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Changes to What You Buy

Want to know more about the health reform law and what it means for people without employer-based health insurance? We’ll walk you through the basics of how Affordable Care Act (ACA) has changed the health insurance buying process, all in three steps:

  1. Changes to WHAT you buy
  2. Changes to HOW you buy
  3. Changes to WHEN you buy

No More Pre-Existing Conditions

The ACA eliminated pre-existing conditions starting 2014. No more pre-existing conditions means you can’t be denied coverage, charged more, or denied treatment based on health status.

Preventive Care At No Out-Of-Pocket Cost

At least 15 free preventive services and one wellness visit are covered on major medical plans sold after 2014 without any out-of-pocket cost, regardless of whether you have met your deductible yet. Services must be done in-network to avoid cost sharing.

10 standard essential benefits

  • Laboratory Services
  • Pediatric Services
  • Emergency Services
  • Rehabilitative Services & Devices
  • Mental Health Services and Addiction Treatment
  • Preventive Services, Wellness Services, and Chronic Disease Management
  • Prescription Drugs
  • Ambulatory Patient Services
  • Maternity & Newborn Care
  • Hospitalization

Levels of Coverage

In 2014 a new metallic rating system was introduced to make it easier to tell what level of coverage you’re buying. All metallic plans must cover at least 60% of total average estimated costs for the plan’s benefit package. Meaning, 60% of covered medical expenses paid by the insurance company; 40% by the consumer.

  • Platinum = 90% MOST COVERAGE
  • Gold = 80%
  • Silver = 70%
  • Bronze = 60%
  • Catastrophic < 60% LEAST COVERAGE

Catastrophic plans are only for people under the age of 30 and they may cover less than 60% of the total average estimated costs for the plan’s benefit package. 

Plans that fill gaps in coverage

  • Supplemental Plans
    • Life Insurance
    • Dental Insurance
    • Vision Insurance
    • Critical Illness Insurance
    • Accident Insurance
  • Gap (Short-Term) Plans: Outside of an enrollment period, people may have to wait to get coverage. Gap insurance products like short-term medical insurance may be helpful if you need limited coverage outside of the enrollment window.


Source: https://www.ehealthinsurance.com/resource-center/wp-content/uploads/3-steps-obamacare-ehealth-2016.pdf

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