Obamacare is the slang term for the Patient Protection and Affordable Care Act of 2010. It makes health care more affordable for everyone by lowering costs for those who can’t afford them.
Obamacare was promulgated to provide medical insurance coverage to many uninsured Americans. It included those previously not eligible for coverage, especially persons with preexisting conditions.
The ACA’s primary goal was to mitigate the rising cost of health care. It allowed people to afford reasonable preventive care rather than wait for expensive emergency services to befall them. It also sought to help low-income earners by expanding Medicaid eligibility.
Who is eligible for a Marketplace (Obamacare) Plan?
– Individuals or families who are not eligible for employer health insurance and whose household income is between 100% and 400% of the Federal Poverty Level.
– Individuals who are offered a health insurance plan from their employer that is not considered a Qualified Health Plan.
– If your income is within a certain range, you will probably qualify for a subsidy. Please contact us to know the active tables that apply to your case.
– You will not be eligible for a subsidy if your income is below certain levels unless you are pregnant or are disabled. Even if you do not qualify for Medicaid your children may qualify for Medicaid or CHIP.
Open enrollment for purchasing ACA (Affordable Care Act) compliant health insurance is from November 1st through December 15th, with an effective date of January 1st the following year. Unless you have a qualifying event, you will not be allowed to apply for a ACA compliant policy if you miss this deadline.
Policies with an effective date of January 1, 2014 or later:
– Individuals cannot be declined for health insurance or charged more due to their health status or gender.
– Insurance premiums are based on age, your zip code and tobacco usage.
– Coverage limitations or exclusions based on pre-existing conditions are not allowed.
– Annual and lifetime coverage limits have been eliminated.
– Declining an individual for coverage based on their participation in an approved clinical trial is not allowed.
– Maternity and mental health are included on all policies.
– Preventative dental and vision are covered for members up to age 19 on most policies.
– Whether or not children are students they can stay on their parents’ policy until age 26.
– The Medical Loss Ratio (MLR) ensures that 80% of the premium dollars paid to the health insurance companies are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders.
Benefits, rights, and protections:
– Letting young adults stay on their parents’ plan until 26
– Stopping insurance companies from denying you coverage or charging you more based on health status
– Stopping insurance companies from dropping you when you are sick or if you make an honest mistake on your application
– Preventing gender discrimination
– Stopping insurance companies from imposing unjustified rate hikes and helping to keep rates down with the 80/20 rule and rate review provision
– Doing away with life-time and annual dollar limits
– Giving you the right to a rapid appeal of insurance company decisions
– Creating new Health Insurance Marketplaces to allow shoppers to compare health plans
– Expanding coverage to tens of millions by subsidizing health insurance costs through the Health Insurance Marketplaces
– Expanding Medicaid to millions in states that chose to expand the program
– Providing tax breaks to small businesses for offering health insurance to their employees
– Requiring large businesses to insure full-time employees
– Requiring all insurers to cover people with pre-existing conditions
– Making CHIP easier for kids to get
– Improving Medicare for seniors
– Expanding women’s health services, including many new free preventive treatments and screenings
– Ensuring all plans cover minimum benefits like limits on cost sharing and ten essential benefits including free preventive care, OB-GYN services with no referrals, free birth control, and coverage for emergency room visits out-of-network
– Simplifying the process of understanding benefits by requiring insurers to provide an easy-to-understand summary of a health plan’s benefits and coverage
– Reforming the healthcare industry and cutting wasteful spending
– New rules and regulations ensure that all major medical plans provide a minimum actuarial value and have a maximum out-of-pocket costs
– Plus many more benefits, rights, and protections.
Frequently Asked Questions
What is the deadline to enroll in health insurance coverage in the individual market?
In most states, open enrollment for 2023 health plans is scheduled to run from November 1, 2022 through December 15, 2022.
If I don’t enroll in a health insurance plan by the end of open enrollment (December 15), what options will I have?
In most cases, your options will be very limited for the coming year if you don’t enroll in coverage by December 15. Open enrollment won’t come around again until the following November, with coverage effective the following January.
If someone decides not to buy health insurance and is injured in accident, what happens?
When a patient arrives at the emergency room and is unable to pay for his care, staff there are required by law only to perform a medical screening exam, and if emergency medical conditions are present, the staff must “provide stabilizing treatment.”
This requirement is the result of the Emergency Medical Treatment and Labor ACT (EMTALA) of 1986. Patients cannot be turned away from the emergency room (assuming the hospital is a participating provider with Medicare, which virtually all hospitals are) because of an inability to pay for care. Instead, the ER must correct the emergency situation and end any life-threatening conditions.
If I don’t make changes to my plan and just let it auto-renew for January, am I stuck with it for the rest of the year?
Yes, unless you experience a qualifying event later in the year.
If your health plan terminates at the end of 2022 and you’re mapped to a new plan for 2023, you may have a special enrollment period that continues for 60 days after your plan ends (so, until March 1, 2023), during which you can pick from among any of the available options in your area.
But this is limited to situations in which the insurer exited the exchange or the full individual market in your area, or made a major change to plan designs, such as switching everyone from PPOs to HMOs.
I’ve heard that the government can’t really enforce the penalty for not having health insurance. Is this true?
As of 2019, there is no longer a federal penalty for being uninsured. There was a penalty for the individual shared responsibility provision (individual mandate) that applied from 2014 through 2018. Enforcement of the penalty was not the same as it was for other taxes, but it was still enforced and millions of people paid it each year.