Obamacare News Blog

ObamaCare At a Glance

ObamaCare FAQ

We receive questions every day about how the Affordable Care Act, AKA ObamaCare, will affect you. We have compiled a list of answers to those questions.

1) What are the new ObamaCare plans?
The plans are called the Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan.

2) How much do the “metal” plans cost?
This depends on your state, region, and age. For instance, as of July 26, 2013 New Mexico has the lowest rates and New York the highest. To see a break down of rates go to the California Bronze Plan and Silver Plan rate comparison.

3) What are the essential health benefits?
There are ten essential health benefits guaranteed by the Affordable Care Act:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

4) If I have a pre-existing condition are there ObamaCare plans available to me?
Yes, all of them. With the new Affordable Care Act insurance companies can no longer discriminate against persons with pre-existing conditions. This new part of the law is called guaranteed issuance. Also all ObamaCare insurance plans must guarantee renewal on all plans regardless of medical condition

5) How is physical therapy and occupational therapy covered in the new ObamaCare plans?
As far as we can tell, these would fall under the ACA’s rehabilitative and habilitative services as part of their 10 essential health benefits. They should be covered under the new plans, however it is unclear to what extent and under which circumstances.

6) What are habilitative services?
Most people are familiar with rehabilitative services but many have not heard of habilitative. Basically it’s anything that prevents something from occurring or for someone who has not yet attained the skill or use of on their own, for instance a hearing aid or speech therapy.

7) How do I know if I qualify for subsidies?
First, there are two types of subsidies: ObamaCare premium subsidies and ObamaCare cost-sharing subsidies. It depends on which state you live in where you need to fall on the federal poverty line (FPL). Yes, there are perimeters (100-400% FPL) but some states have expanded Medicaid, while others blocked the expansion -meaning that you may be Medicaid eligible leaving in California but not Medicaid eligible if you live in Louisiana. As well as Hawaii and Alaska both have an FPL that is higher than the 48 contiguous states. For your individual answer you should call 800-930-7956.

8) What new rights do I have with the ACA?
There are quite a few rights gained by the law:

• Makes coverage clear
• Insurance companies accountable for rate increases. See ObamaCare 80/20 Rule
• Insurance companies cannot cancel your health insurance just because you get sick
• Choice of doctors
• Up to 26 can stay on parents’ coverage
• $0 preventive care
• Right to appeal

9) Are breastfeeding services covered?
Yes. Your plan must cover the cost of a breast pump (may be a rental or a new one). According to the government’s health care website, “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after you have your baby.” There might be other services available, you should check with your provider for details.

10) Do the new ObamaCare plans offer dental?
For children, yes. For adults, maybe. What is meant by this is children’s dental must be offered as a bundled or stand-alone plan. For adults, plans do not have to offer dental, however plans may choose to offer it bundled or as a stand-alone.

11) Why do I need health insurance?
Well, the quick and easy answer to that is you are mandated to do so or you will pay a fine. But a good reason to have insurance is an average 3-day hospital stay costs $30,000, and the cost of fixing a broken leg costs $7,500. Basically health insurance gives you financial protection.

12) Can you explain to me the different payments I make with ObamaCare?

• Premiums: Fixed amount you pay to have a plan
• Deductible: Amount you have to satisfy before your insurance pays its share (some plans offer services before deductible is met)
• Copay: Fixed amount you pay for a medical service (can be before or after deductible is met)
• Coinsurance: Percentage you pay after deductible is met

We will add to this list as we receive more questions. Please let us know if you feel that a question or information should be added to the list that is not currently here, as we always welcome comments. If you would like to have a specific question answered feel free to call the number above or contact Medicoverage at anytime.