can apply for Washington Apple Health (Medicaid). Or, you can see if you qualify for subsidized health care plans.

Medicaid Expansion and Apple Health

The Affordable Care Act raised the income limit on eligibility for Medicaid, which is called Washington Apple Health in our state. The ACA also simplified how you qualify and how you apply.

You should be eligible for Apple Health if:

  • You are a U.S. citizen or a documented immigrant living in Washington who has been in the U.S. for at least five years,ou are a U.S. citizen or a documented immigrant living in Washington who has been in the U.S. for at least five years,

  • You’re not incarcerated,

  • And your annual income is at or below 138 percent of the federal poverty level.

If you’re single and your income is $16,248 or less, you should qualify. Different amounts are designated for different-sized families. (See chart.)

You can apply for Apple Health at any time — there is no open enrollment period. You will need to know your monthly household income. You don’t need any other financial information. You will also need the Social Security number and date of birth for each household member. If you are not a U.S. citizen, you’ll need your immigration information.

Subsidized insurance

If your income is at or below 400 percent of the federal poverty level (in other words, four times the poverty level), you should qualify for subsidized health insurance. For a single person, that’s an annual income of $46,680. For a family of four, it’s $95,400.

If you qualify for subsidized insurance, you’ll get a tax credit that goes directly to the insurance plan to help pay for your insurance. You can find out if you qualify by applying at Washington Healthplanfinder.

Essential Health Benefits

All qualified health insurance policies and Apple Health& must cover these standard basics:

  • Hospitalization — A stay in the hospital, including inpatient surgery and recovery.

  • Emergency services — Visits to the emergency room, including ambulance services or treatment at an urgent care center.

  • Ambulatory services — Doctor visits when you’re sick or injured, or outpatient clinic visits.

  • Prescription drugs — Medicine your doctor orders.

  • Laboratory services — X-rays, MRIs, blood tests, etc.

  • Maternity and newborn care — For women who need prenatal care or help with pregnancy, complications and delivery.

  • Pediatric services, including oral and vision care — Dental check-ups, routine eye doctor visits, eyeglasses, immunizations, and more.

  • Preventive and wellness services, including chronic disease management — Screening tests for things like osteoporosis and mammograms, and help living with long-term illnesses like diabetes.

  • Mental health and substance use disorder services, including behavioral health.

  • Rehabilitative services and devices — Physical therapy, speech therapy, artificial limbs and other medical equipment.

  • Habilitative* services and devices — Helping people with disabilities learn life skills.

*Only available for Apple Health adult clients eligible through the ACA.