Coverage Protections

"Key changes to the United States health care system as a result of the PPACA include the following: Insurers are prohibited from denying coverage to individuals due to pre-existing conditions. Premiums must be the same for everyone of a given age, regardless of preexisting conditions. Dependents are permitted to remain on their parents' insurance plan until their 26th birthday. Individuals are required to buy health insurance or pay a penalty, known as the individual mandate. This applies to everyone not covered by an employer-sponsored health plan, Medicaid, Medicare, or other public insurance programs such as Tricare. Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service. Essential health benefits must be provided, including ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care, and others rated Level A or B by the U.S. Preventive Services Task Force. In determining what would qualify as an essential benefit, the law required that standard benefits should offer at least that of a “typical employer plan.”"