What is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA) is a healthcare reform law designed to expand insurance coverage, protect consumers, and regulate the insurance industry. Key provisions include protections for pre-existing conditions, Medicaid expansion, and the creation of state and federal health insurance marketplaces. It also impacts Medicare by reducing prescription drug costs and expanding preventive care benefits.

Why does the ACA matter?

The ACA expanded access to health coverage for millions of Americans, particularly those without employer-sponsored insurance or who faced barriers due to pre-existing conditions. It also introduced cost-saving measures for Medicare beneficiaries, including closing the Medicare Part D "donut hole" to reduce out-of-pocket drug costs and expanding access to preventive services like screenings and vaccinations at no additional charge.

The ACA and insurance claims appeals

For Medicare beneficiaries, the ACA ensures clearer appeal rights if a service or medication is denied. Patients can challenge coverage decisions, and in some cases, binding external reviews may be available.

Clearing up ACA misconceptions

• The ACA doesn’t provide free healthcare, but offers subsidies to reduce costs.
• The ACA doesn’t replace Medicare, though it does strengthen certain Medicare benefits.
• Medicaid expansion may help low-income individuals, but eligibility varies by state.

How Solace can help

A Solace advocate can help you access cost-saving programs introduced under the ACA, including financial assistance options and Medicare drug coverage improvements. They can also assist with crafting appeals for denied claims, including those eligible for external review under ACA rules.

What to do next

If you need help understanding how the ACA affects your Medicare coverage, find an advocate today.