Different levels of health insurance coverage under the Affordable Care Act

For the first time healthcare has been overhauled, President Obama has passed a new law that will provide insurance to people who never had it. This health insurance is called the Affordable Care Act (ACA). What is the Affordable Care Act the so called Obamacare?

According to HHS.gov/HealthCare the ACA puts consumers back in charge of their health care. “Under the law, a new “Patient’s Bill of Rights” gives Americans the stability and flexibility they need to make informed choices about their health.” 

50 million people who don’t have insurance through their employers, Medicare, Medicaid, or the private market can buy it through the Affordable Care Act exchanges. Blue Cross, Blue Shield, Aetna, Coventry One, United Health One, Cigna, Humana One and Kaiser will sell insurance to those that don’t have it. 

The ACA exchanges also called the Health Insurance Marketplace offers four primary levels of healthcare: Bronze, Silver, Gold and Platinum. These four plans are based on an average percentage of health care expenses that will be paid by your plan. “The percentages the plans will spend, on average, are 60 percent (Bronze), 70 percent (Silver), 80 percent (Gold), and 90 percent (Platinum).” Your portion of the cost will be in the form of deductible, co-payments and coinsurance payments.

“Catastrophic plans are also available, but they do not meet the minimum requirements of the Affordable Care Act and are available only to those granted hardship exemptions and to those under age 30.”

There is an individual mandate. Those who don’t enroll in a health insurance plan will have to pay a financial penalty. What if you don’t make enough money to afford premiums, deductibles or co-pays? You must buy health insurance through the health insurance exchanges, or marketplaces in order to get tax credits or subsidies. To get the tax credit you won’t have to wait until you file taxes. The tax credit will go straight to the insurance company to lower your premiums by the amount of the tax credit. 

On the other hand, cost-sharing subsidies will reduce the amount of your out-of-pocket expenses that must be paid for medical care. “Out-of-pocket costs include co-pays, deductibles, co-insurance and other fees. People with incomes between 100 percent and 250 percent of the federal poverty level qualify.”. 

The Supreme Court made Medicaid expansion optional, which serves poor people making less than 133 percent of the federal poverty line. There are no private insurance subsidies for poor people. This is problematic for the law because poor people in states that haven’t accepted the Medicaid expansion are out of luck. 

The new Patient’s Bill of Rights law, regardless of Bronze, Silver, Gold and Platinum, must include essential health benefits that must be covered. Your co-payments and coinsurance count toward your deductible.

“The Affordable Care Act (ACA) requires that all plans cover a range of care categories. These are essential health benefits. However, the law does not define specific services, amounts, or duration of care. So it is important to read through the details of each plan. The 10 categories of essential health benefits are:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitation or habilitation services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including vision and oral care

The Affordable Care Act offers new consumer protection from insurance companies that deny coverage of children based on pre-existing conditions and re-sending coverage to people for whatever reason.

The new law promises to improve quality and lower cost to Medicare prescription drug coverage by gradually closing a gap called the “Donut Hole”.  “This means there’s a temporary limit on what the drug plan will cover for drugs.”

The law has a provision that will tie physician to the quality of care they provide. Physicians providing higher quality care will be paid more than physicians providing lower-quality service. Some doctors have more patients than they can care for. Therefore, patients just get sicker and sicker. This provision could remedy that. 

The ACA has a provision for employee’s children under 27 years of age to stay on their parent’s insurance. This health care tax benefit is generally tax free to the employee. “These changes give employers a unique opportunity to offer a worthwhile benefit to their employees,” IRS Commissioner Doug Shulman said. “We want to make it as easy as possible for employers to quickly implement this change and extend health coverage on a tax-favored basis to older children of their employees.” The ACA also provide protection for employees reporting employer violations of the Act’s health insurance reforms.

Families making about $29,000 for a family of four will be covered by Medicaid. A family of four making $88,000 will get tax credit on the sliding scale to help pay for private insurance. Small business with fewer than 10 employees, average wages beneath $25,000 and that provide insurance for their workers will get a 50 percent tax credit on their contribution. The tax credit reaches applies to small businesses with up to 50 employees and average wages of $50,000, though it gets smaller as the business get bigger and richer.  

The president will sit down for his first-ever interview with Web MD to discuss the importance of signing up for health insurance under the ACA. “During a conversation with the site’s health care reform expert Lisa Zamosky, the President will answer questions about health care and the ACA directly from Web MD users in an interview that will air on March 14 2014” 

In conclusion, The Affordable Care Act is a new law or “Bill of Rights” that mandates healthcare for all Americans. There are five categories to choose from. Bronze, silver, gold, platinum, and catastrophic. Here is an opportunity to get health insurance for you and your family at an affordable price.