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The Affordable Care Act Summary: What’s Covered Under the PPACA (A.K.A. ObamaCare)

Cropped SingleCare logo By | July 24, 2015

In the Spring of 2010, the PPACA (Patient Protection and Affordable Care Act) became law – and just a few weeks ago, the Supreme Court upheld the act’s ability to bring subsidized healthcare to low-income Americans. What exactly is Obamacare, and who does it cover?

The topic of health insurance can sometimes feel too convoluted to even approach, let alone use to your advantage. And yet, the lives of millions of Americans depend on sorting through it all. Obamacare has fundamentally altered the way the American healthcare system works, and it’s important to understand how this recently passed law impacts healthcare today.

From “Yes We Can” to “Yes We Did”

Five years ago, the passage of Obamacare heralded what the Wall Street Journal has referred to as “the most ambitious social program in nearly 50 years.” The PPACA, more commonly known as the Affordable Care Act, transformed a system that had previously denied care to more financially vulnerable citizens, and now provides millions of additional Americans with health coverage.

Before Obamacare, those with preexisting medical conditions were at risk of rejection from health insurance providers. Patients could be removed treatment due to basic application errors, and women could be charged additional fees for coverage identical to that received by their male counterparts.

The President’s motivation in passing this legislation was to reform a system that believed made healthcare a “privilege for a few,” rather than “a right for all.” As a result, one of the new law’s major aims has been to increase accessibility – simple videos like this one the White House demonstrate a desire to making healthcare comprehensible and inclusive.

Updating Coverage

obamacare
Image credit: Mark Nozell / flickr

With the passage of Obamacare have come a variety of changes to the way healthcare and health insurance is packaged, sold, and put into practice. These changes will be especially important for young Americans, who often forgo purchasing medical coverage due to their perception that youth and good health reduce their risk of developing substantial health issues.

For example, millennials can now remain on their parent’s existing plan until the age of 26. After this point, they have the opportunity to shop and compare different plans through the federally-run marketplace on healthcare.gov.

Perhaps most importantly, it’s now illegal for insurance companies to reject a candidate for medical coverage because he or she is sick or has a pre-existing medical condition. Providers are also now unable to deny coverage due to simple application errors. And of particular importance to many, the Affordable Care Act has drastically increased the availability of women’s health services, including preventative services and access to contraception.

Affordable Care Act Essentials

obamacare rally
Image credit: United Workers / flickr

One of the most important tenets of the Affordable Care Act is called Minimum Essential Coverage. To comply with this new law, citizens must maintain minimum medical coverage throughout the year. Failing to buy coverage means that you’ll have to pay a fee for each month you aren’t covered, or otherwise obtain an exemption. There’s a bit of wiggle room in the form of a coverage gap extension – two full months to obtain a plan – but the majority of Americans simply have to find a plan that works for them.

There are certain criteria that determine what qualifies as minimum essential coverage — for example, a plan that includes only vision and dental policies doesn’t count. But by and large, most policies provided by the federal government or an employer are covered. For a more comprehensive list of what qualifies, refer to ObamacareFacts.com.

On the other side of the transaction, insurance providers can’t be certified and offered on the Healthcare Insurance Marketplace unless they cover at least ten categories of benefits. Called Essential Health Benefits, the list is as follows:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

 

Can I Afford Health Insurance?

Image Credit: Images Money/flickr
Image Credit: Images Money / flickr

Unfortunately the answer here is “maybe.” If you don’t receive healthcare through your employer and don’t qualify for Medicare or Medicaid, then your next option is to buy insurance through a healthcare exchange. The cost of plans vary based on your location, your age, whether it’s for you or for your whole family, and whether or not you’re a smoker. The government does provide assistance in the form of a subsidy, which can vary depending on your income, but if you don’t qualify for a subsidy, your monthly cost could easily reach $400. In addition to that, remember you’ll be on the hook to pay for the costs associated with non-preventative care through your deductible period.

And whether you’re already covered or just now looking for a medical plan, new providers have stepped in to broaden the benefits beyond what Obamacare can provide. For example, SingleCare offers pay-as-you-go access to medical care, which may save you money and time.

It’s a time of change for healthcare in the U.S. — luckily citizens have more ways to find affordable health coverage than ever before.