Affordable Care Act: What You Don’t Know Could Help You

It’s understandable that many Americans aren’t entirely sure what’s included in the nearly 2,000-page Patient Protection and Affordable Care Act that the Supreme Court just upheld. After all, most lawmakers passed the law without knowing exactly what was included.

A new study by the Pew Research Center shows millions of Americans are in the dark when it comes to understanding what the new regulations may mean and how they might benefit. According to the study, four days after the court handed down its decision, only 55% of people knew that a ruling was even issued. What’s more, only  37% of respondents under the age of 30 knew of the Affordable Care Act.

Whether you’re 25 or 95, the health-care reform may offer some surprising perks. We checked in with experts to find out some of the most-important takeaways for any age group.

If you’re in your 50s…

The ACA has made it possible for people without health care to get preventive screenings.

“If you’re between the ages of 50 and 64, you’re not yet Medicare eligible, but you’re also in a high risk age group,” says Carolyn Rosenblatt of, a registered nurse and elder law attorney. “Before the law, if you didn't have health care through an employer, you couldn't get mammograms, pap smears, prostate exams, and other preventative screenings that can save your life.”

Before ACA, persons without health insurance had to pay out-of-pocket for any preventative screenings, which can cost upwards of $5,000 in some cases, according to Rosenblatt. Screenings are important to people at any age, but because risk for certain types of cancer and disease rises with age, it’s especially important for people 50 and older, she adds.

If you’re 65 or older and on Medicaid…

The ACA may allow you to opt for in-home elder care rather than being forced into a nursing home.

Under the ACA, Rosenblatt says individual states can decide if they want to allow in-home attendant care to be part of their Medicaid offerings, and if they do, each state will receive a 6% increase in Medicaid allowances from the government.

“It costs up to three times as much to put a person in a nursing home as it does for in-home attendant care,” she says. “Medicaid will now pay for people to have a caregiver come into their home every day for a few hours if they are more comfortable staying at home. Even if it’s a humble apartment, the person can stay at home, and in the long run, it’s a money saver.”

If you’re over 65 or have aging parents…

The ACA included an “Elder Justice Act” that protects seniors from scams and abuse.

“The Elder Justice Act will provide for community education programs for seniors, warning them of local scams or online fraud, and will provide for victim assistance for abused or neglected elders,” says Rosenblatt.

Many scams frequently target seniors, such as chimney sweeps that go door-to-door charging thousands of dollars for work that should cost less than $100, or online cons that seek access to a senior’s bank account. The ACA will provide funding for the prosecution of these crimes.

“It comes down to having more support for at-risk elders who need it,” says Rosenblatt.

If you’re out of college but don’t have a job with health benefits…

The ACA allows you to stay on your parents’ health insurance until age 26.  

“If you’re 23 and you have a part time job or you’re not eligible for health benefits yet, you can stay on your parents’ insurance until age 26,” says Evan Portnoy, president at Rampart Benefit Planning and a member of The Independent Insurance Agents and Brokers of New York.

Prior to reform, children could not stay on their parents’ policy as a dependent once they were no longer a full-time student. Parents often opted to supplement their child’s coverage via an expensive Cobra policy that sometimes ran upwards of $600 a month. Under the new law, a dependent child regardless of marital status, employment status, or residence can stay on the month of their 26th birthday, says Portnoy.

“Hopefully it’s going to give these kids a little more piece of mind, but more importantly, they’ll be able to go for preventive care. I can’t tell you how many kids in that age range just never go to a doctor unless they get seriously hurt.”

If you have a pre-existing condition at any age…

The ACA has made it illegal to reject anyone due to a pre-existing condition such as cancer, heart disease, etc.

“This is especially important for seniors who are still working,” says Portnoy. “It used to be that insurance carriers could reject covering someone, even through an employer, or they would reject entire companies of people. They can’t do that anymore.”

Portony described a situation in which some insurance companies previously rejected entire companies: If a company has six employees and two of them are older than 65 or have extreme medical issues, insurance companies know they could never charge enough in premiums to make up for what the claims will be.

“One surgery could be $30,000, and that will eat up a lot of premiums,” he says. “But with the new law, a carrier can’t turn an employer’s group down.”

If you’re seeking a new job…

The ACA has mandated that no employee has to wait more than 90 days for their health insurance to kick-in after being hired.

“Previously, companies could wait as long as they wanted before giving insurance to new employees,” says Portnoy. “But in 2014, 90 days will be the maximum an employer can wait before offering benefits.”

Although it’s technically illegal for a company to make younger employees wait longer to receive benefits, in many cases young people right out of college internships have been put on a longer “probation” term than other more seasoned employees. This move would make it illegal for anyone to be withheld benefits for longer than three months.

If you’re a senior on Medicare with high prescription costs…

The ACA is seeking to close the “donut hole,” in prescription medication and make expensive drugs more affordable.

“If you’re not eligible for low-income subsidies like Medicaid, the ACA will bridge the coverage gap with a 50% discount for brand name prescription drugs,” says Anne Hance, partner at law firm McDermott Will & Emery. “A lot of Medicare beneficiaries are reaching that coverage gap.”

The move is intended to reduce the cost of certain brand name prescription drugs by 50%, and over the course of the next 10 years the gap will close completely, meaning that 100% of all prescription drugs for seniors on Medicare will be covered by 2020.