The Affordable Care Act

​Good health is our most important asset.  In fact, it is priceless.  If you have experienced a period of poor health, you know what I mean.  In this country, one of the best ways to avoid financial disaster is to have health insurance.

Currently 92% of Americans are insured either through private or public plans. While many people intend to work until age 65, which is when they become eligible for Medicare, sometimes life happens and we may find ourselves retiring earlier than expected.
  
Finding coverage for the gap years when retirement arrives earlier than Medicare eligibility can often be a challenge.  As we discussed in a previous article, sometimes Cobra, can fill the gap.  However, sometimes the gap is longer than the Cobra allowance and/or Cobra may be more expensive.  If you worked for a small company, they may not even be required to offer Cobra.  One can search out private insurance, but if there is a pre-existing condition that may not be an option.  This is where the Affordable Care Act known as ACA or Obamacare comes in to fill the gap.
  
The Affordable Care Act (ACA) made health insurance available to those who, for a variety of reasons, did not have insurance coverage.  It is non-discriminatory (everyone qualifies regardless of pre-existing conditions) and available in all 50 states through federally or state run health insurance exchanges. 

Many people perceive ACA insurance as a version of Medicaid.  This is not true!  ACA insurance is provided by the same insurance companies that many of us get through our employers such as Blue Cross Blue Shield, United Health, etc.  And just like you can select different coverage options when you get insurance through an employer, the same holds true for ACA insurance.
  
All plans, regardless of state, will fall into one of four plan categories: Bronze, Silver, Gold, or Platinum. These four "metal plans" adhere to a price structure that matches their coverage rates.  Pricing varies depending on state, location within state, age, and the plan selected.

The ACA established subsidy guidelines to help income challenged households afford the insurance.  For additional information on types of subsidies and income thresholds go to 2022 ObamaCare Eligibility Chart and Subsidy Calculator (obamacarefacts.com)

The ACA offers ten essential benefits to the insured:

1. Ambulatory patient services. Outpatient care that you receive without being admitted to a hospital
2. Emergency services. You can’t be charged more for going to an out-of-network hospital’s emergency room if it’s a true emergency
3. Hospitalization. This includes overnight in-patient stays at a hospital
4. Pregnancy, maternity, and newborn care. Medical services for you and your child, both before and after birth, as well as the cost of the delivery, birth control, and breastfeeding services
5. Mental health and substance use disorder services. This includes counseling or psychotherapy
6. Prescription drugs. All drugs may not be covered but insurers must offer an approved list of medications for which they will pay a portion of the costs
7. Rehabilitative and habilitative services and devices. This is intended to help people with chronic conditions, disabilities, or injuries regain or improve skills
8. Laboratory services. Tests that doctors might run to aid in diagnosis
9. Preventive and wellness services and chronic disease management: This outlines doctor’s visits, such as annual exams and vaccinations
10. Pediatric services, including oral and vision care: In addition to the above benefits, children’s benefits must include vision and dental care.

Keep in mind premiums and co-pays vary, so it is important to understand what each plan requires.  There are deductibles too.  HSAs can be used with some of the plans.  We advise seeking additional advice or reading up on the interpretation of HSA benefits with respect to the ACA.

Signing up for ACA is easy.  If you are an Illinois resident, simply go to this site.  If you are a resident of another state, Google affordable care act and your state’s name.  Most of the state-run exchange sites end in .gov.  There are many agencies selling ACA coverage which can be helpful, but you should be aware that you cannot qualify for a subsidy if you are buying your ACA coverage through an agency.

If you have additional questions, please contact Jenifer at jenifer@mosaicfi.com