What Are Obamacare and the ACA, and Can They Work for You?

What is the ACA? It’s the Affordable Care Act, implemented in 2010. It is widely known as Obamacare and is sometimes referred to as the Marketplace.

Why do we have the ACA? This law was passed to protect consumers from insurance companies driving up patient costs or restricting their care, especially for preexisting conditions and chronic diseases. Before this law was passed, a person with a preexisting condition either had a hard time finding health insurance, or could only find very expensive insurance or none at all. For a person with a long-term health condition like heart disease or diabetes, the ACA has been very helpful.

The ACA has also been helpful for lower-income Americans as the federal government subsidizes the price of their premiums. The lower the income, the greater the subsidies.

Getting Care When You Have Health Insurance Under the ACA

First, you can sign up for health insurance under the ACA during open enrollment periods which, for individual health insurance (not Medicare) extend from November 1 to December 15. This insurance goes into effect the first day of the new year.

Once this insurance goes into effect, there is no waiting period to get treatment for a new or preexisting condition.

These additional points also apply once the insurance becomes effective:

  • There is no maximum benefit limit with these policies.
  • 100 percent of preventive care visits and screenings are covered.
  • Prescription drug coverage is included.

There are also Special Enrollment Periods (SEPs) during which certain people can enroll in health insurance plans. We’ll be providing more information about SEPs in this blog so check back often to learn more.

When you complete your enrollment during a SEP, the effective date of the health insurance is the first day of the next month. You can start any treatment you might need on that day.

Things to Watch for as You Choose a Health Insurance Plan

Before enrolling in a plan, you should make a list of any doctors or hospitals you want to utilize. You should know what prescriptions or surgeries are coming up for anyone who will be covered.

For your medical expenses to be covered by your insurance, you will need to ensure that the doctor or hospital you want is in network with your insurance. It is your responsibility to know who’s included in the network of your chosen insurance. You can call the insurance company directly or your insurance agent.

Don’t ask the doctor or their office staff if they are in-network for a particular insurance. They don’t always have the correct answer. It is 100 percent the consumer or patient’s responsibility to ensure that the practitioners they need or want are in-network.

There will not be any recourse if the insurance company rejects your claims because you saw a practitioner that is not in their network. You will have to wait until the next open enrollment period to change your insurance if you are determined to stay with the same practitioners or hospitals.

Finding the Best Coverage

When you’re a client of MBhealth, we’ll not only help you find the best coverage, we’ll find out if your favorite practitioners are in network with the company offering you the best coverage.

There are good plans available under the ACA and we know what to look for. We can make the whole process much easier for you and ensure you get the best coverage possible. If you need to change your insurance or need to get insurance for the first time, give us a call at: (314) 544-5400 and let’s chat. 

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