Services Covered Under Obamacare and the ACA (Affordable Care Act)
The Affordable Care Act provides several benefits to those who have health insurance. These benefits include the following:
- The amount of health insurance used can’t be limited
- Certain Health Insurance coverage cannot be restricted
- An insurance company can’t deny someone who is chronically ill
- Wellness and pregnancy exams are free and without a co-payment
- Health insurance companies can’t raise premium rates without state approval
- Children up to the age of 26 can be added to their parent’s health insurance plan
- A person can’t be denied health insurance because of their pre-existing conditions
- Health insurance companies can’t drop someone from the plan because they become ill
All Health Plans Must Be ACA Qualified
A Qualified Health Plan, or QHP, is a health insurance plan that provides coverage for the 10 essential benefits outlined in the 2010 Affordable Care Act. What are “Essential Health Benefits” and who must have them? From 1/1/2014 and forward, all new health insurance plans (insured small group and individual health insurance plans) must cover the 10 bulleted benefits below called “Essential Heath Care Benefits” to qualify as being an ACA plan (Obamacare). Qualified Health Plans MUST cover these 10 items without any lifetime or annual limits on these “Essential Health Benefits.”
Essential Benefits Included in the Affordable Health Care Act
- Prescription Drugs
- Laboratory Services
- Maternity and Newborn Care
- Hospitalization (for surgeries and overnight stays)
- Rehabilitative and Habilitative Services and Devices
- Pediatric Services (including dental and vision care)
- Preventive and Wellness Services and Chronic Disease Management
- Emergency Services (including services provided at an out-of-network hospital)
- Ambulatory Patient Services (clinics, doctors office, same-day surgery centers, etc.)
- Treatment for Mental Health and Substance Abuse Disorders (counseling services and psychotherapy)
These essential health benefits are the minimum requirements for all Marketplace ACA (Obamacare) plans. They are broad categories, and the specific services that are covered vary from one state to another, depending on what that state requires.
In addition to these requirements, Qualified Health Plans must also comply with limits regarding your cost-sharing expenses (your out-of-pocket expenses) including deductibles, co-payments and annual out-of-pocket limits.
Preventive Services Covered
Preventive services are covered under the Affordable Care Act at no cost to the insured. This means there is no co-payment or deductible. There are specific services provided for all adults and specific benefits provided to women and children.
All adults can receive screening for certain cancers or diseases such as Hepatitis B & C and HIV. Screenings for things such as diabetes, high cholesterol and high blood pressure are also offered. Adults that are at a high risk for chronic disease can receive diet counseling. If you are depressed, you can be screened for that as well. Also, vaccinations are offered at no cost to all adults.
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What is Co-Insurance?
Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.
Health Insurance Coverage Effective Dates
Once you have picked a health insurance policy and paid your first month’s premium, you probably expect your coverage to begin immediately. However, depending on when you enrolled and under what circumstances, you may have several weeks before your health insurance coverage takes effect.
Health Insurance ‘Metal’ Plans Explained
Health insurance companies that sell plans on the Health Insurance Marketplace can offer four types of qualified health insurance plans, including Bronze, Silver, Gold, and Platinum. The plan you choose determines not only the premium you pay but also what portion of your health costs you pay.
Health Insurance Quotes
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Services For Women
Because women’s health care needs are unique, some of the most common preventive services that are offered to women include:
- Contraception
- Anemia screening
- Screening for syphilis
- Screening for gestational diabetes
- Breastfeeding counseling and support
- Folic acid supplements for pregnant women
- Urinary tract infection screening and screening for other infections
- Tobacco use intervention and counseling for pregnant women who use tobacco
- Prevention and screening for pre-eclampsia for women who are pregnant and have high blood pressure
- Rh incompatibility screening for pregnant women and follow-up screening for those who are at high risk
The Affordable Care Act also covers other specific preventive services for women who are at a higher risk for certain conditions, such as breast cancer.
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Services for Children
A variety of preventive services are available for children. Some of these include:
- Immunizations
- Autism screening
- Depression screening
- Behavioral assessments
- Newborn blood screening
- Oral health risk assessment
- Hearing and vision screening
- Screening for a variety of diseases including HIV and Hepatitis B
- Development screening for children younger than three years old
Let Nevada Insurance Enrollment Guide You
When choosing a health insurance plan, be sure to speak with a local, licensed health insurance agent who studies and understands Nevada health plans. This will ensure you choose a health insurance plan that best fits your needs and your budget.
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Recent Posts
Why Does Health Insurance Have an Open Enrollment?
The Affordable Care Act / Obamacare, put specific enrollment periods in place to prevent people from only enrolling in health insurance when they were sick or needed surgery.
Are Fertility Services Covered by Health Insurance?
Even if you live in a state that requires health insurance coverage for fertility treatments, there may be certain requirements that you have to meet to have services covered. For example, if you have unexplained infertility, you might only qualify for in vitro fertilization after a period of time or a specified number of in-vitro cycles.
Affordable Care Act Pros and Cons: Will It Last?
While a lot of good has come from the law, there have been serious downsides as well, leaving many to wonder whether the ACA will stand the test of time or be repealed and replaced.
What Happens If You Forget To Pay Your Premium By The Due Date?
Life happens, and while you should make every effort to pay your health insurance premium on time, health insurance plans generally will have grace periods. You may have a grace period of 30 days, or if your insurance plan is through Nevada Health Link (on-exchange), it may be up to 90 days.