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- Obamacare reformed health insurance providing universal coverage and financial assistance
- Open Enrollment is the annual time to sign up for required Health Insurance Plans
- Obamacare Plans use a system of metal labels to help consumers compare plans
- Obamacare works through state and federal marketplaces or insurance exchanges
- Obamacare expanded CHIPs and Medicaid for low-income adults and children
- Federal and state regulators work to improve prices, competition, and plan coverage
The top ten things about Obamacare include the individual mandate for coverage, and that insurers can no longer refuse to cover applicants because of prior health conditions. Comparison shopping makes it easier to find the best health insurance plan. Comparison shopping focuses on value for the individual or family based on particular needs and preferences. Start comparing health insurance providers now by using our FREE tool above!
The ACA requires every person to get health insurance through a qualified health plan that provides essential health benefits. Those who fail to do so will pay a shared responsibility fee unless exempt. In 2016, the individual penalty is the greater of 2.5 percent of annual income or $695.00. For a minor, the individual penalty is $347.50. The family penalty is the greater of 2.5 percent of adjusted family annual income or $2.085.00. There are exemptions, and the Congress did not intend a punishment policy; rather, the law seeks to encourage universal participation in its programs for better health and disease prevention.
Chips and Medicaid Coverage
The Children’s Health Insurance Programs and Medicaid cover low-income children and adults with low-cost or free medical care. The Obamacare intake system automatically refers applicants that do not qualify because of low incomes to Medicaid and CHIPs offices for consideration. In states that accepted federal aid for Medicaid expansion, the numbers of covered low-income persons has climbed dramatically. Overall, increase insurance coverage of low-income persons is a major impact of Obamacare towards improving healthcare in the US.
CHIPs and Health Care Reform
The Children’s Health Insurance Program provides low-cost health care to children and teenagers. It has open enrollment year-round. The Affordable Care Act expanded CHIPs along with Medicare by raising the income limit. The rates of uninsured children have dropped over the years with CHIPs providing a key asset even in states that refused Medicaid expansion.
Running from November 1, 2015, through January 31, 2016, the Open Enrollment is the annual period in which everyone has a right to sign up for health insurance through Obamacare exchanges and private insurers.
The Open Enrollment is a vital period in the annual cycle of the Obamacare programs.
It is the all -important beginning when millions of people sign for insurance, and those who do not qualify because of low income can get Medicaid or CHIPs coverage. Open enrollment ends the time when everyone has a right to sign for health insurance coverage. It begins the time when statutory penalties apply to each month without coverage.
Health Insurance Plans
The Obamacare marketplace provides review and approval of qualified health plans and costs. The federal government and each state that operates a marketplace must review and approve insurance plans prior to offering them through the exchanges. The guidance offered to insurance providers can be active or passive. Some states actively engage insurers on the details of each plan, and others offer comment in connection with approving or rejecting a plan. Either method can produce the desired result of an intense effort to reduce costs and expand benefits for consumers.
Health Insurance Reform
The ACA was designed to change the health insurance industry and prevent some of its worst practices. These practices included denials for sickness, and past health conditions, increased costs for females and women with past pregnancies. When allowed to determine policies for profits and risks, industry practices caused many poor health care outcomes; some found it particularly disturbing that insurance providers routinely denied coverage to children with life-threatening illnesses. The ACA provides a core of essential health benefits along with important protections and consumer rights.
Price Discrimination under the ACA
Insurers can discriminate when pricing based on a limited set of factors including age, location, family status, and tobacco usage. They may not discriminate on the basis of gender and prior medical conditions. The essential health benefits must appear in any policy sold on the Obamacare exchanges and in any policy that satisfies the individual mandate for insurance coverage by a qualified health plan.
Mental Health and Treatment
Obamacare provides a right to mental health basic services and his includes detection and treatment for addictions and substance abuse. Mental health as a disease was a major theme and reform of the ACA.
It has set the tone for a critical re-evaluation of mental illness as a form of disease; it was intended to reduce the stigma of mental illness.
