The Affordable Care Act (ACA), which many refer to as Obamacare, received a lot of attention, some good and some bad. It eliminated pre-existing condition barriers to coverage, and provided subsidies for those who couldn’t afford coverage. It also penalizes those without coverage and employers who do not provide coverage. The ACA made a lot of changes that affect your health care coverage and costs, and it is important to be aware of these changes if you want to get the best insurance at the lowest price.
If you have coverage through an employer, there might not be a lot of change if the plan was grandfathered. For non-grandfathered plans and those purchased by individuals, here are some of the ways the ACA affects you:
Benefits That Affect Most Plans
- No more exclusions for people with pre-existing conditions or disabilities.
- Premiums can no longer vary based on health or gender (tobacco users can be charged more).
- No limits on total annual or lifetime benefits. If you are seriously ill, need expensive treatment or take expensive covered prescriptions, you cannot longer run out of insurance coverage.
- Clearer explanations of insurance coverage.
Each health plan must provide 10 essential health benefits:
- Preventive and wellness care, such as physicals; screenings for cancer, health disease and other chronic issues; and vaccinations.
- Lab tests, both preventive and inpatient
- Hospital stays
- Emergency services
- Outpatient services, such as doctor visits or tests done outside a hospital
- Maternity and baby care
- Mental health and substance abuse services
- Prescription Drugs including generic and brand-name drugs as specified by your plan formulary
- Rehabilitation services for people dealing with developmental issues or recovering from an accident or injury
- For children, dental and vision services
An estimated 50 million people did not have insurance in 2012. This lack of coverage has led to health consequences for those who do not receive preventive care or wait until an illness is very serious before getting care. The Affordable Care Act requires individuals to buy coverage and, if they meet the financial requirements, provides subsidies to help them afford it. The ACA also requires most employers to provide coverage for employees who work 30 hours a week on average in a month.
High Deductible Plans with Health Savings Accounts
Health Savings Accounts and high-deductible health insurance plans are a great option for people who are in generally good health or who prefer more flexibility in choosing doctors than the typical Health Maintenance Organization or Preferred Provider Network offers. When you’re covered under a high deductible health insurance plan with a Health Savings Account, you and your employer (if applicable) make tax-free contributions into your account. You use the money to pay for any doctors you see, prescriptions, dental care or other health care costs until what you have paid equals the amount of the deductible. Then, the health insurance kicks in. These plans, which put the insured/consumer in charge, were changed and improved by ACA.