Paths to Coverage for Kids: Private Sector Coverage

The Affordable Care Act makes significant changes to the private health insurance market.  The table below, adapted from a University of California Berkeley Labor Center Report, summarizes key ACA provisions affecting the private market.

ACA Standards for Private Sector Plans

 

Marketplaces Grand-fathered Plans1 Employer-Sponsored Plans Individual Plans
No lifetime or annual limits ✔Not applicable to grandfathered individual plans
Dependent coverage up to age 26
Preventive services without cost sharing. Based on the Advisory Committee on Immunization Practices for routine immunizations and Bright Futures for children’s services.
Out-of-pocket maximums
Limited deductibles Small group only Small group only
Essential health benefits Small group only
Waiting periods limited to 90 days
Elimination of pre-existing condition exclusions. In effect as of September 2010 for children and January 2014 for adults ✔Not applicable to grandfathered individual plans

1 Any individual or employer-sponsored plan that existed before March 23, 2010
Source: Affordable Care Act Summary of Provisions Affecting Employer-Sponsored Insurance. UC Berkeley Labor Center. June 2012.

Resources

Child-Only Coverage and the Affordable Care Act: Lessons for Policymakers: This Commonwealth Fund issue brief examines state responses to some insurers ceasing to offer “child-only” plans.

Implementing the Affordable Care Act: State Action on Early Market Reforms: This Commonwealth Fund issue brief examines the numerous consumer protections that took effect in September 2010 as it relates to the private market.

Implementing the Affordable Care Act: State Actions on the 2014 Market Reforms: This Commonwealth Fund issue brief highlights states’ action on the ACA’s private market reforms that apply both inside and outside of the law’s new health insurance marketplaces.

Regulations, guidance, and fact sheets released by the Centers for Medicare and Medicaid Services’ Center for Consumer Information and Insurance Oversight are available on the following topics:

  • Affordable Insurance Marketplaces
  • Health market reforms including annual limits, young adult coverage, employer responsibility, and grandfathered plans.
  • Pre-existing Condition Insurance Plan
  • Other insurance protections including COBRA, Mental Health Parity, Newborns and Mothers’ Health Protection, and Women’s Health and Cancer Rights.

Click a link on the right to continue exploring private market coverage options available to children.