ACA (Affordable Care Act)
Understanding the Affordable Care Act (ACA) for those under the age of 65.
Navigating Healthcare Reform with Inspire Medicare
Overview of the Affordable Care Act (ACA)
The ACA was enacted to increase access to affordable health insurance, reduce the number of uninsured Americans, and improve the quality of care. Key provisions of the ACA include:
Individual Mandate
Requires most Americans to have health insurance or pay a penalty (though the penalty has been reduced to $0 as of 2019).
Medicaid Expansion
Expands Medicaid eligibility to include more low-income individuals and families.
Health Insurance Marketplaces
Provides a platform for individuals and families to compare and purchase health insurance plans.
Subsidies and Tax Credits
Offers financial assistance to help lower the cost of premiums for those who qualify.
Essential Health Benefits
Mandates that all health insurance plans cover a core set of essential health benefits, including preventive services, emergency care, maternity care, mental health services, and prescription drugs.
Detailed Breakdown of ACA Benefits
Key Benefits of the ACA
2. Essential Health Benefits: Most ACA-compliant plans must cover a set of essential health benefits. These include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Maternity and newborn care (both before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
The Importance of Preventive Care
How to Choose the Right Plan
1. Assess Your Needs
Consider your health needs and those of your family. Do you have any chronic conditions? How often do you visit the doctor? Do you need regular prescriptions?
2. Comprehensive Treatment
Look beyond the monthly premium. Consider the deductible, copayments, coinsurance, and out-of-pocket maximum. Sometimes a plan with a higher premium but lower out-of-pocket costs can be more economical.
3. Check the Network
Make sure your preferred doctors and hospitals are in the plan’s network. Out-of-network care can be significantly more expensive.
4. Consider Additional Benefits
Some plans offer extra benefits like dental, vision, or hearing coverage. Weigh these additional benefits when choosing a plan.
Assess Your Needs
Consider your health needs and those of your family. Do you have any chronic conditions? How often do you visit the doctor? Do you need regular prescriptions?
Comprehensive Treatment
Look beyond the monthly premium. Consider the deductible, copayments, coinsurance, and out-of-pocket maximum. Sometimes a plan with a higher premium but lower out-of-pocket costs can be more economical.
Check the Network
Make sure your preferred doctors and hospitals are in the plan’s network. Out-of-network care can be significantly more expensive.
Consider Additional Benefits
Some plans offer extra benefits like dental, vision, or hearing coverage. Weigh these additional benefits when choosing a plan.
Still unsure of the best plan for you? Need help understanding the ACA?
Reach out to our team of expert agents, we’re here to make finding the right plan easy!
The Health Insurance Marketplace
Bronze Plans
Lower premiums, higher out-of-pocket costs. Ideal for those who are generally healthy and do not anticipate needing much medical care.
Silver Plans
Moderate premiums and out-of-pocket costs. A good balance for those who may need more medical services.
Gold Plans
Higher premiums, lower out-of-pocket costs. Suitable for those who expect to use more medical services.
Platinum Plans
Highest premiums, lowest out-of-pocket costs. Best for those who require frequent medical care.
Understanding Subsidies and Tax Credits
Premium Tax Credits
Reduce the amount you pay for your monthly insurance premiums. Available to those with household incomes between 100% and 400% of the federal poverty level (FPL).
Cost-Sharing Reductions (CSRs)
Lower your out-of-pocket costs for deductibles, copayments, and coinsurance. Available to those with household incomes between 100% and 250% of the FPL who choose a Silver plan.
FAQs about the ACA
1. Who is eligible for subsidies?
2. Can I be denied coverage for a pre-existing condition?
3. How do I enroll in a Marketplace plan?
How Inspire Medicare Can Help You
