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:
- Changes to WHAT you buy
- Changes to HOW you buy
- 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
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.
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