What is covered under obamacare?
Obamacare plans have essential health benefits and offers hundreds of plans that cover health care needs in various ways. Comparison shopping on the exchanges is a vital part of getting the right plan. Start comparing health insurance plans now by using our FREE tool above! It goes deeper than premiums and coverage percentages, it looks at the features that have greater importance to the applicant.
Metal Plan Types
Obamacare plans cover a wide variety of medical services from routine checkups to hospitalization and surgical procedures. Called the metal plans, the four types of health insurance plans use metal labels Platinum, Gold, Silver, and Bronze to describe the extent that insurance pays costs rather than the consumer.
- Platinum: 90-10 ratio of insurance to consumer paid costs.
- Gold: 80-20 ratio of insurance paid to consumer aid costs.
- Silver: balances the insurance versus consumer payment at 70-30.
- Bronze: plans pay sixty percent or more and leave about forty percent, a 60-40 division.
Prior Medical Conditions
Among the most important changes that the Affordable Care Act made to the health insurance industry were reform price and insurability. For decades, consumers were denied coverage because they were sick. They were denied coverage for prior conditions that included pregnancy in women of child-bearing age.
Insurers charged more for women because they might get pregnant and refused to cover some women because they had delivered children.
Some of the most memorable cases were children with life-threatening illnesses who were denied coverage at every opportunity for costs savings.
No Price discrimination
Obamacare permits the use of five factors to raise individual prices for coverage. Insurers can set higher prices for individuals based on tobacco usage, age, family status, plan type, and geographic location. Obamacare prohibits all other forms of price discrimination.
Mental health detection and treatment is included in Obamacare required coverage. All quality health plans must include these protections and services. The ACA treats mental health conditions as other diseases. It is one of the ten essential health benefits and as such it can have no annual limits or lifetime dollar limits.
Addiction Treatment Services
Substance abuse, alcohol and drug addictions are diseases within the meaning of the Obamacare mental health protections. Providers must offer addiction detection and treatment services as they would with other covered conditions. One issue raised by observers is that addiction treatment has a need for customization and individual approaches that may be difficult to manage in a managed care environment.
Maternity care is one of the ten essential health benefits of the Affordable Care Act. It must be included in every Obamacare policy with no annual limits or lifetime dollar limits. It was a remarkable transition from pre-Obamacare when pregnancy was a ground for denial and childbirth considered a prior medical condition.
Annual Sign-up Period
Obamacare offers an annual Open Enrollment in which everyone has a right to shop, select, and purchase a quality health plan. The plans offered on the Obamacare exchanges meet the requirement of the individual mandate. Running from November 1, 2015, to January 31, 2016, Open Enrollment is the last opportunity for consumers to get coverage for the calendar year 2016.
Remedies for Missed Enrollment
Once the OPEN Enrollment closes, there is no longer a right to sign up. Consumers would need to find a government extension- such as when systems failed to allow people to complete timely enrollments, or find an exception. The law provide exceptions to Open Enrollment for Life Events. These are changes in status that require a new opportunity to sign up. Life Events include the below-described status changes.
- Birth of a child
- Adoption of a child
- Losing health care as a dependent
- Losing health care coverage by loss of a job
- Moving to a different state.
Treating preventable diseases by early detection and health management is a path to tremendous reductions in medical costs and improving the levels of health in the US populations. It applies to those covered by health plans and Medicaid. The background of the enactment of Obamacare includes careful analysis of the impact of preventive care. Minor changes such as regular check-ups hold the potential to reduce costly and debilitating disease like diabetes, lung cancer, and tobacco-related diseases like emphysema.
The Health-focused Future
In the Information Age, medical research has taken giant steps due to the potential of information aided research. The amazing new frontiers include gene-based medical care. Innovations will come on stream and help predict disease, detect disease, and with gene-based medical care, sometimes cure diseases that are not now curable. Obamacare bases its long-term focus on medical innovations and preventive medicine. The true course for reducing the national costs of medical care lies in keeping an growing and aging population healthier. The costs of maintaining health are far less than the costs of treatment and cures.
