Everyone who has health coverage uses ObamaCare in one way or another. It is a misconception that only one demographic is impacted by the Affordable Care Act. Those who are impacted the most by ObamaCare’s provisions are those covered under the expansion of Medicaid, those who qualify for cost assistance, those who got covered by…
Health Insurance Denial and Cancellation Appeal Rights Under the Affordable Care Act (ObamaCare) Customers have appeal rights for the denial of health insurance claims, the cancellation of health plans, and marketplace decisions under the Affordable Care Act (ObamaCare). However, one must appeal within the proper timeframe. Here are the most important things you need to…
An employer can cut back hours, but once you qualify for employer health insurance they must offer coverage until the end of the calendar year.
Deferred Action for Childhood Arrivals (DACA) recipients are not eligible for ObamaCare, don’t have to comply with the mandates, can’t use the marketplace, and can’t get cost assistance.
Those who want to repeal ObamaCare due to being upset with the cost or the mandate should think carefully about why guaranteed coverage for preexisting conditions matters.
A final rule from HHS prohibits discrimination based on race, color, national origin, sex (and gender identity), age, or disability.
If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.
Gender based pricing rules apply to new plans in the individual and small employer markets. They do not apply to grandfathered plans, large employers, or self insured businesses.
Preventive screening, including mammograms, is covered at not cost under ObamaCare but additional exams may have cost sharing or may not be covered.
A legal immigrant can buy a private plan or get cost assistance through ObamaCare (if they file taxes), but can’t get Medicaid before 5 years in most cases.
The ACA does not require coverage of prophylactic mastectomy or reconstruction procedures, but some state laws do. Thus it will be plan specific and state specific.
Wellness visits and key preventive care are covered with no out-of-pocket costs, but some related services aren’t covered without cost sharing.
If an employer offers grandfathered or large group coverage that doesn’t offer all benefits of the ACA it may still count as minimum essential coverage.
A public company can refuse to offer birth control for religious reasons, but a third party must provide free birth control to all employees with coverage.
The Affordable Care Act covers screening and counseling for domestic and interpersonal violence as a free preventive service for women.
College students have a number of health plan options including the Marketplace, Medicaid, school health plans, catastrophic plans, and their parents plan. Below we take a look at student health options under the Affordable Care Act (ObamaCare). FACT: A university health plan counts as Minimum Essential Coverage for ObamaCare if it’s fully insured or self insured. Aside…
Out-of-network emergency care is covered under all insurance plans sold after March 23rd, 2010 as part of Ten Essential Benefits under the Affordable Care Act.
Employees can get free contraceptive coverage on employer plans, even if an employer is exempt from offering contraception for religious reasons. Coverage is provided through a third party and is not provided by the employer.
The free preventive visit under ObamaCare covers routine wellness and prevention, it may not cover discussion of existing conditions and other asides.
You have a 60 day special enrollment period starting the moment your baby is born to add your child to a Marketplace family plan or to switch to a family plan.
Pregnancy, ability to become pregnant, and gender have no affect on health insurance premiums. However, the ACA does provide improved benefits and some free services to pregnant mothers and women.
Under the ACA you can be charged a tobacco surcharge for smoking of up to 50% of your premium after subsidies, regardless of where you get coverage. Typically won’t be charged the full amount and some insurers may not charge anything at all.
Everyone gets one free preventive visit a year, other visits are subject to cost sharing, you may owe the full amount for a visit not coded correctly.
A health insurance premium can’t be based on health status or claims, so an insurer can’t increase premiums based on claims made. The ACA protects against discrimination based on health status. You can’t be denied or charged more based on health status or claims.
ObamaCare covers rehab for alcohol and drugs as part of it’s ten essential benefits. Treatment can still include cost sharing amounts and other limits.