Affordable Care Act (ACA)

The Affordable Care Act — formally the Patient Protection and Affordable Care Act, signed into law in 2010 — is the most sweeping reform of the US health insurance system since Medicare and Medicaid. Its central goals were to expand access to coverage, protect consumers from restrictive insurer practices, and slow the growth of healthcare costs.

The law's consumer protections are its most tested features. Insurers must issue coverage on a guaranteed issue basis and cannot deny coverage or charge more because of pre-existing conditions. Plans cannot impose lifetime or annual dollar limits on essential health benefits, must cover a defined set of essential health benefits (including preventive care at no cost-sharing), and must allow adult children to remain on a parent's plan until age 26. Premium variation is limited to factors such as age, location, family size, and tobacco use.

The ACA also reshaped how people obtain coverage. It created health insurance marketplaces (exchanges) where individuals compare standardized plans grouped into metal tiers — bronze, silver, gold, and platinum — based on actuarial value, with premium tax credits available to lower-income enrollees. It expanded Medicaid eligibility in participating states and set employer shared-responsibility rules for large employers, while medical loss ratio rules require insurers to spend a minimum share of premiums on claims and quality improvement.

State life and health insurance licensing exams test the ACA's core provisions — guaranteed issue, pre-existing condition protections, age-26 dependent coverage, essential health benefits, and metal tiers — as does the CCMA exam, where medical assistants need a working knowledge of health insurance basics for billing and patient intake.