Healthcare Reform 101

Learn the basics of the Affordable Care Act and how it affects you.

 

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Healthcare Reform 101

Whether you know it as Obamacare or the Affordable Care Act (ACA)—these names refer to the same thing. And contrary to what many people believe, the ACA does not mean free health care or government-provided health insurance. The ACA is a law that impacts everyone who utilizes healthcare today. 

No one can be denied basic coverage.

Before the ACA, health insurance carriers could easily refuse coverage if they felt you were "at risk". Either too old, too sick, overweight; or you suffer from what’s called a "pre-existing condition." Not anymore. Carriers can no longer refuse to cover the sick or increase rates based on medical history.

You are legally required to have it.

Another big change brought on by the ACA is what's called the Individual Mandate. This means that practically everyone is now legally required to have health insurance unless you're one of the few who qualify for an exemption. Just like we need car insurance to be on the road, we now need to insure our health or pay a penalty to the Internal Revenue Service (IRS). 

And there’s a timeline for getting it.

In order to get insured, we all need to purchase health insurance during the Open Enrollment Period. This year's open enrollment period runs from November 1, 2016 – January 31, 2017.

Once open enrollment ends, we won't be able to sign up for coverage for the rest of the year unless we experience a life changing event that effects our health care needs. The government refers to these as qualifying life events and include having a baby, getting married or a death in the family.

You may be eligible for government assistance.

To help make health insurance more affordable, the government now offers a way to get lower health care costs for those who qualify.

Depending on what you qualify for, you could receive special discounts on your monthly health insurance premium or the amount you pay when you visit your doctor's office.

Insurance must cover basic health care needs.

The government has determined 10 basic categories that all insurance plans must now cover. They call these, the essential health benefits, and include things like doctor visits, hospitalizations and pediatric care. When we have health insurance, we're now guaranteed care to treat and prevent illness or injury.

Essential benefits covered by every plan.

Obamacare requires every health plan sold in the insurance marketplaces to provide coverage for ten essential health benefits.

So, no matter what plan we choose, it's guaranteed to cover:

  • Outpatient Care
  • Emergency Room Services
  • Hospitalization
  • Maternity & Newborn Care
  • Mental Health Services & Addiction Treatment
  • Prescription Medication
  • Laboratory Services
  • Preventive Care
  • Pediatric Care

It's important to note that not this does not mean all of these services will now be completely free. Health insurance carriers aren't required to take on the entire cost for these benefits. Rather, the carrier will pay a percentage of these costs. The percentage that is covered can vary from plan to plan.