The Affordable Care Act, also known as both ObamaCare and, its official title, the Patient Protection and Affordable Act, was passed on March 23, 2010. On June 28, of 2012, the United States Supreme Court upheld the health care act.
The law requires all Americans, with certain stipulations and exceptions, to have health care by a predetermined date. The goal of the act is to reform health care and ensure that the 45 million uninsured and millions of underinsured citizens of the United States can get affordable and acceptable health care. The act also attempts to decrease the cost of healthcare expenses. The goal to have everyone in the United States covered by 2016.
Affordable Care Act Benefits
With Obama Care, citizens can purchase private insurance, get insurance from their employer program, or take advantage of the individual state Health Insurance Marketplace, if their state has one. The marketplaces each have a window of enrollment, which must be adhered to unless of emergency situations. The deadlines, rules, health providers, and descriptions offered can be found at each marketplace website.
The businessman, who needs to know his obligations, can also find information at the websites. Remember, if you own a business with more than 50 employees, you have specific requirements. There are ten basic benefits, also called Essential Benefits, that the insurance offered at the marketplace should provide:
1. Hospitalization benefits
2. Emergency room care
3. Outpatient care
4. Maternity and newborn baby services
5. Pediatric tests and services
6. Mental health care and addiction treatments
7. Prescription drugs
8. Laboratory services and tests
9. Wellness, chronic disease, and preventive services
10. Rehabilitative equipment and services
Affordable Care Act Plans
There is no dollar cap on the Essential benefits. There is no cap in order to ensure that people get full treatments and do not have to worry about the costs. There is a cap for out-of-pocket costs that a person might have to pay. There are five different levels of benefits. They each have a different level of maximum payment percentage:
Platinum………90% average
Gold…………….80% average
Silver………….70% average
Bronze………..60% average
The different tiers plans offer to you:
1. Employer-sponsored insurance coverage (can include COBRA and retirement insurance coverage)
2. Medicaid Part A coverage
3. Medicare Advantage
4. CHIPS
5. TRICARE
6. Coverage for Peace Corps volunteers
7. Refugee Medical assistance
8. Coverage stated on the non-appropriated Fund Health Benefit Program
9. Health care self-funded and offered to by colleges and universities for policy terms starting this year by December 31, 2014
10. Veteran’s health care
11. State high-risk for a policy that will begin on or before December 31, 2014
Enrolling in Affordable Care Act
Each year, there will be an enrollment window. This year that window began on November 15, 2014 and enrollment will close on February 15, 2015. There are year round emergency enrollment options. An emergency would be an event such as pregnancy or loss of your current insurance coverage. You can also apply for government care plans such as CHIP (Children’s Health Insurance Program) and Medicaid throughout the year. For CHIPS enrollment go to your state website. For more information on CHIPS and Medicaid, visit http://www.hhs.gov/. CHIPS will cover such needs as:
• Emergency services
• Routine check ups and appointments
• Doctor visits
• Immunization
• Needed prescriptions
• Vision and dental care service
• Outpatient and inpatient hospital care
• X-ray and lab services
Before you enroll in a plan, visit your state’s market website. Review all the plans and expenses in your specific state. You will find there will be chat help and frequently answered question options at the state website. Once you are knowledgeable and comfortable with moving ahead, you can begin the process of applying for Obama Care.
Applying for Health Insurance Coverage:
- Create a marketplace account either by phone (call 1-800-318-2596 for the correct number), in person, or at the market website.
- The official marketplace website for any state not providing a marketplace is www.healthcare.gov
- Complete the Affordable Care Act application
- Pick the desired health plan
- Enroll in the desired health plan
- Then contact your new insurance agency and make the plans to remit your first payment
Affordable Care Act Eligibility
The Affordable Care Act website will provide a calculator program where you can determine any benefits you may be eligible for with Affordable Care Act. You may find you can be awarded some benefits, but possibly not all of them. You should have all data and documents ready when you apply. The minimum requirements state that you must be a United Sate’s citizen, qualified immigrant (check https://healthcare.gov/immigration-status-and-the-marketplace/, be living in the United States, and not currently be incarcerated.
You will need to have your social security number, legal resident or citizenship documents (if necessary), job information, recent tax forms and filings, and any information on current health care coverage you may have with you as you apply.
