The Changing Health Insurance Landscape

No matter what your thoughts on the Patient Protection and Affordable Care Act (PPACA or ACA), it has set the stage for profound changes in the healthcare and insurance landscape.

Coverage Has Improved Under ACA

The act sets the stage for minimum benefits, referred to as essential health benefits, which must be offered by all private and public health insurance plans. These benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care, mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Pediatric services, including oral and vision care
  • Preventative and wellness services and chronic disease management (No Cost)

Under the Act:

  • Insurance coverage must be offered to all applicants regardless of pre-existing medical conditions. It means that no one can be turned away without coverage.
  • Children may remain on their parent’s plan until age 26.
  • You cannot be dropped or rates increased if you become ill or injured.
  • Lifetime benefit ceilings have been removed.

Available Assistance

The Act provides assistance in the forms of advance premium tax credits and subsidies to lower the cost of care significantly. Households earning up to 400% of the Federal Poverty Level may be eligible for the tax credit, which is applied directly to the premium to reduce their cost of insurance. The subsidy is used to reduce the deductibles, coinsurance, co-payments and out-of-pocket expenses.

Carrot and the Stick

The law requires that everyone must obtain health insurance coverage. For 2016 and 2017, the penalty for not having insurance is $695 per adult, $347,50 per child, up to $2085 per family or 2.5% of the gross adjusted income for the household, whichever is greater!

For many, the cost of great coverage is less the penalty or cost of self-insuring medical and prescription costs.

Impact on Medicare

The Affordable Care Act focuses on individual and family private insurance and small company employee coverage, but it has also had a far ranging impact on other types of health insurance as well.

Medicare insurance, which is the cornerstone of health insurance coverage for citizens over sixty-five, has been impacted. Insurance coverage under Medicare has incorporated many of the innovations introduced by ACA including an expansion of essential health benefits and the discontinuation of any pre-existing condition as well as other changes.

Even if you have had your Medicare coverage for a number of years, it is worthwhile to review your plan with our staff of certified professionals. Together, we can identify any and all changes for your present plan; new benefits features that may be available for you; and ways to further reduce your costs associated with healthcare and insurance.