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- Obamacare plans cover the essential health benefits
- Obamacare promotes wellness and early detection of preventable illness
- Obamacare offers four types of plans weighted by Actuarial Value
- Obamacare coverage includes low, and no cost care from Medicaid and CHIPs
- Medicare, Medicaid, and CHIPs satisfy the Individual Mandate
Obamacare coverage centers on the ten essential health benefits. It reforms the industry to stop denials of coverage based on factors that include age, gender, and pre-existing conditions. Comparison shopping is the best way to determine what services are covered by Obamacare Plans. Comparison shopping focuses on the parts of the plans of greater importance to the individual or family subscriber. Start comparing health insurance rates now by using our FREE tool above!
The Individual Mandate
The key to promoting universal coverage among US citizens, nationals, and permanent residents is the Individual Mandate. The mandate requires insurance coverage, and Obamacare provides individual plans, family plans, small employer plans, and sets standards for all other private and employer-based health insurance coverage. Employers with 50 or more employees must offer insurance.
Minimum Essential Coverage
The coverage needed to avoid the penalty is minimum essential coverage. The minimum consists of the essential health benefits and a qualified plan must offer at least ten of the benefits. The core of the essential coverage is to provide basic medical care for everyone at no extra costs. These include the critical phases of the initial examination, tests, and health screenings. The needed follow-up with lab services and diagnostics procedures is also included.
The goal is early detection of preventable diseases.
The model might be a condition like diabetes. If detected and managed early, patients might only need to use diet and lifestyle changes to control the effects and eventually reverse any symptoms. Allowed to proceed to a full-blown condition, the disease can cause catastrophic damage and premature death. In addition to the awful costs in human suffering, the accumulated costs to the nation are enormous for things that could have been prevented.
Penalty for Non-Coverage
The penalty for going without coverage in the calendar year 2016 is $695 per adult and $347.50 per child. The formula taxes the greater of 2.5 percent of gross income or $2,085. The government assesses the fee as 1/12th of the amount for every month of non-coverage. There are numerous exemptions including hardship and a waiver for up to three months of non-coverage in a year in which there is some coverage. Exemptions include those below the annual tax filing threshold; those receiving exempt income such as supplemental security income do not have to meet the mandate. The federal government does not count such income for filing purposes.
The Obamacare Marketplace
The Obamacare marketplace consists of the federal portal, healthcare.gov and the state-sponsored insurance exchanges such as KYnect the highly successful state exchange in the state of Kentucky. Consumers can get subsidies, payment assistance, and other financial benefits only through the federal or state exchanges. The coverages include small business incentives for companies with 25 or fewer employees to receive tax credits. The SHOP program aids business with up to fifty employees.
Tobacco usage is the unique pre-existing factor that permissibly affects the rates and terms of coverage. The nation’s overall health is diminished by the extent of tobacco usage. Overall it causes significant health deterioration among its users. The consequences of tobacco use range from mild to catastrophic, and the evidence supports the loss of $billions each year in productivity and medical costs due to tobacco-related illnesses.
Smoking cessation is a feature of Obamacare, and it rewards those tobacco users that adopt cessation programs with lower future costs.
By reducing tobacco usage, Obamacare coverage reduces long-term health costs for the nation. To the extent that users cease tobacco use and smoking, the nation’s overall levels of health will rise as will the record of preventable death and illness.
HMO or PPO for the Most Coverage
The health care providers have business forms that help make efficient use of their medical resources. Two common types of health services organizations are the PPO and the HMO. PPO or Preferred Provider Organization has a loose network of a variety of service providers; one does not need referrals from a primary care doctor. The trade-off is usually higher out of pocket costs and in some instances the consumer must pay for all of a service’s charges. The HMO uses a gateway professional to guide the patient and help bring the needed resources to the situation; the primary care physician is the critical person in the HMO type of plan. HMO offers favorable cost sharing in exchange for a narrower network of resources and the guidance of the primary care physician. There are numerous other forms of provider organization; some are hybrids having the style of an HMO but with no primary care physician, for example.
The CO-OP program holds great promise as a way to increase services and decrease costs to the consumer. It involves the difficult task of organizing a medical care network and appealing to subscribers to take on a new service provider.
The ACA authorized funding to start CO-OPs, and more than half have not survived the initial phases.
However, those that do survive will provide important lessons and models for future development. Competition is an ideal way to control and lower costs; initiating a new service in a competitive field is difficult because of competition with known brands.
The expansion of Medicaid was an important policy from Congress to help low-income persons have access to quality medical care at costs affordable to them. It was a watershed moment in national policy to close the gap that prevented many low-income earners from getting the medical care they needed to maintain healthy, productive lives. It is still a source of dissatisfaction to millions that local governments have not moved to accept the extension of Medicaid coverage to vulnerable parts of state populations.
Many states rejected federal aid to expand Medicaid for low-income adults. However, moist states permit broad healthcare aid to children. States have separate rules for eligibility but need is always the focus. CHIPs had no waiting for children to enter the program. While adults waited for the Obamacare roll out, CHIPs was available immediately for children to start receiving medical care. CHIPs have no open enrollment requirement; Children can get into the program at any time.
Four Types of Plans
Obamacare offers four types of plans and the program ranks them by actuarial value. Actuarial value is the percentage of essential benefits paid by insurance rather than the consumer. The below-listed items describe the four types of plans.
- Platinum plans have an actuarial value of ninety percent of essential benefits covered by insurance; these plans have high premiums and low deductibles and costs.
- Gold plans have an actuarial value of eighty percent of essential benefits these plans have high premiums and lower deductibles and costs than Silver and Bronze plans.
- Silver plans have an actuarial value of seventy percent of essential benefits these plans have medium-high premiums and moderate deductibles and costs.
- Bronze plans have an actuarial value of sixty percent of essential benefits; these plans have subsidies, low premiums, and high deductibles and out of pocket costs.
Obamacare’s Comprehensive Coverage Framework
From many vantage points, Obamacare coverage is comprehensive and far- reaching. The reforms re-set the health insurance baseline, and universal acceptance was a primary breakthrough; it affected millions who had been or would continue to be denied coverage. Obamacare was flexible to permit many commercial approaches to managing and delivering healthcare services.
Its focus was on the core of essential benefits that promote wellness and detection of preventable diseases. It treats mental health issues as if physical health issues.
Comparison shopping is an ideal method for determining the advantages of offered health insurance plans. It focuses on the needs of the individual or family and provides a framework for analyzing coverage. Comparison shopping is the best way to find the right plan. Start comparing health insurance rates now by entering your zip code in our FREE tool below!