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Six Things You Need To Know About Obamacare

Edward Neeman | Published: June 14, 2018

Magnifying glass Obamacare money

Health insurance is in the news a lot lately, and it can be confusing! Here are six things you need to know about the Affordable Care Act, aka Obamacare.

1) You Must Get Health Insurance During Open Enrollment

Under what's called the individual mandate, all legal U.S. residents (who don't qualify for an exemption) must purchase basic health insurance coverage. And they can only get it during Open Enrollment. If you don’t get health insurance, you will pay a tax penalty.

This tax penalty is either a set fee, or percentage of your annual income. And in case you're still thinking of opting out of coverage, keep this in mind: If you don't get insurance, you will have to pay the penalty plus the full cost of any healthcare you receive this year. So it's a good idea to buy a plan, even for the most basic coverage.

2) Sick People Can Get Health Insurance Too

Before Obamacare, insurance companies could simply refuse to cover people who were already sick. When you applied for a plan, insurers would scan your medical records to look for signs of illness. Anything from an old sports injury, to asthma, to more severe diseases like diabetes or cancer could disqualify you from getting a plan. Sometimes insurers would offer an overpriced policy, or flat-out deny coverage.

This discrimination kept 25% of America from getting affordable health insurance! So Obamacare put an end to this practice. Now insurers must cover anyone—even if they're sick or injured. But there's one exception: Under the new law, tobacco users can be charged up to 50% more for a plan. So if you're a smoker, now's the time to seriously consider quitting!

3) If You Can't Afford A Plan, You Can Get Help Paying For It

Obamacare has made 11 million Americans eligible to get help paying for healthcare. There are two ways to get help paying for an insurance plan: a tax credit or a cost-sharing reduction.

A tax credit helps pay for part of your monthly premium. It is available to people with an expected household income that falls between 100 and 400 percent of the Federal Poverty Level (FPL).

There is also something called a cost-sharing reduction. This helps pay for part of your out-of-pocket expenses. It is available to individuals with an expected household income that falls at or below 250 percent of the FPL.

If you qualify for help, you have to buy a plan through the Marketplace. So talk to an insurance agent to see which plans are available in your area!

4) You Have A Legal Right To Understand What You're Buying

In short, insurance plans must be easy to understand. When you're trying to compare plans, the last thing you want to read is a long-winded explanation of each plan’s costs and benefits. Under Obamacare, all health insurers must now provide you with a Summary of Benefits and Coverage (SBC)—an easy-to-understand explanation of what a plan covers.

That means you can compare multiple plans at a time, just as easily as you compare frozen pizzas at the grocery store. (Seriously. The SBC is designed after the Nutrition Facts label used for packaged foods.) So no more confusing jargon only lawyers and insurance experts could interpret. Just a straightforward summary that anyone can understand. Hooray for transparency!

5) Plans Have To Cover Stuff You'll Need

All new health insurance plans must meet a minimum set of requirements for healthcare that you and your family might need.

Here are the 10 essential health benefits that every plan must include:

  1. Emergency services: Trips to the emergency room in case of accident or sudden illness
  2. Inpatient care: Treatment you receive in the hospital
  3. Outpatient care: Treatment you receive without being admitted to a hospital (like a doctor or clinic visit, same-day surgery, and hospice or at-home care)
  4. Maternity and newborn care
  5. Services for mental health substance use disorders: Includes counseling, behavioral health treatment, and psychotherapy
  6. Prescription drugs: Medications prescribed by your doctor to treat an illness or ongoing condition
  7. Rehabilitation services: Includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more
  8. Lab tests to diagnose or monitor an injury, illness, or condition
  9. Preventive services: Includes counseling, physicals, vaccines, woman and child wellness visits, and care for managing a chronic disease
  10. Pediatric services: Includes dental care and vision care for kids

Specific benefits vary by state and insurance provider. Talk to an agent to see exactly what’s covered by a plan you’re considering.

6) You're Guaranteed Preventive Services

Essential benefit No. 9 is worth pointing out because 70% of deaths in the U.S. are related to chronic diseases like diabetes, obesity, cancer, and high blood pressure.

And in many cases, these diseases are largely preventable.

Thanks to Obamacare, you'll get free care for services that keep you from becoming a future statistic. So you won't be charged for preventive services like annual checkups, vaccinations, and tests for chronic diseases. Buy insurance this year, and you'll get the care you need to protect your health.