The day the Patient Protection and Affordable Care Act breathed life, it was an instantly contentious issue. As the bill progressed from House to Senate chambers, politicians rallied to get health reform eliminated from the agenda, as it had been in years past. When the Affordable Care Act was signed into law, opponents pushed their objections all the way to the Supreme Court, but the law was ultimately upheld. The health law isn’t perfect, and there are certainly arguments on both sides that have merit. However, rather than engage in a policy discussion, we wanted to highlight some specific benefits that are part of Obamacare that consumers should be aware of when buying their own healthcare coverage.
The Affordable Care Act, also fondly known as Obamacare, will continue to be an extremely political issue. Detractors will continue to push for repealing the law for the unforeseeable future.
Without taking sides either way, this article explores 8 features of Obamacare health insurance for consumers:
1. Essential health benefits are required
All Obamacare health insurance plans are required to offer 10 essential benefits. This could be in reaction to limited medical benefit plans that were originally created as supplements to major medical health insurance, but over time were being sold as standalone health insurance plans. Limited medical benefit plans have high deductibles, high coinsurance and copays, payout limits and do not cover services like preventive care, in most cases. You know you have a qualified Obamacare health insurance plan if your health insurance benefits include:
- Outpatient care
- Trips to the emergency room
- Treatment in the hospital for inpatient care (an overnight stay)
- Pregnancy care before and after the baby is born
- Mental health and substance abuse services
- Prescription drugs
- Services and devices that help you recover from a debilitating injury or disability
- Lab tests
- Preventive services
- Pediatric services, which includes dental and vision care for children.
This comprehensive list of services are required by health insurance companies to place in their healthcare policies.
2. Preventive services are free.
A number of preventative services must be included in an Obamacare. Services include well-woman visits, mammograms, colonoscopies, vaccinations, HIV and cholesterol screening. Theoretically, by encouraging the general population to seek out preventative services, health insurance companies can avoid more serious health issues, and with it higher medical costs, by detecting issues sooner – all while promoting a healthier lifestyle.
3. Coverage of pre-existing medical conditions.
Before the Affordable Care Act, a health insurance company could reject a health insurance application if the applicant had a history of diabetes, heart problems or even claims for mental health services in their health history. No more. Regardless of medical conditions, all Americans are able to enroll in a health insurance plan and not pay any extra in monthly premiums based on the member’s health profile. (Note: The trade-off is that coverage for an Obamacare plan needs to be purchased during the Open Enrollment Period of each year. This rule is in effect to prevent people from delaying the purchase of health insurance until they get sick and need it.)
4. Subsidies to help with affordability of coverage
Nearly 12 million Americans now have health insurance through either a state-based exchange or the federal marketplace, and 87 percent of those individuals have received financial benefits in the form of tax subsidies to help pay the monthly cost of their healthcare plan. Obamacare also helped expand Medicaid coverage in some states, so the working poor who made too much money to qualify for Medicaid assistance but too little money to afford health insurance now have a chance to obtain healthcare coverage.
5. Children can stay on their parent’s health insurance plan until age 26.
The number of students graduating from college with full-time jobs in hand is 91.5%, but many of those graduates are under-employed compared to their education level, working the same jobs they had in college. And the number one cause of injury in young adults is accidents, either driving or sports related. This group needs health insurance. With the passing of the Affordable Care Act, parents can now keep their children on their healthcare plan until age 26 – even if their kids are married. This is a win for young millennials who are focused on paying off college debt and landing that first entry level job.
6. No annual limits on coverage.
The number one cause of bankruptcy in America is due to medical debt. In recent years, some of this was caused by annual limits. Individuals with critical illnesses could hit their annual limit within months due to treatment or inpatient care. Now, if you are diagnosed with an illness that needs ongoing treatment, in-network providers, coinsurance and copayments keep costs lower than what has historically been the norm.
7. Health insurance companies must spend 80% of total premium dollars on healthcare services.
By law, health insurance companies have to report where your monthly premium dollars are spent. That means, if they spend more than 20% of your money on costs other than paying for healthcare services, they have to rebate all of their customers the difference back.
8. Congress must shop on the health insurance exchanges.
You might not think you live like a congressman, but you do. If there is not an employer-sponsored health insurance available through s spouse, congressmen and congresswomen have to purchase their health insurance on the exchange just like everyone else.