Shortly after Barak Obama was elected to be President of the United States, he and many members of congress agreed that the citizens of the United States did not have fair access to comprehensive health insurance.
The parties involved were in agreement that most Americans could not afford comprehensive health insurance and those who could were often denied coverage because of pre-existing illnesses.
Early in President Obama’s first term, a team was assembled to design a healthcare marketplace that would provide comprehensive health insurance for those people who were not insured or were underinsured because:
- Health insurance companies were either denying coverage or imposing surcharges for individuals with pre-existing conditions.
- Comprehensive health insurance was unaffordable for many Americans.
- Many low-income individuals and families could not qualify for Medicaid.
- Most individual health plans did not include many “essential health benefits.”
- Preventive health services were not completely covered by private insurance companies.
As a result of the perceived failure of traditional health insurance companies to service a large portion of the citizenry, the Affordable Care Act (Obamacare) was signed into law in March of 2010.
Affordable Care Act (ACA)
ACA Health Insurance was created and designed to reduce the cost of comprehensive health insurance for individuals and families who qualify.
This new healthcare law includes premium tax credits for those who qualify and cost-sharing reductions to reduce the cost of health insurance for individuals and families who could afford or qualify for comprehensive health insurance in the past.
Moreover, the health insurance plans under the ACA (Obamacare) must include coverage for the twelve “essential health benefits” which are mandated by the ACA.
- Ambulatory patient services
- Emergency services
- Family planning services
- Breastfeeding services
- Mental health and substance abuse services
- Hospitalization (emergency and inpatient)
- Maternity, pregnancy, and newborn healthcare
- Pediatric services
- Laboratory services
- Prescription drug coverage
- Rehabilitative and habilitative care
- Wellness and preventive care and chronic disease management
In addition to the 12 “essential health benefits,” the Affordable Care Act also requires participating insurers to offer certain preventive services at no cost to a policyholder.
Preventive Services that are Mandated by the ACA
With the understanding that preventive services would significantly help policyholders and reduce the overall cost of healthcare to insurance companies.
The Affordable Care Act mandates the participating health insurers to offer free preventive services for all covered adults, women, and children.
| ADULT PREVENTIVE SERVICES | |
|---|---|
| Abdominal aortic aneurysm screening | Alcohol abuse screening and counseling |
| Aspirin for prevention of cardiovascular disease | Blood pressure screening |
| Cholesterol Screening | Colorectal cancer screening for adults |
| Depression Screening | Diet counseling |
| HIV/AIDS screening | Vaccines |
| Obesity screening and counseling | STD prevention and counseling |
| Syphilis screening | Tobacco use screening |
| Type 2 Diabetes screening | |
| PREVENTIVE SERVICES FOR WOMEN | |
|---|---|
| Anemia screening | BRCA counseling for high risk women |
| Breast cancer mammography and counseling | Breastfeeding counseling |
| Screening for cervical cancer | Contraception with counseling |
| Domestic and interpersonal violence screening and counseling | Specific items and services for pregnant women |
| Gestational diabetes screening | Screening for Osteoporosis |
| Rh incompatibility screening | |
| PREVENTIVE SERVICES FOR CHILDREN | |
|---|---|
| Autism screening | Behavioral assessment |
| Immunization vaccines | Hyperthyroidism screening for newborns |
| Depression screening | Developmental screening |
| Dyslipidemia screening | Fluoride chemoprevention supplements for children |
| Hearing screening for newborns and children at specific intervals | Height, weight, and BMI measurement |
| Hematocrit or hemoglobin screening | Iron supplements for children 6 to 12 months |
| Lead screening for at risk children | Vision Screening |
The ACA Health Insurance Marketplace
The Affordable Care Act Health Insurance Marketplace is a platform that was established to offer a variety of health insurance plans to individuals, families, and small businesses.
This Marketplace was developed and then established as a method to distribute comprehensive health insurance plans to the millions of Americans who were uninsured or underinsured.
ACA Pros and Cons
Because of inherent issues with any health insurance plan, especially if it’s designed by the government, there are going to be pros and cons to consider. These pros and cons are not because the ACA was designed with flaws, but rather, designing a plan that will accommodate many millions of policyholders is almost impossible because everyone has different needs to accommodate their circumstances.
Pros
Many more Americans are able to get health insurance than ever before. In fact, HHS reported in April of 2022 that there are over 35 million people covered by the affordable care act.
Health insurance in America is now more affordable than ever before. The ACA mandates that health insurance companies must now spend a minimum of 80% of premiums collected on healthcare and improvements. Moreover, the ACA has the ability to stop health insurance companies from rasing their rates unreasonably.
Applicants can no longer be denied coverage because of preexisting medical conditions. Prior to the ACA, health insurers could place waiting periods on preexisting conditions or even deny coverage completely.
All ACA health plans must include many preventive services and screenings
Retail Prescriptions are more affordable than ever before.
Cons
People who do not qualify for subsidies will likely pay more for ACA health insurance than they paid for their previous plans.
Your taxes will likely go up. Certainly, new taxes were passed by Congress to help pay for the Affordable Care Act. The wealthy folks in America are subsidizing the lower earners to help cover the additional cost of the ACA insurance program.
Businesses are cutting the hours of their workers so they will not have to offer employer-sponsored insurance.
Frequently Asked Questions
When can I enroll in ACA Health Insurance?
For coverage to begin in the first day of the year, the Open Enrollment period in HealthCare.gov states begins on November 1 and ends on December 15th.
How long will it take for my coverage to take effect?
In most states, if you enroll in a plan by December 15th and pay your initial premium payment by the due date, your new plan will take effect on January 1st.
Can I change insurance companies after I enroll in a plan?
You can change companies or plans anytime during the Open Enrollment.
Can I enroll in Medicaid in the ACA Marketplace?
You are allowed to enroll in Medicaid anytime, not just during Open Enrollment.
Do I have to provide proof that I'm eligible for Special Enrollment?
The ACA Marketplace (HealthCare.gov) requires an applicant to provide documentation of eligibility for a special enrollment. Verification is required for the following qualifying events:
- Loss of minimum essential coverage
- Permanent move
- Marriage
- Adoption, placement for adoption, placement for foster care, or child support or other court order, and
- Medicaid or CHIP denial
What is the Exceptional Circumstances Special Enrollment Period
The most common reason for claiming Exceptional Circumstances is when you qualify for Special Enrollment but miss the deadline because you were impacted by Covid-19 either physically or your employer was impacted and you were unsure if whether your job-based health insurance would continue to be available. However, if you had a life event more than 60 days ago and missed your Special Enrollment Period, contact the Marketplace Call Center at 1-800-318-2596 to find out if you qualify for Special Enrollment.
Certainly, there are dozens of more FAQs that will come while you are covered by or applying for ACA Health Insurance either directly through HealthCare.gov or through a licensed agent if your question is not listed here, please visit the HealthCare.gov FAQ page.
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