By Norma J. Goodwin, M.D., Founder and President, Health Power
Few benefits of the Affordable Care Act (ACA) are well known, although they should be, especially by:
- Those who don’t yet fully understand the many benefits of enrolling, and
- Those who support the nation’s movement from health disparities to health equity.
Health Power’s Affordable Care Act table below contains a simply stated summary of key benefits. The table is meant to: (a) increase knowledge and understanding about ACA, and (b) encourage and support enrollment.
12 Simply Stated Affordable Care Act Benefits
|Key Feature||Brief Description of Related Benefit|
|Length of coverage under a parent’s health insurance policy||Young adults can have their health care covered on their parent’s health insurance policies until 26 years of age.|
|Coverage for pre-existing illnesses||Pre-existing illnesses cannot be denied health insurance benefits.|
|Ceiling on health insurance coverage||Ends lifetime (and most annual) ceilings on the cost of health care.|
|Although major Medicaid expansion is called for in the legislation, each state can decide whether or not it wants to do so (opt out).||Although a major expansion of Medicaid is called for, as a result of the subsequent Supreme Court ruling, states have the right to opt out without losing any of their current Medicaid program benefits.For states that expand their Medicaid Programs, 100% of the related cost is paid for by the Federal government for the first 3 years, and then 90% until 2020.
|Medicare benefits||Guaranteed Medicare benefits are safe, and many preventive screenings are now free – such as immunizations, mammograms and colonoscopy (test for colon cancer).|
|Cost of prescription medications||Prescription medications will cost less because the so-called “doughnut hole” (the gap in payment for prescription drugs under Medicare Part D) will decrease over time, until it is eliminated in 2020.|
|Health insurance transparency||All participating health plans must provide a uniform and easy-to-understand summary of their coverage for all enrollees and applicants. This responds to a widespread consumer and small business complaint about how complex health insurance information has been in the past.|
|Employer health insurance coverage||If you like your employer’s health insurance coverage, you can just keep it, and don’t have to do anything. However, if you don’t like the coverage, you can buy coverage through your state’s health insurance exchange (or the federal program where there is no state exchange).|
|Access to health insurance exchanges, or marketplaces, was called for in the legislation.However, the subsequent Supreme Court ruling permitted states to opt out of establishing exchanges.||
You can buy coverage through state health insurance exchanges, which are online marketplaces where companies compete for consumers, or through the federal website.
Where states have not established exchanges, enrollment can be done through the federal website, which now works well (Its start-up had a variety of problems).
|Individual mandate to have health insurance||Most taxpayers who don’t have health insurance by March 31, 2014 will have to pay a special tax on their annual tax return. This would not apply to persons who have Medicare, Medicaid, or employer insurance.|
|Benefit in states with expanded Medicaid programs||Low to middle income persons and family members less than 65 years of age may be eligible for a subsidy to help pay their health insurance cost. At present, persons with incomes up to $44,680 are eligible for a tax credit refund for purchasing their health insurance.|
|Medicare payment to hospitals and health insurance companies||Starting in 2013, Medicare payments to hospitals will be decreased if they have too many patient readmissions within 30 days. Thus, patients may get more in-home support. This will also decrease the cost of in-hospital care.Insurance companies must use more of the premiums they receive for patient care rather than administrative costs, or send their consumers rebates. This year, the rebates will average about $150 per eligible family, or a total of over $ 1 billion.High income taxpayers (more than $ 200,000 per individual and $ 250,000
per couple) will have to pay more for Medicare hospital insurance taxes.