Health insurance is provided by a patchwork of public and private sources in the U.S. The majority of Americans with health coverage—about two-thirds—have private health insurance, with over half of them getting insurance through an employer. The remainder of those with health coverage get insurance through pubic programs such as Medicare, Medicaid, TRICARE or the VA. According to the U.S. Census Bureau, in 2018, 8.5% of Americans, or 27.5 million, did not have health insurance.
The Patient Protection and Affordable Care Act (ACA) contains key provisions and services that most private insurance plans must provide. Importantly, the ACA:
Visit the Laws & Protections section of our website for comprehensive information about the ACA.
Public health programs like Medicare and Medicaid, as well as self-funded, grandfathered and short-term private health plans are not required to abide by all of the ACA rules. For more specifics, visit healthcare.gov.
If you have private individual or group health insurance and believe that your legal rights under the Affordable Care Act have been violated, you should contact the health insurer first to understand its coverage decision. If the issue cannot be resolved directly with the insurer, the next step is to contact your state insurance commissioner's office. Finally, you can contact the Health Insurance Hotline at the Center for Consumer Information and Insurance Oversight (CCIIO) at Health Insurance Hotline at (410) 786-1565 or email: [email protected] .
Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about what Medicare covers and how to manage claims and appeals.
Each state manages its Medicaid program independently. Contact your state program if you have questions or concerns about Medicaid eligibility, benefits or coverage.
