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Key Provisions

Protection for Individuals & Families Effective in 2010

  • No out-of-pocket costs for in-network preventive services
  • No cap on lifetime benefits and restricted annual limits
  • Young adults can stay on their parents' plan up to age 26
  • Seniors' prescription drug "donut hole" will be closing
  • No out-of-pocket costs for seniors' preventive Medicare services
  • Insurers must give refunds to consumers if an insurer’s medical loss ratio is less than 80 or 85 percent

2014 and Beyond

  • Most people must maintain qualifying health insurance coverage or pay in their annual tax return a penalty for each month without such insurance. The penalty in 2015 is $325 or 2% of income in excess of the tax filing threshold, whichever is greater. The penalty changes each year. More information on the individual mandate and penalty
  • U.S. Citizens and legal residents cannot be denied health insurance coverage, even if sick
  • Individuals and small employers will be able to shop for health insurance policies through a Health Insurance Exchange
  • Non-grandfathered individual and small employer health insurance policies will cover ten specific essential health benefits. More information on essential health benefits
  • Individuals and families who qualify will be able to receive premium subsidies to help cover the cost of health insurance policies
  • In person assistors, sometimes referred to as "navigators," may be available to help you compare and select a private health insurance plan that's best for you. More information on assistance

Small Employers - (1-50 employees)

  • Small employers are not required to offer health insurance
  • Small employers with fewer than 25 full time equivalent employees may qualify for a tax credit of up to 50% of their contribution toward employee premium costs if the employer covers at least 50% of the cost of single health care coverage for each employee and employees have average wages of less than $50,000. More information on the small business tax credit | Tax Calculator
  • Small employers will be able to shop for health insurance coverage through the Health Insurance Exchange, starting in 2014

Large Employers - (more than 50 full-time equivalent employees during the preceding calendar year)

  • Large employers may have to pay a penalty, starting in 2015, if one of its full-time employees obtains coverage through an exchange and receives a premium subsidy. More information on penalties - please note that employer penalties have been delayed until 2015 for employers with over 100 full time equivalents and until 2016 for those with 50-99 full time equivalent employees.
  • An employee offered employer coverage can only receive a premium subsidy for exchange coverage if the employee does not enroll in the employer’s coverage and the employee’s contribution toward the self-only premium exceeds 9.5% of household income or the plan pays less than 60% on average of covered health care expenses.