Managing the Affordable medical Care Act may sound confusing, but it isn’t difficult. The goal of the Affordable Care Act is to enable individuals to access affordable, quality health insurance thus reducing overall spending on health care in the United States. The state governments, the federal government, insurers, individuals, and employers have an equal responsibility to oversee medical care for everyone. Critical requirements for individuals interested in any plan are as follows:
• Individuals must have qualifying health care coverage, otherwise known as minimum essential coverage, for every month.
• An individual must qualify for an exemption, or fulfill a payment when filing his or her federal income tax return.
• Those which qualify must live in the United States and be a citizen. Nor may they be incarcerated.
While many may view this as a burden, the health care law offers rights and protections that make coverage fairer and easier to understand.
One benefit to bear in mind when considering health plans under the Affordable Care Act is that health insurance companies cannot refuse coverage or charge individuals more because they have a pre-existing condition. They also cannot charge more for services based on the sex of the individual. Other benefits include, but are not limited to, the following:
• Providing free preventive care
• Additional coverage options for young adults
• Holding insurance companies accountable for rate increases
• Protecting a patient’s choice of doctors
Additionally, the Affordable Care Act ends lifetime and yearly dollar limits on coverage of essential health benefits in any health plan or insurance policy. This is great news for individuals with pre-existing and chronic conditions. Before this, many plans had a lifetime limit, or a dollar limit, on what they would essentially pay out for covered benefits during the enrollment in that plan. Individuals would then need to pay the cost of all care that went beyond those limits.
The right plan is out there for each individual, but it is vital to remember that there will be fees if patients don’t have the minimum essential health coverage.
Each insurance plan defines the prescription drugs that it covers in its formulary. Health plans publish their formularies so that individuals can check for the medicines they take before signing up. If a patient has trouble finding a plan’s formulary online, they can try calling the insurer or working through a broker who can help to find the information that is needed.
All insurance plans have a deductible that must be met before the insurance company starts to pay for services. Some plans have a pharmacy deductible which lowers the amount that individuals must pay before the insurance company starts to cover the cost of prescriptions. Regardless of the deductibles, prescription drug costs count towards the annual medical expense caps of $6,639 and $13,292 per individual and family.
Under the Affordable Care Act, access to healthcare is a legal right. If you need help understanding what this means for patients or your medical billing process, speak to us at Advanced Reimbursement.