Obamacare is a source for families that experience the pain of addiction. Drug dependence is a major concern today as waves of opioid dependence sweep across the country. The current conditions magnify the importance of every source of treatment for addictions. Prescription medication abuse is another leading cause of addiction and increased demands for treatment services. Obamacare treats mental health services as an essential health benefit.
Obamacare plans must meet minimum values for coverage of plan costs when allocating expenses between the insurance provider and the consumer. Called actuarial value, the plans must meet certain percentages of insurance paid coverage to qualify for a given metal band classification. The below-itemized list describes the actuarial values of the four classes of Obamacare health plans.
- Platinum Plans provide 90 percent insurance to ten percent consumer paid costs.
- Gold Plans offer a balance of 80 percent insurer paid and 20 percent by the consumer.
- Silver Plans strike the payments balance at 70 percent insurance paid to 30 percent by the consumers.
- Bronze Plans provide insurance payment for about 60 percent of plan costs leaving 40 percent for consumer payment.
Tobacco cessation is an important feature of the Affordable Care Act because it permits insurers to charge more to consumers that choose to smoke or use particular tobacco products. Consumers who successfully complete smoking cessation and other treatment for tobacco use can get reductions in premiums. The goal of the tobacco-use exception to price discrimination is to encourage a healthier lifestyle. Research has definitely linked tobacco usage to severe, debilitating and sometimes fatal diseases.
The statute provides a tax penalty to enforce the individual mandate. It provides an incentive to get coverage and keep essential health benefits. The penalty increases each year until it amounts to the equivalent of getting the lowest priced Bronze Plan.
Exemptions from the Mandate
The ACA provides exemptions from the individual insurance mandate. Those who do not have coverage that includes essential health benefits are subject to a fine. The statute lays out a policy towards exemption. It empowers the federal government to issue individual exemptions when required by various kinds of hardship. The exemptions include the below-listed items.
- Those Not required to file tax returns are exempt, and
- Those for whom health insurance not affordable are exempt, as are
- Those who receive economic hardship exemptions
Special Enrollment Periods and Extensions
The federal and state governments may announce extensions for enrollment due to circumstances that interfere with enrollment. These have included overwhelming numbers of applicants during the closing days of enrollment, and malfunctions in websites and technical issues. One cannot plan for these circumstances, and the law provides exceptions based on a change of status after Open Enrollment, the so-called Life Events. These changes trigger an individual special enrollment period. Life Events include the below-described occurrences to create special enrollment periods.
- Divorce or Marriage
- Moving to a different state
- Giving birth or adopting a child
- Losing health insurance through a job
- Losing health insurance as a dependent
High Incomes Should Shop Outside
Those with income at or near the federal poverty line for families or individuals will get small financial benefits if any from purchasing plans on the Obamacare exchanges. They can enroll on the exchanges and buy a policy there. There are qualified health plans covering the locations in which they reside. Private insurers choose not to put these policies on the Obamacare exchanges. To get the full range of choices, higher income consumers must shop outside of Obamacare.
A Silver Lining
One way to analyze an Obamacare plan is to examine the financial incentives and advantages in the law and see how many fit a given plan. The Silver Plan may be best for those with qualifying incomes.
It combines the savings account, premium subsidy, and payment assistance features in a plan that covers 70 percent or more of plan costs.
This type of analysis points to the difference between rating benefits and comparison shopping. For a given consumer situation, these financial benefits may not be as important as the location, network resources, and co-pay of a frequently needed health service. When weighted by the particular needs, preferences and priorities, comparison shopping might yield a completely different recommendation based on circumstances.
Compare to get the Best Plan for You
The top ten things to know about Obamacare show the impact the reform laws have had on the insurance industry and the numbers of Americans with health coverage. The remarkable successes are not the end of the need for change; indeed, the law contemplates further actions in several areas including future aid for Medicaid expansion and incorporating technological innovations for preventive medicine. Comparison shopping lets consumers place priority in the plan features of greater importance. Customized comparisons are more meaningful when determining value than surface factors like prices and premiums. Comparison shopping is a valuable tool for consumers when shopping on or off the Obamacare marketplace. Start comparing health insurance plans now by entering your zip code in our FREE tool below!