Affordable Care Act
The 2010 US reform law that rebuilt individual and small group insurance markets around guaranteed issue and subsidies.
Overview
It barred denial or rating for pre existing conditions, set essential health benefits every plan must cover, allowed rating only by age, location, family size, and tobacco, and created marketplaces with income based premium subsidies and cost sharing reductions. The individual mandate penalty was zeroed in 2019, yet marketplace enrollment grew past 21 million in 2024 on expanded subsidies. Insurers stay in the market partly through risk adjustment, which shifts money from plans with healthy members to plans with sick ones. The law also let states expand Medicaid, required dependent coverage to age 26, and cut Medicare Advantage payment formulas.
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Health Maintenance Organization
Members choose a primary doctor who manages care and writes referrals to specialists, and care outside the network is generally no...
Preferred Provider Organization
Members can see specialists without referrals, the main convenience over HMOs. In network care might be covered at 80 or 90 percen...
High Deductible Health Plans
Until the deductible is met members pay the full negotiated price for most care, though preventive services are exempt from the th...
Health Savings Accounts
Contributions are deductible, growth is untaxed, and withdrawals for qualified medical expenses are tax free, a combination no oth...