Obamacare

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Understanding the Affordable Care Act and Your Healthcare

For more than a decade, the Affordable Care Act (ACA) has been a fundamental part of the American healthcare landscape. While the initial rollout was marked by political debate and confusion, the law has several lasting provisions that continue to impact how North Carolinians access healthcare. It is also crucial for seniors and their families to understand what the ACA does—and what it does not do—when it comes to long-term care.

Key Lasting Impacts of the ACA in North Carolina

While the headlines have faded, the core components of the ACA remain in place, providing significant protections and new options for residents.

  • Protection for Pre-Existing Conditions: Insurance companies can no longer deny coverage or charge you more based on a pre-existing health condition.
  • The Health Insurance Marketplace: For individuals under 65 who do not have employer-sponsored insurance, the federal marketplace at HealthCare.gov provides a platform to shop for and purchase private health insurance plans, often with tax credits to help lower the cost.
  • North Carolina’s Medicaid Expansion: In a major development, North Carolina has expanded its Medicaid program. This means that many more low-income adults who were previously uninsured may now be eligible for healthcare coverage through North Carolina’s Medicaid program.

What the ACA Means for Seniors on Medicare

A common point of confusion is how the ACA affects those who are 65 and older. It is essential to understand:

  • The ACA is NOT Medicare: If you are 65 or older, your primary health insurance is Medicare. You do not need to shop for a plan on the ACA marketplace.
  • The ACA Strengthened Medicare: The law made several improvements to Medicare, most notably by closing the Part D prescription drug “donut hole,” which has significantly lowered out-of-pocket drug costs for many seniors.

The Unsolved Problem: Paying for Long-Term Care

The single most important thing for families to understand is that the Affordable Care Act did not create a new benefit to pay for long-term care. The staggering costs of an assisted living facility or nursing home are not covered by the ACA, nor are they covered by Medicare. This remains the greatest financial risk for most seniors.

This is where proactive planning becomes essential. An experienced elder law attorney can help you navigate the options that do exist to pay for care, such as qualifying for Medicaid or the VA Pension, as part of a plan to protect your assets.

Call our office at (919) 256-7000 to schedule a consultation.