Important Questions Related to the Affordable Care Act

Americans who don’t have access to an employer-sponsored plan or government-designed plan like Medicare need to shop for health insurance plans themselves. While shopping for ACA-compliant health insurance plans, people should be aware of a few vital things related to the Affordable Care Act, so they can confidently shop for a plan as per their requirements. To help people understand different aspects of the Obamacare plan, below some important questions are answered that will provide people clarity on the ACA plan.

What is the Affordable Care Act (ACA)?

The Affordable Care Act or Obamacare is a healthcare reform that was signed into law by President Barack Obama in March 2010. Earlier is was also known as the Patient Protection Act, and it includes a list of a health-related act designed to extend health insurance coverage to uninsured Americans. The Act not only provides coverage to uninsured, but created health insurance exchanges, expanded Medicaid eligibility, and prevented insurance companies from denying coverage due to pre-existing conditions. It is only due to this act that children below the age of 26 years can remain included in their parents’ health insurance plans.

What are the essential health benefits covered under the ACA-compliant health plans?

All ACA-compliant health plans along with plan sold on the Health Insurance Marketplace should cover the following essential health benefits:

 

  • Emergency services
  • Laboratory services
  • Prescription medications
  • Pediatric services
  • Hospitalization
  • Preventive and wellness services and chronic disease management
  • Mental health and substance use disorder services
  • Ambulatory patient services
  • Rehabilitative and habilitative services
  • Breastfeeding
  • Family planning
  • Pregnancy, maternity, and newborn care

 

Besides essential services, the Affordable Care Act requires most health plans including those sold on the Marketplace, to cover a list of preventive services at no cost to policyholders. These preventive services include patient counseling, immunizations, regular checkups, and numerous health screenings.

 

Who should apply for the Affordable Care Act?

 

The Affordable Care Act health insurance marketplace was created to help people find cost-effective health plans, who do not have health care coverage through their employers, or a government program like Medicare or Medicaid. Therefore, all uninsured Americans can purchase health insurance plans through ACA-marketplace.

 

When to apply for the ACA-Plans?

 

The ACA-marketplace open enrollment period starts from Nov. 1 and ends on December 15 in most of the states. However, in 2019 the end date of the open enrollment period was extended until December 18. Six states along with the District of Columbia also extended the open enrollment deadline as mentioned below:

 

California — Jan. 31

Colorado — Jan. 15

Massachusetts — Jan. 23

Minnesota — Dec. 23

New York — Jan. 31

Rhode Island — Dec. 31

District of Columbia — Jan. 31

 

Where to apply for ACA-plans?

 

HealthCare.gov is the best place to shop for ACA-compliant health plans, and this is the site where the majority of Americans shop for the individual health plan. However, 11 states and the District of Columbia have their marketplace. States having their marketplaces are Colorado, California, Connecticut, Idaho, Maryland, Minnesota, Massachusetts, New York, Rhode Island, Vermont, and Washington. To access their marketplace, people need to visit healthcare.gov. On visiting this site, they need to click on “Get Coverage” and select their state. People after clicking will be either directed to their state marketplace, or they will need to click on “continue” to access the federal site.

 

People also have the option to call the marketplace call center at 800-318-2596 to apply over the phone that accepts calls throughout the day in all the days. People also have the option to apply in person with the help of navigators. Navigators are the people trained by nonprofit and community organizations, to help people while applying for the coverage. People can find a navigator by visiting the site localhelp.healthcare.gov and provide their zip code to find a list of nearby navigators.

What is the cost of the ACA-plans?

The cost of the ACA-plans depends on five factors such as an individual’s age, location, income, family size, and the type of plan chosen. The average monthly plan of a benchmark plan, which is the second-lowest silver plan, in 2020 is $388 for a 27-year-old enrollee and $1,520 for a family of four. It is observed that older adults are required to pay higher premiums for ACA health plans compared to younger adults.

 

Is it true that the premium of ACA plans will be lower than the last year?

 

According to the Centers for Medicare and Medicaid Services, monthly premiums for the popular silver plan on the ACA health insurance marketplace will drop on average by 4% for 2020. However, the premium prices will vary across the county. In some of the states, premium charges of ACA plans are expected to decrease, whereas in some of the states the premium charges are expected to increase. Therefore, it depends upon the county and states where one is living. The premium amount will vary widely depending upon the state and the plan.

What are ACA Subsidies and what are the criteria to qualify for the subsidies?

 

The ACA or Obamacare subsidies are government subsidies designed to help low or middle-income individuals and families pay for their health insurance coverage. To qualify for the ACA subsidies, individuals should meet the following criteria:

 

  • Currently living in the United States
  • Must be a U.S. citizen or legal resident
  • Should not be currently incarcerated
  • Income should not be more than 400% of the federal poverty level.

How people can prove their eligibility for the subsidy?

To prove their eligibility for the subsidy people will need to provide following detailed information on their applications:

 

  • Date-of-birth along with home addresses of all individuals applying for the coverage under the plan.
  • Name of employer, Social Security numbers, along with the income status of every member of the family, irrespective if they all are applying for coverage or not.
  • Expected family income for 2020
  • Plan ID along with policy number of their current plan
  • Letter or document received from insurer regarding renewal of the plan

 

What are the different types of ACA plans?

Mainly there are four-type of ACA-plans available in the health insurance marketplace such as:

  • Preferred Provider Organization, or PPO Plans
  • Point-of-Service or POS Plans
  • Health Maintenance Organization or HMO Plans
  • Exclusive Provider Organization or EPO Plans

 

However, while choosing a type of ACA health plan, individuals should keep certain factors in mind like their budget, area where they live, and the kind of healthcare required.

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