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The world of health insurance is an ever-changing maze of twists, turns, and unexpected costs that can be confusing to navigate.
By definition, health insurance is a health coverage plan that covers any medical, dental, and surgical expenses incurred. A comprehensive health insurance plan will reimburse you for part or all of the costs acquired from an injury or illness. Some plans on-the-market are even willing to pay the medical care facility directly, without the delays of reimbursement.
There are thousands of healthcare insurance programs offered by both private and public entities that you can use to safeguard your health. That said, this article will focus on the Affordable Care Act (ACA)-compliant insurance plans.
What is the Affordable Care Act (ACA)?
The Affordable Care Act, also commonly known as Obamacare, is a comprehensive healthcare reform that was passed into law by President Barrack Obama in 2010. It was formerly referred to as the Patient Protection and was later developed to make healthcare insurance coverage affordable to many uninsured Americans.
The ACA has created a marketplace that controls and prevents insurance providers from limiting coverage due to pre-existing conditions. The Affordable Care Act has also instituted a set of rules and regulations to adhere to when covering primary health benefits. Similarly, through ACA, people with low incomes can qualify for additional savings on health insurance programs through cost-sharing and tax credits.
What makes a plan ACA-compliant?
ACA-compliant health insurance plans are medical policies that conform to the Affordable Care Act’s rules and regulations. When a program is ACA compliant, it means that an insurance company is forbidden from instituting lifetime or annual coverage limitations. This clause promises that an insurance provider will not impose limits on your coverage, regardless of the number or frequency of your medical bills.
The second compliance requires that during the Open Enrollment Period (OEP), the issuing of insurance plans should be guaranteed, meaning that a person should be awarded coverage regardless of their pre-existing conditions. A qualifying life event (QLE), exclusive to the open enrollment clause, can also enable you to enroll in a plan that does not limit your coverage due to a pre-existing condition.
Typically, an ACA-compliant plan must abide by the Affordable Care Act’s provisions. These stipulations are crucial to you as a consumer. Most of these insurance plans are usually purchased from the state health insurance marketplace, through healthcare, or are employment-based. To conform to ACA-regulations, an insurance company must offer or cover the ten essential health benefits such as:
- Hospitalization, where you’ll be given services like overnight stays and surgical procedures
- Prescription medication
- Maternity care, i.e. care for you and your unborn or newborn infant
- Pediatric services, including vision and oral care
- Laboratory services
- Ambulatory patient services that entail the outpatient care you receive in the care facility without being admitted
- Mental health and substance use disorder services, including mental and behavioral treatment such as psychotherapy and counseling
- Rehabilitation and habilitative services and devices, including devices that assist those with disabilities, chronic conditions, or injuries and help them regain mobility or full cognition
- Emergency visits that grant full-access care from the nearest healthcare facility (Note: You should be treated whether you have insurance. In these cases, your insurance provider can’t charge you more for receiving medical care from out-network care facility)
- Preventive and wellness services and chronic disease management services, including shots and screening tests
Insurance benefits should also include birth control coverage and breastfeeding coverage. The birth control coverage plan must consist of counseling and contraceptive programs to all women, as prescribed by the doctor. Whether provided by an in-network or out-network provider, these services need to be delivered without extra charges, regardless of your deductible status.
Some of the contraceptive methods covered include sterilization, hormonal methods, barrier methods, emergency contraceptives, implanted devices, and patient education and counseling. Under ACA guidelines, an insurance plan must offer counseling services, breastfeeding support, and equipment to pregnant and nursing women for as long as these services are needed.
The program should follow the doctor’s recommendations and provide care before and after birth. Other additional benefits that may be provided by your provider include dental and vision coverage, as well as medical management programs such as diabetes, back pain, and weight management.
What plans are not ACA-Compliant?
A non-ACA-compliant insurance plan is a type of healthcare policy that is offered outside the ACA marketplace and doesn’t adhere to the ACA guidelines. These types of plans are attractive because of their ability to provide cheap insurance coverage. However, most of the insurance plans leave consumers at risk of massive medical bills, due to their limited coverage and hidden costs. Such plans include fixed indemnity plans, short term plans, association health plans, and health care sharing ministries.
Conclusion
The health insurance marketplace approves ACA-compliant insurance plans, which means that they are readily available for those in need of all-encompassing health coverage. These plans are expected to follow the established guidelines regarding cost-sharing while offering the same essential benefits. However, it is vital to note that while marketplace plans feature the same benefits, the benefit categories may vary depending on your state’s requirements.
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This content is brought to you by Jana Gray.
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