The Affordable Care Act And What It Means For You
The Patient Protection and Affordable Care Act went into effect October 1st, with the commencement of open enrollment. Due to the political nature of its implementation, it is commonly referred to as “Obama Care”, because President Obama used it as part of his campaign platform for both the 2008 and 2012 elections. This comprehensive health reform was signed into law by President Obama in March 2010. The Affordable Care Act introduces many changes to healthcare, making preventative care and medical coverage more affordable and available for many Americans. Certain provisions of the law are already in effect, while many other provisions go into effect in the upcoming years.
What’s Changing in 2014?
Significant changes to healthcare are introduced by the Affordable Care Act. One of these changes is the addition of the Marketplace, which allows consumers to search and apply for insurance coverage in any state. The Marketplace also allows individuals and small businesses the opportunity the compare health plans, putting consumers on an even playing field. Another noteworthy change introduced by the Affordable Care Act is that coverage cannot be denied or be more expensive based on pre-existing medical conditions such as disability or pregnancy.
What is Covered?
Helping to create comprehensive healthcare coverage, the new law mandates health insurers cover 10 essential benefits under the new law. Covered benefits include: Emergency services, ambulatory patient services, hospitalization, mental health and substance use disorder services, laboratory services, prescription drugs, rehabilitative services and devices, chronic disease management, pediatric services including dental and vision care, and preventative and wellness services.
The dental and vision care are only mandated for those ages 18 or younger, and is considered an essential benefit for this group. Those older than 18 may still be paying out of pocket expenses even under the Affordable Care Act, but this may vary from state to state. Some states offer vision and dental coverage separate from health insurance.
One of the main goals of the Affordable Care Act is to eliminate loop holes for insurance companies and increase transparency of the healthcare system. This is accomplished in several ways:
- Information for consumers is available online. Consumers can now compare health insurance coverage options to decide which coverage is most appropriate for their situation.
- Prohibiting coverage denial for children based on pre-existing conditions. Insurance companies can no longer deny children under the age of 19 due to previously existing conditions.
- Eliminating lifetime limits on insurance coverage. Lifetime dollar limits for essential benefits, like hospital stays, are prohibited.
- Prohibiting insurance companies from rescinding coverage or payouts. Previously, insurance companies could deny payment for services by searching for an error or technical mistake in the customer’s application. This is now illegal, closing the long-standing loophole.
- Eliminating annual limits on insurance coverage. Annual dollar limits on essential benefits are prohibited.
- Appealing Insurer’s Decisions. The new law provides consumers with an easy to access, streamlined process for appealing insurance company decisions, and establishes an external resource for the review process.
The Affordable Care Act also changes the way preventative care is viewed and handled. Seeking to achieve a reduction in long-term costs, preventative care is at the forefront of the new law. In effect as of September 23rd, 2010, free preventative care, such as mammograms and colonoscopies, must be offered by new plans. Other programs available seek to prevent diseases and illnesses, helping identify and educate consumers on major sources of negative health risks, such as smoking and obesity.
Additional information is available at healthcare.gov
This guest post was contributed by Justin. He reports on recent developments in the healthcare and personal fitness industries. When he’s not writing, Justin works full-time in medical billing services, and provides practice management for emergency care centers.