The standards also rescued ACA-compliant plan buyers from lifetime benefit limits and annual benefit limits. Before Obamacare took effect, plan buyers who needed expensive care could exhaust their health insurance benefits , and have nowhere else to turn. These rules apply to student health insurance as well, and those plans commonly had very low lifetime limits pre-ACA. Under the Affordable Care Act, all individual and small-group major medical plans must include coverage of the following EHBs:.
And thanks to Obamacare, health plans offered to college students are just as comprehensive as the ACA-compliant plans offered to everyone else. Health reform advocates hailed Obamacare for its many provisions designed to expand coverage — and to prohibit discrimination. Section prohibits discrimination in health plans — including discrimination based on gender identity or sexual orientation.
That has been a boon to the LGBT community. The Trump administration rolled back those consumer protections with a new rule that was issued in , but the Biden administration announced in May that Section requirements would once again include a prohibition on discrimination by health care entities based on sexual orientation or gender identity.
Another major improvement under the ACA is birth control access — with plans required fully cover ie, with no cost-sharing at least one version of every FDA-approved method of birth control for women. Under the ACA, recission retroactive cancellation of your coverage by a health insurance company is prohibited — unless your application was fraudulent or included intentional misrepresentation. The law includes numerous provisions designed to reduce Medicare spending, drive down costs, and improve coverage for Medicare beneficiaries.
Among them:. The ACA is gradually cutting Medicare costs by restructuring payments to Medicare Advantage , based on the fact that the government was spending more money per enrollee for Medicare Advantage than for Original Medicare. Medicare Advantage enrollment has continued to increase; the ACA has not dampened that market at all.
Our Open Enrollment Guide : Everything you need to know to enroll in an affordable individual-market health plan. The ACA changed the tax code to increase revenue for the Medicare program. Starting in , the Medicare payroll tax increased by 0. The Medicare Modernization Act of included a provision to pay 10 percent bonuses to Medicare physicians who work in health professional shortage areas HPSAs.
The ACA expanded this program to include general surgeons, from to the end of The ACA includes numerous cost-containment provisions that have been implemented over the years since the law was passed. An additional opportunity to disenroll from Medicare Advantage and sign up for Part D. The Medicare Advantage disenrollment period allowed seniors drop their Medicare Advantage plan, switch back to Original Medicare , and purchase a Part D plan.
As of , it was replaced with the Medicare Advantage Open Enrollment Period , which is a longer window January 1 to March 31 and allows more flexibility for enrollees, as they now also have the option to switch from one Medicare Advantage plan to another during this window.
Metal levels include Bronze, Silver, Gold, and Platinum. But these plans also make you pay a higher percentage of your medical bills. This means that Bronze plans typically have the lowest premiums, which is the amount you pay each month to stay on the plan, but the highest out-of-pocket costs when you need medical care or prescriptions.
Platinum plans have the highest premiums, but you pay the least out of pocket. All Obamacare plans include ten essential health benefits. These are categories of health services that must be covered under the Affordable Care Act.
Additionally, these benefits have no annual or lifetime limits, which means there is no cap on coverage for these services. If you receive automatic financial help to pay for your coverage, you probably have an Obamacare plan.
The ACA lets plan members apply for two types of assistance: premium tax credits and cost-sharing reductions. A premium tax credit, also known as a subsidy, lowers the amount you pay each month for your plan. How much you save will depend on your annual income and the size of your household. If your plan has a discount each month, it is likely you have Obamacare coverage. In , the American Rescue Plan increased the amount of subsidies and expanded who could receive them for two years.
A maximum income cap to receive the premium tax credit was removed previously, four times the federal poverty level. If the cost of a benchmark plan second-cheapest silver plan in your area costs more than a certain percent of your annual income, you qualify for subsidies. A cost-sharing reduction is a discount that lowers the amount you have to pay for deductibles, copayments and coinsurance.
Your income level and size of your household will also determine whether you qualify for these additional savings. But you must enroll in a silver plan to qualify for a cost-sharing reduction. The average nursing home stay is about 2. If you buy a policy before age 60, the fixed daily benefit may not be enough by the time you need it.
If you feel you are in danger, call or contact your local authorities. To complain about a long-term-care facility, contact your state's long-term care ombudsman or local elder abuse resources. If you have a disability, you have three options for health coverage through the government.
Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply. Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease permanent kidney failure requiring dialysis or a kidney transplant.
Learn about eligibility, how to apply and coverage. Learn about the Marketplace, how to enroll, and use your coverage. Federal, state, and local government agencies and programs can help with your health needs if you have a disability. Learn more about benefits for people with disabilities from the Social Security Administration. Contact your local city or county government to find out what medical and health services are available locally for people with disabilities.
Your state social service agency can help you locate medical and health programs. Visit USA. Ask a real person any government-related question for free. The law mandates that employers provide breastfeeding mothers break time and a private space to express milk during the workday.
About 2. Later on, additional young adults gained coverage though marketplace financial assistance and Medicaid expansion. As a result, the uninsured rate among people ages 18 to 24 fell by half, dropping to 15 percent in The ACA raised standards to ensure that children in low- and middle-income families can access health coverage.
About one-quarter to one-third of new enrollees under Medicaid expansion are children. The ACA also defined pediatric dental and vision care as part of essential health benefits, ensuring that kids covered through both the marketplace and Medicaid have coverage for those services.
Further, expanding coverage to adults—through the ACA marketplaces and Medicaid expansion—helps parents stay healthy and provides financial security to the entire family. Prior to the ACA, 9 percent of individual market plans did not cover prescription drugs. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers.
The ACA also expanded the B drug discount to include more providers, including critical access hospitals and rural referral centers.
The ACA also laid out a process for faster Food and Drug Administration approval of biosimilars , biologic drugs that are essentially analogous to generic versions of branded drugs.
By encouraging competitors for high-cost biologic drugs, the ACA rules on biosimilars can potentially help bring down the price of these types of prescription drug costs and help make new therapies available to patients who need them.
These are all important steps toward drug affordability, but there is much more work to be done. Medicaid expansion is particularly important for coverage and the sustainability of the health care system in rural areas. Rural residents are more likely to be covered by Medicaid: Medicaid expansion reduced the amount of uncompensated care that hospitals provide, boosting the financial viability of rural hospitals relative to their counterparts in nonexpansion states.
While more than rural hospitals have closed in the past decade, the closures have occurred disproportionately in nonexpansion states. The ACA provides patients and the health care system with resources to combat the opioid crisis , which has hit rural areas particularly hard. Without this requirement, only 1 in 3 people covered through the individual market would have had access to SUD treatment. Many people in rural and other medically underserved communities rely on community health centers and other Federally Qualified Health Centers FQHCs for comprehensive primary care.
Federal grants provide 1 in 5 revenue dollars that community health centers receive, and 70 percent of that funding comes from the Health Center Trust Fund set up by the ACA. Before the ACA closed the coverage gap, about 5 million Medicare enrollees fell into it. The ACA also invested in other improvements for the Medicare program by establishing the Center for Medicare and Medicaid Innovation , which is responsible for developing ways to improve patient care and lower health care costs.
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