The Affordable Care Act (ACA) includes various mandates to ensure that all Americans obtain health coverage and seeks to improve the overall quality of the care provided. This article will discuss various components of the ACA and its impact on individuals with special needs and the elderly, including minimum essential health insurance coverage, Medicaid expansion, the health insurance marketplace, continued health insurance coverage for dependents and Medicare benefits.
Minimum Essential Coverage
Effective Jan. 1, 2014, all nonexempt individuals must have minimum essential coverage. 26 U.S.C. §5000A(a). Exempt individuals include prisoners, undocumented immigrants, Native American tribal members, individuals who cannot afford coverage, individuals who live in states that opted out of Medicaid expansion, individuals who have no plan options in the state health insurance marketplace or individuals with a gap in coverage not to exceed three months. 26 U.S.C. §5000A(e). Minimum essential coverage is defined as one of the following: group health plans; employer-sponsored retiree health plans; public benefits plans such as Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) or Tricare; private health insurance (including a marketplace plan); Medicare Advantage plans; and self-funded student health plans. 26 USC §5000A(f). An individual’s failure to obtain such minimum essential coverage will result in a penalty upon filing his or her annual income tax returns. 26 USC §5000A(b).
