Understanding ObamaCare (Patient Protection and Affordable Care Act)
ObamaCare is a nickname for The Patient Protection and Affordable Care Act (sometimes called the Affordable Care Act, ACA, or PPACA for short), a health reform law signed on March 23, 2010, by President Barack Obama.
ObamaCare seeks to reform health insurance and healthcare in the United States by creating new rules for insurers, offering cost assistance for health insurance, and more.
What Does the ObamaCare Do?
The Affordable Care Act (ObamaCare) aims to provide more Americans with access to affordable health insurance. It also aims to improve the quality of healthcare and health insurance, to regulate the health insurance industry, and to reduce health care spending in the US.
The law attempts to accomplish the above through a number of regulations, taxes, tax breaks, mandates, and subsidies.
For example, the law includes regulations that stop insurers from denying coverage to those with preexisting conditions, tax credits for health insurance premiums, subsidies for out-of-pocket costs, a mandate for large employers to provide full-time employees health insurance, and taxes on those who profit due to the expansion of healthcare like drug companies.
Specifically, the Affordable Care Act:
Offers Americans some new benefits, rights, and protections regarding their healthcare and health insurance
Sets up a Health Insurance Marketplace (HealthCare.Gov) where Americans can purchase federally regulated and subsidized health insurance during open enrollment.
Expands Medicaid to all adults in states that embraced the program.
Improves Medicare for seniors and those with long-term disabilities.
Expands employer coverage to millions of employees.
Introduces new taxes (mostly on higher earners, businesses, and industry) and tax breaks.
With that said, the above is only a part of what the Affordable Care Act does. In all the law contains over 1000 provisions. You can learn more about the benefits, rights, and protections in the Affordable Care Act here or keep reading to learn more.
Insurance Marketplace?
The health insurance marketplace (also known as an exchange) is an online price comparison website where Americans can shop for affordable quality insurance and receive cost assistance for lower premiums, reduced out-of-pocket costs, or even qualify for Medicaid and CHIP.
Many states have their own health insurance marketplace. Meanwhile, states that don’t have their own marketplace use the federal marketplace HealthCare.Gov. Find your state’s Health Insurance Marketplace now.
ObamaCare and Cost Assistance
Cost assistance is offered on both premiums and out-of-pocket costs.
Those making between 100% – 400% of the federal poverty level (FPL) may qualify for cost assistance through the marketplace. Those making less than 138% of the poverty level may qualify for Medicaid or CHIP.
100% of the poverty level is between $13,590 for an individual and $27,750 for a family of 4 for 2023 coverage.
138% of the poverty level, is $18,754 for an individual or $38,295 for a family of 4 for 2023 coverage.
400% of the federal poverty level is $54,360 for individuals and $111,000 for a family of 4 buying 2023 coverage.
Cost assistance is only available through the health insurance marketplace.
Find out more about what ObamaCare will cost you. Many Americans will be eligible for subsidized health insurance of anywhere from roughly 2% – 9.5% of their Modified Gross Adjusted Income (or even free coverage via Medicaid and CHIP).
TIP: The poverty levels adjust every year. Make sure to check out the most recent poverty levels.
ObamaCare and Open Enrollment
Health insurance must be obtained during open enrollment. Open enrollment for 2018 health plans sold on the Health Insurance Marketplace runs from Nov 1st to Dec 15th each year (in most states).
Individuals and families without access to employer coverage, Medicaid/CHIP, Medicare, or another type of “minimum essential coverage” need to enroll during open enrollment (or qualify for a special enrollment period).
Individuals and families are well advised to apply at healthcare.gov during open enrollment or apply for a special enrollment period, to see if they are eligible for financial assistance for lower premiums, reduced out-of-pocket costs, or even Medicaid (Medicaid eligibility has been expanded in many States).
Find out how you, your family, and your business can qualify for federally subsidized health insurance. Download our free ObamaCareFacts.com ebook to learn more about the Marketplace and open enrollment.
TIP: Remember, the mandate to get coverage is repealed from 2019 forward, so you won’t need to deal with exemptions moving forward.
ObamaCare Benefits, Rights, and Protections
The ACA includes a long list of new benefits, rights, and protections including:
Letting young adults stay on their parents’ plan until 26
Stopping insurance companies from denying you coverage or charging you more based on health status
Stopping insurance companies from dropping you when you are sick or if you make an honest mistake on your application
Preventing gender discrimination
Stopping insurance companies from imposing unjustified rate hikes
Doing away with lifetime and annual dollar limits
Giving you the right to a rapid appeal of insurance company decisions
Expanding coverage to tens of millions by subsidizing health insurance costs through the Health Insurance Marketplaces (HealthCare.Gov and the state-run Marketplaces)
Expanding Medicaid to millions in states that chose to expand the program
Providing tax breaks to small businesses for offering health insurance to their employees
Requiring large businesses to insure employees
Requiring all insurers to cover people with pre-existing conditions
Making CHIP easier for kids to get
Improving Medicare for seniors
Ensuring all plans cover minimum benefits like limits on cost-sharing and ten essential benefits including free preventive care, OB-GYN services with no referrals, free birth control, and coverage for emergency room visits out-of-network
10 Essential Benefits
One important feature of the ACA is the new ten essential benefits included with every major medical plan.
Starting January 1st of 2014, the following “Ten Essential Benefits” had to be included under all insurance plans with no lifetime or annual dollar limits:
Ambulatory patient services (Outpatient care). Care you receive without being admitted to a hospital, such as at a doctor’s office, clinic or same-day (“outpatient”) surgery center.
Emergency Services (Trips to the emergency room). Care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.
Hospitalization (Treatment in the hospital for inpatient care). Care you receive as a hospital patient, including care from doctors, nurses, and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board.
Maternity and newborn care. Care that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery and care for newborn babies.
Mental health services and addiction treatment. Inpatient and outpatient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder.
Prescription drugs. Medications that are prescribed by a doctor to treat an illness or condition.
Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for “habilitative reasons”).
Laboratory services. Testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.
Preventive services, wellness services, and chronic disease treatment. This includes counseling, preventive care, such as physicals, immunizations, and screenings, like cancer screenings, designed to prevent or detect certain medical conditions. Also, care for chronic conditions, such as asthma and diabetes. Note: please see our full list of Preventive services for details on which services are covered.
Pediatric services. Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.
Changes to the Affordable Care Act
There have been some changes to the Affordable Care Act under the Trump administration. The most important change is arguably the ACA previously required you to get coverage or pay a fee. However, under Trump the fee for not having coverage was reduced to zero starting in 2019.
Despite the changes, here in 2020 the Affordable Care Act is still “the law of the land,” and that means there is still cost assistance and protections for pre-existing conditions for Americans who choose to get covered during open enrollment each year.
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