The Affordable Care Act (ObamaCare) created federal and state marketplaces, or health insurance exchanges. The Supreme Court ruled that states could decide whether to create their own exchanges and 13 states and the District of Columbia set up their own state-run marketplace. The states that opted for the federal marketplace use the health insurance exchange website, HealthCare.gov, which is the federally facilitated marketplace.
Facts about ObamaCare
The reason the Affordable Care Act (ObamaCare) was passed to ensure all Americans were able to get health insurance, lower the cost of healthcare and in turn reduce the growing cost of Medicare and Medicaid.
Medicare and Medicaid were established in 1965 during the LBJ administration as part of his plans for the Great Society. Medicare was a comprehensive health insurance program for all elderly citizens, that was financed through the Social Security system. Medicaid, funded by federal and state governments, was established to complement Medicare providing health and medical aid to low-income families.
Health insurance exchange sites lay out health insurance plans in a format similar to an online store. There are four types of plans available: bronze, silver, gold and platinum showing how each of the plans share costs.
Regardless of the plan you choose, Bronze, Silver, Gold or Platinum, the same set of Essential Health Benefits will be covered for Addiction treatment, Ambulatory patient services, Care for newborns and children, Chronic disease treatment (such as asthma and diabetes), Emergency services, Hospitalization, Laboratory services, Maternity care, Mental health services, Occupational and physical therapy, Prescription drugs, Preventive services (such as cancer screenings and vaccines) and Speech-language therapy
All plans sold in the ObamaCare marketplace cover the same basic categories of health care services but each of the plans pay for different amounts of health care costs.
Each plan requires the payment of a monthly fee (called a “premium”). The first reaction is to go for the lowest premium - but lower monthly premiums do not always save you money.
If you choose to pay less each month in premiums, your plan will charge you more for health services, such as doctor visits, throughout the year and you will pay more for out of pocket expenses.
Each category of health plans (Bronze, Silver, Gold or Platinum) only provides a guideline to the average amount of health care costs that the plan will pay. A plan may pay more or less of your costs, depending on how much care you need.
Out-of-Pocket Costs are based on the chosen plan’s deductible, co-payment, co-insurance and out-of-pocket maximum.
Deductible: A deductible, or excess, is the amount you have to pay for covered services before your insurance starts to pay.
Co-payments: Co-payments are a set dollar amount that you pay each time you receive a service (such as say a $25 fee for each doctor’s visit or $125 for an emergency room visit.
Co-insurance: Co-insurance is your share of the costs of a healthcare service that you must pay, based on a fixed percentage of the total charge for a service. For example, 15% co-insurance for a hospital visit charge of $1,000 means that your share of the costs would be $200 (20% of $1,000).
Out-of-Pocket Limit: A plan’s out-of-pocket limit is the most you pay during a policy period (typically a year) before your plan starts to pay 100% of the allowed amount.
The categories of plans (Bronze, Silver, Gold or Platinum) to help to compare ballpark costs
Bronze Plans: The Bronze plans are the lowest monthly premiums and pay for about 60% of medical care costs
Silver Plans: The Silver plans pay for about 70% of medical care costs
Gold Plans: The Gold plans pay for about 80% of medical care costs
Platinum Plans: The Platinum plans are the highest monthly premiums and pay for about 90% of medical care costs
The Marketplace also provides information to find out whether you qualify for money-saving federal subsidies which can lower your out-of-pocket costs or Advanced Premium Tax Credits, which lower your monthly premiums.
The magnitude of the Affordable Care Act (ObamaCare) is reflected in its hundreds of sections, which are detailed under ten main title headings, that constitute the law:
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