Making The Affordable Care Act Easy

Open enrollment has closed, but it’s not too late to get covered.

Rite Aid is here to help you understand your healthcare options. While open enrollment has closed, there are certain life events that will create a special enrollment period just for you. And if you were hit with a tax penalty for not having coverage in 2014, a special enrollment period is open now through April 30, 2015 so you can avoid tax penalties for 2015. Call 1-855-880-8777* to find out if you qualify and get answers to any questions you might have about finding a plan that fits your needs.

Information you will need to choose a plan

  • Number and ages of household members

  • Your address

  • Household annual income

  • Current health insurance coverage and premiums/notice from your employer

  • Whether or not household members are smokers

What is the Affordable Care Act?

What is the Affordable Care Act?

It’s a law that was created to give all Americans access to health insurance, and provides additional protection to those who already have health insurance.

Also referred to as "health care reform," the Patient Protection and Affordable Care Act (ACA) was passed by U.S. Congress in 2010.

If you don’t already have health insurance, here are the key benefits you will receive through the Affordable Care Act:


Extending health care coverage to Americans without insurance or those with pre-existing conditions.


Covering the costs of preventative care.


Allowing young people to stay on their parents’ health plan until they are 26.


Insurance companies can’t put lifetime limits on the benefits they pay.

Need help enrolling?
Talk to an independent insurance agent at 855-880-8777.*

How does the Affordable Care Act affect me?

4 things you need to know

  • Open enrollment ended on February 15, 2015, but there are certain qualifying life events that will create a special enrollment period just for you. These events include: getting married, having, adopting or placement of a child, permanently moving to a new area and losing previous coverage. For more information, please call 1-855-880-8777* to talk with an independent licensed insurance agent or go to healthcare.gov.

  • If you have been denied insurance because of a pre-existing condition, starting January 1, 2014, you can no longer be denied insurance or charged more just because of this.

  • You may already have health insurance from an employer, private insurer or government-associated program like Medicare that meets the minimum standards. If you’re unsure if your plan meets the minimum requirements, talk to your manager or your employer’s HR representative.

  • If you are worried about how you will afford a health plan for yourself or your family, you may qualify for a subsidy. This is money offered from the federal government to help Americans and their families pay for their health coverage. You must qualify to receive subsidy money and this depends on income levels set by the Federal Government. Keep in mind, you will not qualify for subsidy money if you get employer health insurance, Medicare or Medicaid.

    Will you qualify for a federal subsidy for your health coverage?

    Find your family size and match it up to your income to find out if you may qualify.

    Up to
    $45,960

    Up to
    $62,040

    Up to
    $78,120

    Up to
    $94,200

    Up to
    $110,280

    Up to
    $126,360

    Up to
    $142,440

    Up to
    $158,520

    1
    2
    3
    4
    5
    6
    7
    8

Need help enrolling?
Talk to an independent insurance agent at 855-880-8777.*

Affordable Care Act terms made easy

Click on the term below to find the definition.

Access

This refers to medical care availability based on proximity, transportation options, types of medical facilities, etc.

Advanced Premium Tax Credit (also Subsidy)

This is federal money offered to help mid- to lower-income Americans pay for health coverage for their families. You have to qualify to get subsidy money based on income levels determined by the Federal Government. If you think you may qualify, you can check poverty and income levels here. Keep in mind, if you are covered by group health insurance or Medicaid, you will not qualify for these subsidies.

Affordable Care Act (ACA)

You have probably heard this referred to as "health care reform". Officially, it’s the Patient Protection and Affordable Care Act and U.S. Congress passed it in 2010. Some benefits that were key to the act include extending health care coverage to Americans without insurance or with pre-existing conditions and adding efficiencies to the health care system.

Agent

Somebody you would see who is licensed to sell health insurance to individuals.

Beneficiary

The individual who receives insurance benefits.

Benefits Coverage

This refers to specifically what your health plan will pay for — an annual physical, lab work, etc. What your insurance covers depends on the plan you have and your benefits documents will list the items covered and the items you may be responsible for paying for.

Broker-Agent

This is an independent insurance salesperson who is licensed as an agent and as a broker. They typically represent particular insurers. However, they some times function as a broker. This means they will search the entire insurance market in order to find a plan that will maximize protection and minimize cost for the applicant.

