10 Obamacare Facts You Need to Know

Are you still confused about Obamacare? Don’t worry, you are not alone. But because it pays to be knowledgeable and have the right information, you should learn the facts about Obamacare. Officially known as the Patient Protection and Affordable Care Act or simply Affordable Care Act (ACA), it was a signed into law on March 23, 2010 as a means to reform the healthcare industry. Its goals are to give more Americans access to quality health insurance. It also aims to reduce healthcare spending in the U.S.

The Facts Behind Obamacare

1. ACA Requires That You Must Have Health Insurance.
Otherwise, you will incur a fine of $95 or 1% of your income, depending on which is greater. If you have uninsured children, you will pay a fine of $47.50 – half of your fine as an adult, for each kid, or up to $285 for a family. Fines increase every year, however, and the numbers are sure to increase in 2016. So, if you want to avoid such penalties, you need to get health insurance. In the event that you are experiencing hardships that keep you from getting one, or you have religious objections, you may apply for a coverage mandate exemption.

2. You Must Have Minimum Essential Coverage.
When buying a policy, make sure to ask an insurer if it counts as minimum essential coverage and not a short-term health policy. Medicare, Medicaid and employer-based coverage often include minimum essential. But if you buy from private insurance companies, you need to verify about minimum essential coverage.

3. A Choice Of Health Plans Is Provided.
Health plans provided by the state comes in four types: bronze, silver, gold and platinum. What you choose depends on your health conditions and specific needs.

  • Gold or platinum plan is highly recommended for people who take prescription drugs and those who visit the doctor frequently.
  • Silver plan is ideal if you can get help paying for out-of-pocket costs.
  • Bronze plan is the most affordable in terms of premiums, but will cost you more when you acquire health care services.

Ideally, you should get a plan that best suits your needs and budget. But if you can’t find a plan for less than 8% of your income and you’re under 30 years old, you can qualify for a catastrophic plan. Another alternative would be to purchase plans through HealthCare.gov or your state marketplace, so you can qualify for low premiums and cost assistance.

4. Free Or Low Cost Care Is Expanded.
In 2014, the public health program for the poor was expanded in 24 states and the District of Columbia. This gave people who qualify access to free or low-cost care. How is eligibility determined? Solely based on your income and the size of your family. In 2013, a family of four that earns up to $32,499 may qualify. If you want to find out if you are eligible, simply fill out an application in the health marketplace of your state.

5. You Are Covered Even If You’re Sick.
Most health insurance has exclusions for pre-existing conditions, and those who do offer coverage entails hefty premiums. But with the Obamacare in place, health plans are forbidden from refusing coverage or charging more for people with pre-existing health problems, such as high blood pressure, diabetes, and cancer. The only exception is when the health plans have “grandfathered” status, one that has been in place since March 23, 2010 and has not undergone any major changes.

What if you already have an existing insurance plan, but has pre-existing condition exclusions? Get another one from your state’s health marketplace.

6. Preventive Care Is Free.
One of the major benefits of the Affordable Care Act is preventive health services that you can get at no cost. You won’t have to pay for anything out of your pocket when you get flu shots or when you undergo testing for cholesterol or screening for colon cancer. However, if a test reveals that something is wrong and follow-up care is needed, this would be the time that you will pay for healthcare services.

7. Free Birth Control.
Don’t want to spend a dime on birth control? You might be able to get it for free if you follow methods approved by the Food and Drug Administration, and those that are prescribed by your doctor. Under ACA, birth control is free if you have health insurance, regardless if it is employer-based, private or through state marketplace, and that you get a prescription for any type of FDA-approved birth control. The only exemption is when your insurance plan has a “grandfathered” status or sponsored by religious employers.

8. Cost Assistance Is Available.
Under ACA, 6 in 10 Americans who are not insured can be covered for $100 or less a month, because of cost assistance offered by the state health marketplace. Does this apply to you? To qualify, your annual household income should meet the requirements for cost assistance. Otherwise, you will end up repaying tax credits.

9. Health Programs Are Encouraged.
The law now permits employers to introduce wellness programs and to offer incentives, as a means to encourage wellness in the workplace or out of it, depending on the program. The law also permits employers to increase penalties for individuals who do not want to participate, but only after giving fair notice.

10. All Plans Are Required To Offer Basic Care.
With Obamacare, all health plans cover the basics, such as immunization, annual checkups, and preventive tests. Make sure you take advantage of these, since you are covered with no out-of-pocket costs, regardless if you are healthy or has pre-existing conditions, or based on your gender.

When shopping for health insurance, make sure you evaluate first your needs and that of your family. Then compare it against the benefits listed on a benefit sheet to ensure that the plan you choose would work for you. Under ACA, you can change your plan any time during open enrollment, so if you are unhappy with your current coverage, identify what you want changed and then consult with an agent or health insurance expert.

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