ACA Protects Low-Income Individuals from Excessive Medical Debt

Many people are unaware that the Affordable Care Act (ACA) includes provisions to protect low-income individuals from being burdened with excessive medical debt. One such provision limits the amount that creditors can collect from these individuals for medical bills.

Understanding the Provision

According to the ACA, creditors cannot pursue low-income individuals for more than the average amount that insurers or Medicare would pay for similar medical services. This provision applies to emergency room visits and other medically necessary care provided by out-of-network healthcare providers.

How it Works

When a low-income individual receives medical care from an out-of-network provider, the provider may balance bill the individual for the difference between their charges and the amount that insurers or Medicare would pay. However, under the ACA, creditors cannot collect this balance from the individual if their income falls below a certain threshold.

Income Threshold

The income threshold for this protection varies depending on the state in which the individual resides. In general, it is set at or below 200% of the federal poverty level (FPL). For example, in 2023, the FPL for a single individual is $13,590. Therefore, the income threshold would be $27,180 (200% of $13,590).

Consequences of Violating the Provision

Healthcare providers and creditors who violate this provision may face penalties, including fines and other enforcement actions. Individuals who believe their rights under this provision have been violated can file a complaint with the appropriate federal agency.

Conclusion

The ACA’s provision limiting the amount of medical debt that creditors can collect from low-income individuals is a significant protection against financial hardship. It ensures that these individuals can access necessary medical care without the fear of being burdened by overwhelming debt. If you meet the income threshold and receive a medical bill that you believe violates this provision, it is important to seek help from a licensed insurance agent or legal professional.