A quick reference – Patient Protection and Affordability Care Act (PPACA).

A quick reference - Patient Protection and Affordability Care Act (PPACA).

This complex law will take several years to implement.  It has and will continue to change the United States insurance and medical care delivery systems.  This guide is only a summary of some of the affects for individuals and families to help point out changes and responsibilities we all share in these rules or guidelines. 

Beginning September 23, 2010 the following changes were implemented:

  1. Children under age 19 cannot be excluded from a policy because of pre-existing health conditions.
  2. No one can be dropped from a policy due to a sickness.  However, a policy can be cancelled if   premium is not paid on time or someone knowingly commits fraud on an application.
  3. For policies purchased after March 23, 2010, free access to preventive services without paying a copayment, coinsurance or deductible.
  4. Lifetime benefit limits (a limit on the amount an insurance company will pay) are prohibited.  Annual benefit limits are also restricted and phased out completely as of 2014.
  5. Freedom to choose a primary care doctor or pediatrician from the insurance company’s network of doctors and can see an OB-GYN doctor without a referral.
  6. Health care plans can no longer require prior approval for emergency care at a hospital outside your plan’s network.
  7. Children can remain on a health insurance policy until they turn 26 years of age, even if they are married, not living with parents or are financially independent.

Starting January 1, 2014

  1. Insurers will no longer be able to deny or limit coverage or refuse renewal, to anyone based on medical conditions.  Also their ability to charge someone higher rates due to health status, gender or other factors will be limited.
  2. Individuals without employer coverage and small businesses will be able to purchase health insurance through a state exchange.  California’s exchange is called Covered California and is found on the web at www.coveredca.com.  Guidelines for enrolling during an open enrollment period were governed by the Federal Government and implemented by the State.  Open enrollment 2014 began October 1, 2013 and continued until March 31, 2014.  The 2015 open enrollment will begin October 15, 2014 and end December 7, 2014.   
  3. U.S. citizens and legal residents will have to purchase health insurance or pay a penalty fee to the federal government.  The 2014 penalty is $95 or 1% of taxable income, whichever is more. The 2015 penalty will increase to 2% or $325 and the 2016 penalty will increase to 2.5% or $695.
  4. Those with incomes from 133%-400% of the federal poverty level (FPL -$23,850 a year in 2014 for a family of 4) will receive a tax credit or government subsidies to help them pay for the health insurance.
  5. Insurance plans will be standardized to assist individuals in choosing a plan to best fit their budget and healthcare needs.

Plan Name





Percent of Coverage





Out of Pocket     Maximum per Year

Ind. $6,350   Fam. $12,700

Ind. $6,350      Fam. $12,700

Ind. $6,350       Fam. $12,700

Ind. $4,000     Fam. $8,000


  1. Originally, businesses with more than 50 employees would have to offer health insurance or pay a penalty to the government; however, the penalty portion of this law was delayed until 2016.

A licensed insurance broker can help you figure out which type of plan would work best for your family’s financial and healthcare needs, provide you with comparisons of available plans and help make the application and enrollment process go smoothly.  Brokers provide service on the policies they recommend and can also help process claims or answer questions about the coverage you choose.  Brokers are paid a service fee by the insurance companies and their services do not impact the premium or fees you pay. 


All information contained within or provided in conjunction with the Content is subject to change without notice. Reasonable efforts have been taken to ensure the accuracy and integrity of all information provided within and in conjunction with the Content.  Amante & Associates Insurance Solutions, Inc. is not responsible for misprints, out-of-date information, or errors.