After 14 Years, ACA Protections Remain Crucial for Older Adults

The Affordable Care Act (ACA), passed 14 years ago this week, strengthened Medicare and Medicaid and created important coverage guarantees and consumer protections for people of all ages.

From expanding access to affordable care to preventing discrimination based on health status, as well as improving Medicare’s financial status, the ACA made significant improvements to the nation’s health care infrastructure. These advances are especially important for older adults, who are more likely than younger adults to have health problems that cause them to rely on the ACA’s consumer protections.

Some of these benefits and protections are so important that it is hard to recall what the health insurance landscape and consumer rights were like before the ACA’s passage. As a reminder, we are highlighting some of the key components of the landmark legislation.

The Benefits

• Medicaid Expansion: The ACA gave states the option to expand their Medicaid programs to include coverage for low-income, non-elderly adults (ages 19-64) without dependent children. To date, 41 states (including D.C.) have expanded Medicaid, which studies indicate has led to historic coverage gains, improvements in access and financial security, and economic benefits for states and providers.
• Age-Based Discrimination: The ACA prevents insurers from charging older consumers more than three times what younger people pay. Prior to the ACA, there was no limit on this disparity; health insurance companies were typically free to set significantly higher and often cost-prohibitive premiums based on an individual’s age, among other factors.
• Pre-Existing Conditions, Community Rating, and Guaranteed Issue: The ACA does not allow compliant insurance plans to deny, limit, or charge people more for coverage based on a pre-existing condition.
• Elimination of Lifetime and Annual Limits: The ACA prevents private insurance plans from placing annual or lifetime limits on coverage. These important reforms help protect consumers from catastrophic health expenses and medical-bill-induced bankruptcy. Before the ACA, insurers could simply stop paying for an enrollee’s health care expenses after their costs reached a certain amount—often leaving the sickest patients responsible for extremely high costs.
• Essential Health Benefits: To ensure that people with ACA-compliant plans have access to comprehensive coverage, the health law requires most insurers to cover, at a minimum, a set of 10 essential health benefits (EHB). Prior to the ACA, consumers were often unable to find affordable coverage for many of these services—nearly 1 in 5 Americans lacked coverage for mental health care, and almost 1 in 10 didn’t have any prescription drug coverage, despite 60% of the population needing at least one medication per year.
• Access to Preventive Services: The ACA dramatically improved access to no-cost preventive services within Medicare and Medicaid and requires most private health insurance plans to cover a range of preventive health services without patient cost-sharing (co-payments, deductibles, or co-insurance). These changes, particularly when considered alongside the ACA’s coverage expansions, have increased access to clinical preventive services and improved public health.

Medicare Rights looks forward to continuing to work with policymakers to build upon these important reforms.