Benefits, Rights, & Protections

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.

If a doctor doesn’t accept ObamaCare (doesn’t accept Medicaid or a private plan you bought on the Marketplace), then they are considered out-of-network for purposes of cost sharing.

If you are moving states and have lived in the country for less than 5 years or are low income you’ll want to be aware of Medicaid and CHIP eligibly in your state.

The coverage of a transplant depends upon insurance, but ObamaCare can help as many of it’s new protections limit costs and what one can be denied for.

Mental health, including substance abuse disorders (drug and alcohol) are covered on all non-grandfathered plans as part of ten essential health benefits.

Free preventive services are only covered in-network. Some plans may cover part or all of the costs out-of-network, but this is an exception to the rule.

If you are on a family plan and someone loses eligibility for the plan, you get a 60 day special enrollment window to switch to an individual plan.

Gender ratings (charging women more than men or vice versa for health coverage) are illegal under the ACA, but some plans are grandfathered in and can charge more based on gender and discriminate based on health.

When you return to the US as an expat you can either enroll in a health plan through the Marketplace via special enrollment, or if applicable take employer coverage.

You have 60 days from the day you turn 26 to get your own health insurance plan, enroll before your birthday for coverage that starts when the old plan ends.

I am a teacher in SC with health insurance through the state’s health plan under Blue Cross Blue Shield. This insurance does not cover an annual gynecological visit nor birth control pills. I have contacted my insurer to ask why they don’t have to cover this under the Affordable Care Act and they said they… Read More

Pre-existing conditions are covered for special enrollment, if you are enrolling outside of open enrollment use the Marketplace.

Only US citizens and legal residents can get Marketplace health insurance, but there are a number of other options for pregnant foreign citizens.

If you project to make between 100% – 400% of the Federal Poverty Level and you can get cost assistance, less and you may get Medicaid depending on your state.

When you move with a chronic illness you’ll need to apply for coverage before you move to avoid a coverage gap, this can be done via special enrollment.

Prosthetics are covered on most ACA plans, but replacements and adjustments aren’t considered an “essential health benefit”, thus services can be limited.

Whether or not a treatment is subject to cost sharing is based on your plans cost sharing schedule as laid out in the plan documentation.