Young Adults Coverage
Obamacare changed health insurance to require insurers to allow young adults to stay on a parents health policy until age 26. This added coverage has helped young people in two important ways.
- It provides coverage that includes maternity benefits and recognizes the importance of families working together and sharing resources.
- It sets young people on a course to receive regular medical care.
It is a time in many lives when the potential life-shortening and severe conditions that affect later years can be discovered, treated, or cured. The preventable illnesses include diabetes, obesity, and mental health issues.
Obamacare raises the income limit for Medicaid coverage. This change required state action to accept federal funds and implement the change to protect to most vulnerable, low-income earners in the states. Unfortunately for those in severe need, many Governors rejected Medicaid expansion and left their citizens without protection intended for them and available elsewhere. With health insurance coverage from qualified health plans, Medicaid, and Children’s Health Insurance Programs, first responder organizations, clinics, and hospitals no longer have to carry the entire burden if unpaid and uncollected debts.
Strengthening Local Health Care
A major contribution of Obamacare is its impact on local medical care institutions. Hospitals and emergency services providers have carried burdens from unpaid bills.
They provide emergency care, often critical and life-threatening circumstances such as trauma from crime and violence, overdosed drug addicts, and chronic mental illness.
Many hospitals have closed or curtailed needed services because of the pattern of patients unable to pay for the costly care and emergency services they require. Expanding Medicaid and CHIPs, Obamacare has provided a source of payment for services rendered to low-income residents.
The Centers for Medicaid and Medicare Services provides seed grants and financial assistance to local organizations that create consumer owned and operated providers. These organizations can provide:
- low prices
- plow back profits to inform future decisions on expanding services and lowering prices
These organizations are not easy to create nor operate in a competitive market. It is difficult to develop a client base on healthcare where familiarity, trust, and experience matter a great deal or consumer choices. Many CO-OPs have failed or performed poorly. The concept is important, organizations dedicated to consumer-oriented policies and practices can help drive down the prices of health services by providing competition and offering lower prices.
The Employer Mandate
Employers with fifty or more full-time employees must offer health insurance to 95 percent of their employees. The Employer Mandate has a penalty provision for those who fail or refuse to provide coverage. The Employer Shared Responsibility Provision can cause fines in the range of $2,000 to $3,000 per employee for each full year of non-coverage.
Small Business Options
The SHOP program provides tax credits to small businesses that offer health insurance coverage to employees. The rules aim to give these valuable credits to small concerns. The maximum amount of credit goes to employers with ten or fewer employees. The maximum number of employees eligible for this credit is 25 employees averaging less than $50,000 per year in salary.
Obamacare brings the power of group buying to the benefit of every consumer. It has long been true that large companies paid less for health insurance than small companies. They used buying power to drive down prices and shape plans to their liking. Obamacare does something similar with the millions of subscribers that enroll. While not a single payer system, it behaves as a group; there is more bargaining power and better bargains in the Obamacare marketplace as a result.
Obamacare’s Sweeping Changes
Obamacare has changed the face of health insurance to be far more consumer friendly and beneficial. It has set the nation on a course to emphasize prevention, better health, and far lower costs. To take advantage of the many features and benefits of Obamacare, consumers must use comparison shopping techniques.
Finding the Best Obamacare Value
Comparison shopping is the best way to find the value in health plans and get the plans that best fit the individual or family health care needs and preferences. Obamacare groups policies by the actuarial value; this balance between insurance paid and consumer aid costs is important. The actuarial value may not be the most important factor for a family or individual. They should look at all options including those outside of Obamacare. They should weight the assessment in favor of services, facilities, locations, or other factors important to them. They should use comparison shopping to find the best Obamacare plan for their needs. Start comparing health insurance options now by entering your zip code in our FREE tool below!