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Marketplace Common Questions

Your rights and protections under the ACA

Young adults may remain on their parent’s coverage until age 26 (effective plan years on or after 9-23-2010).

No pre-existing condition exclusions are allowed for children (effective plan years 9-23-2010; for adults effective 1-1-2014).

Health insurance consumers have expanded appeal rights (effective for new plans beginning on or after 9-23-2010).

No rescissions or policy cancellations are allowed due to illness (effective for plan years beginning on or after 9-23-2010).

No lifetime limits on benefits are allowed (effective for plan years beginning on or after 9-23-2010).

Annual limits on benefits are being phased out (from $750,000 in 2010/2011 to $1.75 million in 2011/2012 to $2 million in 2012/2014).

No-cost preventive services are available before deductible is met (effective 1-1-2011).

Medicare Part D Prescription Plan coverage gap (donut hole) is being phased out (50% reduction in gap effective 2011).

Private insurance companies must provide a Standardized Summary of Benefits & Coverage (SBC) with clear, consistent and comparable information about the health plan benefits and coverage (effective 9-23-2012).

Small employer tax credits are available (effective 2010, increasing in 2014).

Twenty-three states, including Maine, now offer federally funded Consumer Assistance Programs to provide help to consumers with health coverage options and enrollment (2011).

Insurance companies are required to provide rebates to enrollees if they spend less than 85% of their premium dollars on health care as opposed to administrative costs and profits (effective 1-1-2011).

States have the option to expand Medicaid eligibility to cover a new population with 100% federal funds (2014-2016).

Each state has a Health Insurance Marketplace through which tax credits are available for people in certain income ranges.

The Minimum Essential Coverage Requirement requires most people to have creditable health insurance or face a penalty, though there are exceptions.

All plans sold on and off the Marketplace must cover certain Essential Health Benefits (EHBs).

No pre-existing condition exclusions will be allowed for anyone of any age.

Plans can no longer vary rates based on gender (note: Maine already prohibited gender rating).