ObamaCare offers a wide range of benefits and services. Some of the Benefits of ObamaCare are all ready rolled out and many more ObamaCare benefits are coming in 2013, 2014 and beyond. Find out what the benefits and services ObamaCare are and how Obama's health care reform affects you, your family or small business.
As one benefit of Obamacare, if you make less than $93,700 as a family ($46,021 as an individual) you and your loved ones will receive health insurance financing in order to help pay your premium when you purchase health insurance through the online marketplace. This means that you won't be paying the full cost of Obamacare. Middle and low income families and individuals will also be helped with out-of-pocket costs and medicaid coverage if your family decides to offer it.
Because of the new health law, 12.8 million individuals and businesses got back more than $1.1 billion in rebates in 2012 from insurance companies who underspent on medical care.
Obamacare offers you and your family many protections these protections include.
• No annual limits on healthcare
• Insurance companies can't drop you when your sick
• You can't be denied coverage for preexisting conditions
• Obamacare has a strong focus on preventive services
• A large improvement to women's health services
• Reforms to the Healthcare Industry to cut wasteful spending
• Better Care and Protections for Seniors
The new ObamaCare health care law states that health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges (Exchanges), offer "essential health benefits". Please note that grandfathered plans may not be required to provide these services. Read more information about ObamaCare "grandfathered plans".
Starting January 1st of 2014 the following "benefits" must be included under all insurance plans:
• Emergency services
• Laboratory services
• Maternity care
• Mental health and substance abuse treatment
• Outpatient, or ambulatory care
• Pediatric care
• Prescription drugs
• Preventive care
• Rehabilitative and habilitative (helping maintain daily functioning) services
• Vision and dental care for children
The following is a full list of protections and benefits available under ObamaCare from Consumer Reports:
Whether your health insurance is purchased by you or your employer, the health law has outlawed practices that have left people without health insurance when they need it most. These protections include:
Curbs on canceling policies. Insurers can no longer cancel your policy if you get sick, a practice known as "rescission." They cannot cancel your coverage if you make an honest mistake on your application.
Rapid appeals. Consumers can appeal insurance company decisions to an independent reviewer and receive a response in 72 hours for urgent medical situations.
Ban on lifetime limits. Major or long-term illness can rack up serious medical bills. Health insurance policies used to set lifetime limits on how much they would pay for an individual's medical bills. These are now illegal, meaning people with insurance won't have to get into debt because their coverage runs out.
Annual dollar limits on their way out. Insurance companies can still set limits on how much they pay for an individual's medical expenses each year, but as of September 23, 2012, the law says this limit must be no less than $2 million. In January 2014, limits will be completely eliminated. Exceptions: Insurers can still impose other types of benefit limits like doctor visit limits, prescription limits, or limits on days in the hospital.Better Benefits
Free preventive care and annual checkups. The law focuses on prevention and primary care to help people stay healthy and to manage chronic medical conditions before they become more complex and costly to treat. New private health plans must cover and eliminate cost-sharing (co-payment, co-insurance, or deductible) for proven preventive measures such as immunizations and cancer screenings. Additional preventive measures for women kicked in August 2012, including free well woman visits, screening for gestational diabetes, domestic violence screening, breast-feeding supplies, and contraception, all with no cost-sharing. Exceptions: Workplaces run by religious organizations that object to birth control do not have to pay for contraception, but insurers must pick up the cost. Existing plans that haven't changed significantly since passage of the law can continue to charge for preventive care until 2014.
Premium rebates if insurers underspend on care. The health law says that most insurers must spend at least 80 percent (85 percent for insurers covering large employers) of the premiums you pay on medical care and quality improvements. If insurers spend too much on overhead, such as salaries, bonuses, or administrative costs, as opposed to health care, they must issue premium rebates to consumers each summer.
Standard disclosure forms. Starting September 23, 2012, all health plans must use a standardized form to summarize benefits and coverage, including information on co-payments, deductibles, and out-of-pocket limits. Insurers must note any excluded services all in one place. Insurers must also calculate and disclose your typical out-of-pocket costs for two medical scenarios: having a baby and treating type 2 diabetes. Future years will include more coverage examples.
