By Emily Newhook
The implementation of the Affordable Care Act (ACA) means big changes in 2014, including the way many young Americans pay for doctor’s appointments and other health care expenses. Here are three facets of the law that take effect this year – and how they may change your next doctor’s appointment.
1. Pre-existing conditions won’t prevent you from getting most types of coverage
Between 19% and 50% of Americans under the age of 65 have pre-existing conditions. Pre-existing conditions refer to medical issues that exist before you apply for insurance. Serious examples include cancer, ongoing mental illness and HIV/AIDS, but you could have also been denied coverage based on common complaints such as hay fever or an overbite – until now, at least. Now, your insurance company cannot deny you or your enrolled family members coverage for any pre-existing conditions. (Certain “grandfathered” plans in existence before March 23, 2010 are exempt from this requirement. Your insurer will notify you if you have a grandfathered plan.)
2. You may get help paying for medical expenses through subsidies, tax credits or Medicaid
We all know health insurance is expensive; however, the ACA includes two key provisions that may help take the strain off your wallet:
Premium tax credit essentials
- The premium tax credit is only available for “metal level” (i.e. bronze, silver, gold or platinum) plans purchased through the new health insurance marketplaces.
- Your income must be between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for individuals) to qualify.
- You can choose to receive your premium tax credit in advance (i.e. automatically deducted from the amount you owe for your health insurance premium each month), or at the end of the year when you file your tax return.
- The amount of your premium tax credit will vary based on your income and how much plans cost your area. To find out how much your premium tax credit is worth, check out this handy subsidy calculator from the Henry J. Kaiser Family Foundation.
- Some silver level plan beneficiaries are eligible for another ACA program, cost-sharing subsidies, that lowers copays, coinsurance and deductibles.
In summer 2012, the Supreme Court ruled that states were not required to expand Medicaid– meaning that states can decide for themselves whether or not they plan to pursue that option. Does it matter for you? It might. Expansion is meant to provide insurance for those who do not make enough income to pay for it on their own. Before the ACA, Medicaid eligibility was limited in most states to certain categories of low-income individuals (e.g. children, pregnant women, the aged, blind or disabled). Now, all low-income individuals including childless adults can qualify for coverage through Medicaid in states participating in the Medicaid expansion. The states that expand Medicaid will increase eligibility levels to 138 percent of the federal poverty line ($15,856 for an individual) – a measure that would cover over 40% of all uninsured Americans (especially the working poor) if all states took advantage of the opportunity.
Are you eligible for expanded Medicaid? The first step is finding out whether or not your state leaders support the measure. Click here to see where your state stands on Medicaid expansion.
3. Health insurance plans must offer 10 essential health benefits
Under the ACA, all health insurance plans must offer 10 “essential health benefits” (with the exception of “grandfathered” plans). The 10 essential benefits include:
1. Outpatient care, such as a doctor’s office visit.
2. Emergency services, such as emergency room visits and transportation by ambulance. In addition, you won’t be penalized for going to an out-of-network ER.
3. Inpatient hospital care.
4. Maternity and newborn care.
5. Mental health services and addiction treatment.
6. Prescription medications, though insurers may limit drugs they will cover or require your doctor to try a less expensive medication before they will cover expensive drugs.
7. Rehabilitative services and devices.
8. Laboratory services and preventive screenings such as blood monitoring, x-rays and CAT scans.
9. Preventive services such as wellness exams, certain chronic disease treatment, immunizations, certain wellness services and preventive screenings will be covered.
10. Pediatric services such as well-child visits, immunizations, dental and vision care.
Note that while there are no dollar limits on essential health benefits, there may be some restrictions on the number of days or treatments covered.
There’s a lot of information and misinformation about the ACA and how it will influence your health – and your bottom line. Protecting yourself requires educated decisions about health care, which means it’s crucial to keep reading and stay engaged as you seek out a health insurance option that works for you.
How has the ACA affected your ability to stay healthy and solvent in 2014? Tell us about it!
Emily Newhook is an outreach coordinator for the MHA degree program from The George Washington University, MHA@GW. Outside of work, she enjoys writing, film studies and powerlifting. Follow Emily on Twitter and Google+.