The Affordable Care Act: An Overview of What the Bill Can Offer You by Resident Expert Toni Parker Hall

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By Resident Expert Toni Parker Hall [space]

The Affordable Healthcare Act (ACA) has made its debut; and while there are still many kinks to work out, the bumpiness of expensive medical insurance premiums will eventually become smoother for many American families when they begin to benefit from the lower premiums that the ACA promises. [space]

Regardless of which category you fit in- either you’re currently under an employer-sponsored plan or you’re amongst the uninsured, it would be beneficial to find out what the ACA can offer your family.  If you’ve been one of the unlucky ones who couldn’t get through to a representative, don’t despair! Most people are getting a call back rather quickly.  In the mean time, here is a recap of what the new healthcare bill might offer you.   [space]

The Virtual Marketplace [space]

The most important aspect of the Affordable Care Act is that families are allowed to shop for healthcare insurance via a virtual center called the Marketplace.  In the Marketplace, you will be able to compare qualified health plans to determine which plan is the most comprehensive and economical for your family.  However, keep in mind that each state’s Marketplace will have plans that are specific to that state. Therefore, the plans that are offered in New York might be different from plans that are offered in Tennessee. [space]

Conversely, there is one group of benefits (referred to as the essential health benefits) that will be offered to everyone who has medical health insurance.  The ACA mandates that the essential health benefits be included in all medical insurance plans regardless of whether or not they are employer-sponsored or purchased through the marketplace.  Here’s a peek at what’s covered in those essential health benefits- and at no additional charge to you. [space]

Essential Health Benefits: The Coverage All Plans Must Offer [space]

  • Essential health benefits must cover medical services in at least the following 10 categories:
  • Ambulatory patient services;
  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care; 
  • Mental health and substance use disorder services, including behavioral health treatment;
  • Prescription drugs;
  • Rehabilitative and habilitative services and devices; 
  • Laboratory services;
  • Preventive and wellness services and chronic disease management; and
  • Pediatric services, including oral and vision care.

And while these essential health benefits are very comprehensive-the coverage under the new ACA bill gets even better.  In addition, to essential health benefits, the Marketplace will also offer policy protection to every insuree. [space]

The ACA Bill Protects These Rights! [space]

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The only people who are ineligible for essential health benefits and coverage protection are those who are grandfathered under a plan purchased prior to March 2010.

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Shopping Beyond the Basics [space]

The essential health benefits and policy protection is only a part of what’s included in the new medical plans.  Therefore, it is essential that you fully understand them both to help manage premiums costs when you begin shopping for your actual medical plan, which consists of four categories. [space]

The category you choose will affect the cost of your premium each month and the portion of the bill you will have to pay for medical services like hospital visits or prescription medicine.  I’ve listed them below: [space]

Marketplace Insurance Plans Categories and Average Costs 

  • The Bronze Plan– Covers 60% of medical expenses while you pay 40%
  • The Silver Plan– Covers 70% of medical expenses while you pay 30%
  • The Gold Plan-Covers 80% of medical expenses while you pay 20%
  • The Platinum Plan-Covers 90% of medical expenses while you pay 10%

Please note that I used the word average cost when discussing the four categories. Within each category, there are different options that you can select; and of course, those options come with different costs. [space]

The Bottom Line for You [space]

When you enter the Marketplace to choose a plan, remember that you don’t pay extra for the essential health benefits or the policy protection.  They are guaranteed in each of the four categories.  If you choose the Bronze or Silver plan, your monthly premium will be less expensive, but your medical services will cost more.  Conversely, if you choose the Gold or Platinum plan, your premium will be more expensive, but your medical services will be cheaper.  Lastly, there will be federal subsidies that you can apply for to reduce your overall healthcare costs if you are eligible.  [space]

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