The law makes it easier for some uninsured Americans to find more affordable health insurance right now:
Young adults can stay on a parent's plan until age 26. Health plans must let young adults remain as dependents on their parent's policy until they turn 26, regardless of whether they live at home, attend school, or are married. Exception: Some health plans are not required to extend benefits to young adults if they can get coverage at work; this exception goes away in January 2014.
Chipping away at pre-existing condition exclusions. In 2014 insurers will no longer be able to deny coverage to people with pre-existing conditions or charge them more for premiums. Meanwhile, the health law offers some temporary help.
Adults with pre-existing conditions who have been without coverage for at least six months may be eligible for subsidized coverage through the temporary Pre-Existing Condition Insurance Plan in their state.
Children under 19 with pre-existing conditions cannot now be denied coverage by most insurers. Until 2014, however, insurers can charge more for premiums than they charge for someone without such conditions. Exception: Some individual plans can still refuse to cover a child. This exception goes away in January, 2014.
There is a 365 day waiting period for individuals with pre-existing conditions the BCBS terms and the ACA section "SEC. 101. NATIONAL HIGH-RISK POOL PROGRAM" we can verify that there is a 365 day waiting period for coverage of pre-existing conditions upon purchasing insurance (eliminated along with the pool in 2017).
There is also an "Exclusion Rider" policy that essentially says until 2014 you can be denied coverage on a medically underwritten health insurance policy. EX. You have had surgery previously and you need another operation for the same issue. There are other jargon-y worded restrictions (we'll need to study and report).
The PCIP Pre-exisiting Condition Insurance Plan: makes health coverage available to you if you are a U.S. citizen or reside here legally, you have been denied health insurance because of a pre-existing condition, and you’ve been uninsured for at least six months.
These plans are expensive and thus will most likely not cover low-income individuals. The Program ends in 2014 when insurance through the exchange will cover pre-existing conditions
Visit PCIP.gov for information on plans, premiums, eligibility, and how to apply in your state.
You can apply online or print and complete a paper application from the web site. Or, call 1-866-717-5826 (TTY 1-866-561-1604) to apply.
Some of the biggest changes resulting from the health law take effect January 1, 2014, with the goal of making affordable health care available for all Americans, regardless of their medical history or ability to pay.
Most Americans will be required to have health insurance. As of January 1, 2014, Americans who can afford coverage will be required to purchase health insurance or pay a tax penalty.
No more pre-existing conditions denials. Starting in January 2014, insurers cannot deny coverage to anyone, regardless of pre-existing conditions. And they cannot charge you more because of your gender or more than they charge a healthy person your age. That means you can buy health insurance even if you are seriously ill.
Online insurance marketplaces. Read More About Obamacare Online Insurance Marketplaces
More primary care doctors, coordinated care. With millions more insured Americans on the way, the current national shortage of primary care physicians presents an ongoing challenge to access in the health-care system. The health law has begun to fund training for more primary care physicians and increased resources for community health centers. It also promotes better-coordinated care and increased payment rates for primary care doctors who accept Medicaid or work in rural areas.
Essential benefits offer minimum level of coverage. A minimum level of coverage known as essential benefits must be part of plans, effective January 1, 2014. Individual health plans and those sold to small businesses—whether sold in or out of the health insurance exchanges—must offer a comprehensive package of essential benefits. (See page 9.)
Medicaid expansion assists low income Americans. Up to 17 million Americans could be eligible for Medicaid. As of January 1, 2014, states that choose to can expand their Medicaid programs to legal residents under age 65 earning less than $15,302 for an individual and $31,155 for a family of four. States that opt in will get federal funding to cover 100 percent of the costs for the first three years, then 90 percent thereafter. Exception: Medicaid expansion was the one part of the law that changed significantly with the U.S. Supreme Court ruling on June 28, 2012. The Justices said states can refuse to expand Medicaid to all low-income adults without losing all federal funding for existing Medicaid programs. If a state opts out, it may leave some of its poorest residents without coverage.
It's obvious that ObamaCare offers individuals and families a wide range of benefits and services, but the benefits of ObamaCare go beyond services and tax breaks. The core of health care reform is about Americans ensuring their right to health care, allowing them opportunity to find that new job without jeopardizing their access to coverage and the comfort of knowing that their loved ones will be taken care of when they need it the most. Support Obamacare, protect your interests and help to give every American access to the benefits of ObamaCare.