Claim

When a request is filed to the health plan to pay for a patient’s health care services, this is called a claim.

Copayment

The pre-determined out-of-pocket fee you pay for certain health care services such as a trip to the emergency department.

Deductible

The amount you must pay for your covered health care services before your insurance starts to pay.

Dependent

This is typically a husband, wife or unmarried child who depends on the person who is the policyholder for their health care coverage.

Eligibility (also Subsidy Eligibility)

In order to receive Federal Government monies to help pay for your health coverage, you need to qualify — usually based on household income. If you qualify, you receive the money in the form of a subsidy or cost-share reduction linked directly to your insurance company on your behalf.

Essential Health Benefits

Starting in 2014, it is mandatory that a specific set of health care service categories are covered by certain health plans.

Exchange, Health Insurance Exchange (also Marketplace)

An online site where individuals and small businesses shop and buy health plans. All plans included in the Marketplace must offer a standard level of medical services and health care coverage. Explore the Marketplace

Federal Poverty Level (FPL)

This is used to see if you qualify for federal subsidies and to determine how much help you need paying for health coverage based on your household income. Every year, The Department of Health and Human Services issues new FPL levels.

Health Care Tax Credit

This is money issued to you through a new tax credit. It lowers your health plan premium only if you are purchasing insurance through the Marketplace Exchange. You can use the credit right at time of purchase to lower your personal cost. However, you must qualify for this credit.

Health Insurance Exchange

You will also hear this referred to as the "health insurance marketplace". It’s where state and federal exchanges will offer you a choice of qualified plans from private health insurers.

In Network

Only certain health care providers and facilities are contracted to provide health services to a health plans members. These providers and facilities are referred to as “in network”.

Individual Mandate

One of several ACA reforms that may affect you the most. It requires that every American have health coverage that meets a minimum value standard. And if you don’t, you could pay a penalty.

Individual Subsidies

Financial help from the federal government to help pay for health insurance costs.

Mandate (also Individual Mandate)

One of several ACA reforms. Beginning January 1, 2014, most Americans and legal residents will be required to have minimum essential health benefits.

Marketplace (also Exchange)

Refers to the state and federal health insurance exchanges as a whole.

Medicaid

Government-funded health insurance for low-income Americans.

Medicare

This is government-funded health insurance for Americans over 65. It also benefits those with specific conditions and permanent disabilities.

Navigator

Trained and able to help consumers, small businesses and their employees look for health coverage options through the Marketplace, these individuals or organizations have 5 services to provide to customers. Under law, they are required to: educate people about available health plans, give unbiased information about plan enrollment, available tax credits and cost-sharing, help people enroll in plans, to refer people having issues with their coverage or premium assistance to a program or agency that can help and to provide help in the appropriate language or cultural context.

Network

Your health insurer or plan will contract with certain facilities, providers and suppliers to provide you with health care services.

Open Enrollment

During this time period, you can enroll in a health insurance plan through the Marketplace.

Out Of Network

Facilities, providers and suppliers your health insurer or plan has not contracted with to provide health care services.

Out-of-Pocket Maximum

Before insurance will pay 100% of expenses, this is the maximum amount a person needs to pay for their health care.

Penalty

If you choose not to have health care coverage, this is the amount you will need to pay.

Premium

How much you pay for insurance protection of a specified risk for a specified amount of time.

Primary Care Provider

The one health care provider who an individual sees for their overall health care needs. This health care provider can refer the patient to specialists if necessary.

Provider

A practitioner — i.e. a doctor — or entity — i.e. a hospital — that provides health care services.

Qualified Health Plan (QHP)

A federal or state marketplace certified insurance coverage plan that provides both essential health benefits and affordable health care coverage. The Federal Marketplace only sells Qualified Health Plans.

Qualifying Life Event

You may qualify for a special health coverage enrollment period if you experience a life event such as moving to a new state, a change in income or a change in family size.

Subsidy

Money offered from the federal government to help mid- to lower-income Americans and their families pay for health coverage. You must qualify to receive subsidy money and this depends on income levels set by the Federal Government. Check poverty and income levels here. Remember, you will not qualify for subsidy money if you get employer health insurance, Medicare or Medicaid.