Health Insurance Rules


 Health Insurance Rules

The Affordable Care Act or Obamacare is having a significant effect on American healthcare. It changed the rules of what people are covered by and how much they pay for their own healthcare. This has caused confusion among both consumers, who don't know what changes were made, and medical professionals, who don't know the new rules.

Since the law was passed, insurance companies have needed to open up about their policies and make it easier for people to compare plans. This has caused a lot of confusion.
As a response, the Department of Health and Human Services (HHS) released an updated list of adjustments to health plans this fall . The list included several clarifications about changes that insurers would make since the April 1 implementation date.
The confusion continues today.
The first rule is that all health plans had become available in the new marketplaces on Jan. 1, 2014 -- no matter what they did before. This release is specifically for people who are not yet members of an exchange or Medicare Part D drug program (even if they want that coverage). The changes in the list are listed as "grandfathered" plans that previously were not required to change their plans in any way.
The second rule is that the rules that applied to all plans had changed since they were first announced. These were large changes, but affected only a very small number of people.
A third rule is that premium levels must be much lower, and cover far more people, compared with pre-ACA days. Premiums for individual health insurance ranged from $297 per month for a silver level plan (the cheapest coverage) up to $9,500 per month for a gold level plan (premiums are paid out of pocket and are subject to tax). To put these numbers in perspective, the average price of a single-family house in the United States is $296,100 per month.
The fourth rule is that some hospitals and doctors are no longer affiliated with each other. This is due to a change in the definition of what it means to be "in-network." Under Obamacare, plans must include certain doctors (such as pediatricians) and hospitals (like Memorial Sloan Kettering Cancer Center) as part of their "in-network" base. Plans have been getting rid of insurance firms and other third-party companies by cutting them out as middlemen between you and your doctor or hospital.
Health plans are prohibited from imposing annual caps on how much they will spend on somebody's care under the Affordable Care Act. Annual limits, which are common among employer-sponsored plans, are the most significant way that people get caught in an extended financial bind when they get sick or injured.
Under Obamacare, all health insurance plans must cover at least 10 essential health benefits . This includes maternity care and pediatric services.
Health insurance companies must now provide rebates if they fail to spend 80 percent of premiums on medical services as required by law. The requirement was originally for 85 percent but was lowered to 80 percent after insurers complained it would make their pricing unworkable.
No insurance company can deny coverage to anyone with a pre-existing conditions . (However, younger people can be charged more by insurers if they have a pre-existing condition.)
Health plans must now provide free preventative care as part of their basic coverage. Preventative services include gynecological exams, cancer screenings and vaccines. Preventive services actually were always required under federal law, but under pre-ACA days, insurers could charge an additional co-pay or deductible for receiving these health services. They couldn't refuse to pay for care outright since they would then have to pay for it out of pocket.
Insurers must also cover mental health and substance abuse treatment as part of the "essential health benefits" that all plans must offer.
An Obamacare provision allows adults under age 26 to remain on their parents' health insurance plan. This was already required, but insurers weren't necessarily covering that detail.
The exchanges can provide one year of extra financial help paying premiums to people who had chosen a silver level plan and saw their income drop significantly during the year, causing them to lose their tax credits for the rest of that tax year.
This new rule stated that if a person chooses a silver or bronze plan on the exchange and then discovers it doesn't cover their preferred hospital or doctor's office, they may be allowed to switch plans within 90 days without penalty. People can also change plans outside of 90 days if they discover new information about network coverage.
The new rules also clarify that a plan may not reduce the number of doctors, hospitals and other providers it includes as part of its provider network.
This article was written by a third party. The opinions and views expressed herein do not necessarily reflect the views and policies of
The ACA (Affordable Care Act) is intended to help all Americans have health insurance coverage by expanding Medicaid for low-income adults, creating health insurance exchanges where Americans can shop for coverage, setting standards for what insurers must cover, and prohibiting insurers from denying coverage to people with pre-existing conditions [1]. The original ACA (Affordable Care Act) has been expanded by the Health Care and Education Reconciliation Act of 2010 (HCERA), which amended the ACA to prohibit insurers from denying coverage to children with pre-existing health conditions [2]. HCERA also eliminated lifetime limits on benefits for all individual and employer-based plans and requires every plan to cover 10 essential health benefits. All insured plans must now provide free preventative services and mental health coverage. This article outlines the differences between the Affordable Care Act (ACA) and HCERA.
The HCERA is a law passed in 2010 that extended many provisions of the ACA [3]. The HCERA:
Extends the individual mandate to 2014, requiring that everyone purchase health insurance or pay a 2.5% tax penalty on income their tax return [4]Allows people under 26 years old to stay on their parent's health care plan indefinitelyProhibits annual and lifetime benefit caps on all plansRequires plans to spend at least 80% of premiums on medical services [5]
The ACA (Affordable Care Act) is the 2010 law passed by Congress that expanded access to health insurance in the United States.

The Affordable Care Act (ACA) has become significantly amended since its enactment in 2010. The ACA (Affordable Care Act) has provided insurance to many millions of previously uninsured Americans, but the law is still being amended and the future of the law is uncertain.
In order to prevent a single-payer system from coming to fruition, the ACA (Affordable Care Act) implemented several different measures.

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