The rising cost of health care has been the biggest problem in America for many years now. Previous administrations have attempted to resolve this problem, but it was only after the signing of the Affordable Care Act by President Barack Obama that issue has been given enough attention and the best solution so far.
The Affordable Care Act of 2010, also popularly coined as Obamacare, offers numerous benefits, protections and rights. But it’s main objective is to provide affordable health care for all. To be more specific, here are some of the major benefits of the Obamacare program.
1. Young adults have the option to stay on their parents’ plan until they reach the age of 26. This helps unemployed or still studying get access to quality health plans.
2. Insurance companies are prohibited from denying coverage or charging higher premiums based on a person’s health status. Even those with pre-existing conditions can now be eligible for cost assistance.
3. Insurers are also prohibited from not selling health plans to a person because of his gender or sexual orientation. The rights of the LGBT community are protected and upheld.
4. Insurance companies are prohibited by law from imposing unjustified rate hikes. No more surprise increases in your premiums.
5. New Health Insurance Marketplaces (aka Exchanges) are where the people can buy and compare health plans that count as minimum essential coverage and include the new benefits and protections.
6. Cost assistance is offered to individuals, families and small businesses through the Marketplaces.
7. Twenty-six states have expanded Medicaid to 138% of the Federal Poverty Level, giving millions of Americans the right to have affordable and quality health care services.
8. Large companies are mandated by law to offer health coverage to full-time employees by 2015/2016. This ensures a lot of people that they are protected and that they are going to get compensation.
9. There is no more annual or lifetime limits on healthcare. This means that retirees will still be able to be covered by the Obamacare program.
10. You are allowed to exercise your right to make an appeal any decision made by an insurance company. So, if you are rejected the first time, you can still contest the insurer’s decision and be able to buy the best health plan for your needs.
11. Significant improvements to women’s health services have been made, including new and free preventive treatments and screenings. This is so every woman can have medical assistance right away without worrying about cost.
12. Seniors are to be offered better care and protections. Retirees will have more peace of mind knowing full well that they are in good hands.
13. Non-grandfathered plans at no out-of-pocket limit will now include essential health benefits, such as prescription drugs, maternity and newborn care, emergency care and hospitalization.
14. Coverage is expanded to tens of millions of people through the subsidization of health insurance costs via the Health Insurance Marketplace.
15. Small businesses are offered tax breaks for offering health insurance to employees. This encourages other businesses to do the same.
16. Making CHIP (Children’s Health Insurance Program) for children easier to get.
17. Women won’t need referrals for OB-GYN appointments without higher coinsurance, referrals or higher co-pays.
Essential Health Benefits of the Affordable Care Act
Outpatient Care - the care a patient receives outside a hospital, like a doctor’s office, surgery center or clinic. Home health services and hospice care are also included in this coverage.
Emergency Services – you will receive care for conditions that could potentially lead to serious disability or death, such as accidents or sudden illness.
Hospitalization – if you are sick and you need immediate medical attention, including care from doctors, nurses and other hospital staff. This also includes laboratory and other tests and medications you may receive during your hospital stay.
Maternity and Newborn Care – this is what women who are pregnant receive during their pregnancy as well as throughout labor, delivery and care for newborn babies.
Mental Health Services and Addiction Treatment – a person with mental disorder may be provided inpatient or outpatient care to evaluate, diagnose and treat a mental health condition or addiction. Treatment will include counseling, psychotherapy and behavioral treatment.
Prescription Drugs – prescription medication is recommended by doctor to treat an illness. The Obamacare program aims to cover at least one type of prescription per category and classification of federally approved drugs.
Rehabilitative Services and Devices – rehabilitative services help people get back on track after a stroke. This could be a speech therapy to help the patient recover his mental or physical skills to make the person get back on his feet. Obamacare also covers devices needed for habilitative reasons.
Laboratory Services – tests are necessary to help doctors diagnose an injury or illness. These are also useful in monitoring the effectiveness of a particular treatment administered on the patient. Preventive screenings such as for breast cancer and prostate cancers are offered free of charge.
Preventive Services – wellness services and treatment for chronic service may be administered for free, as well. These include immunizations and screenings to prevent or detect certain diseases.
Pediatric Services – infants and children can receive care, including well-child visits, vaccines and immunizations free of charge. Children below 19 should be offered by dental and vision care.
When Do People Start Enjoying These Essential Health Benefits?
Beginning January 1, 2014, all qualifying plans are to be offered with the Affordable Care Act essential benefits.
Who Can Gain Access To These Essential Benefits?
Health plans sold in individual and small group markets, as well as policies bought on and off the Health Insurance Marketplace and government healthcare plans like Medicare and Medicaid are to include these 10 Essential Benefits. This means that virtually all Americans will have access to the benefits of the Affordable Care Act program.
However, plans bought before the law was passed in March 23, 2010 will be discontinued this year, whereas self-funded administrative services organization plans and large group plans won’t be able to have access to the essential benefits. But it is important to note though that older plans that do not offer those benefits can be bought with lower premium costs because they offer lesser coverage. Certain benefits may also vary by state.
How Much Do These Essential Benefits Cost?
There are Essential Benefits that do not have out-of-pocket costs. All Essential Benefits also do not have annual or lifetime limits but have minimum cost sharing limits.