I've been seeing a lot of posts on my social network about the ACA (Accountable Care Act) also known as ObamaCare and it seems to me that nearly all of us are to some degree confused what it means. So I figured why not post some of the major highlights so that you understand them better. Much of what you will read in this post was copied and pasted from Healthcare.gov. So here goes:What is a Marketplace?
The Marketplace is a new way to find health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.
Insurance plans in the Marketplace are offered by private companies. They cover the same core set of benefits called essential health benefits. No plan can turn you away or charge you more because you have an illness or medical condition. They must cover treatments for these conditions. Plans can't charge women more than men for the same plan. Many preventive services are covered at no cost to you.
No matter what state you live in, you can use the Marketplace. Some states operate their own Marketplace. In some states, the Marketplace is run by the Federal government. Find a marketplace for yourself.
What are "essential health benefits"?
Essential health benefits must include items and services within at least the following 10 categories:
- ambulatory patient services
- emergency services
- hospitalization
- maternity and newborn care
- mental health and substance use disorder services, including behavioral health treatment
- prescription drugs
- rehabilitative and habilitative services and devices
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric services, including oral and vision care.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.
How should I choose a plan?
Plans in the new market place are put into 4 basic categories:- Bronze
- Silver
- Gold
- Platinum
IMPORTANT: The categories do not reflect the quality or amount of care the plans provide.
The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications.
You just gotta ask yourself: Do you expect a lot of doctor visits or need regular prescriptions?
- If you do, you may want a Gold or Platinum plan.
- If you don't, you may prefer a Bronze or Silver plan. But keep in mind that if you get in a serious accident or have an unexpected health problem, Bronze and Silver plans will require you to pay more of the costs.
What are the different plans?
Basically there are two categories:
- Private: Depending on your household income you may qualify for reduced premiums. All plans cover essential health benefits, pre-existing conditions, and preventive care. If you don’t qualify for lower costs, you can still use the Marketplace to buy insurance at the standard price.
- Medicaid and CHIP (Children Health Insurance Program): Both of these are for those with VERY limited income.
When can I sign up and when does coverage begin?
Marketplace open enrollment begins October 1, 2013 and ends March 31, 2014. If you enroll by December 15, 2013, coverage can begin as soon as January 1, 2014.
Do I have to offer health coverage to my employees?
Short answer: If you have less than 50 FTE employees, No. Otherwise, maybe. Long answer.What if I'm self-employed (and have no employees)?
You're not considered an employer. You can use the individual Marketplace to find coverage that fits your needs.
What is AIM and do I qualify?
AIM: Access for Infants and Mothers provides low cost health insurance coverage to uninsured, middle income pregnant women. The total cost is 1.5% of the subscriber's adjusted annual household income. This is much less than the cost under Covered California. If you are pregnant, with income between $3,256 - $4,884 per month for a family of 3, you may qualify for AIM. You’ll find a complete income chart by family size for AIM here: http://www.aim.ca.gov/costs/income_guidelines.aspx . Medi-Cal provides coverage if your income is below these limits.What if I don't want insurance?
Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee.
Will there be enough doctors and will they accept these plans?
Maybe, maybe not. But that's the beauty of a free market (all private plans). It will self-adjust until it works. Nothing is sustainable without all parties benefiting to some degree and it may take a few years but it will adjust appropriately. In the mean time, your doctor may not accept your new plan but some doctor somewhere will. If you don't like it, opt for a more expensive option or pay cash for your care.
To Conclude ...
If you already have health insurance then ACA shouldn't effect you unless you want to shop again starting today.
If you don't have health insurance now you have to have it and you can get some very basic insurance very cheap. It won't be great, but nothing cheap ever is.
If you have very low income, you now have an option you didn't have before.
Ready to apply? Get started.
Questions? Call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325)
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