Benefit Basics for You & Your Family
When Obamcare took affect back in 2010, it started a series of changes in the way health insurance is purchased by individuals and families. The most significant of these changes take effect on January 1, 2014; when you are guaranteed to be able to buy health insurance and what you pay for health insurance will be based on your own or your families income. The health insurance plans will also be offered under new "Metal" plan names explained in that section of this web site; such as SIlver & Gold. The apparent overall goal of Obamacare is to get everyone insured at a price that everyone can afford based on their own or their families income.
One important aspect that seems to be lost in the debate is that you will be purchasing a “private” health insurance plan, just as you do today. You are not buying a health insurance plan from the government! The main difference is that you will have another option for purchasing your health insurance, Health Insurance Marketplaces, formerly called Exchanges; and, you may even get financial assistance for purchasing your health insurance from the government.
You will be buying a health insurance plan from an insurance company with financial assistance from the government based on your actual income. The more you make, the more you pay. The less you make, the less you pay. In either case, if you can buy the lowest cost (Bronze) health insurance plan for less than 8.05% of your income; and you do not buy health insurance; you will pay a penalty or tax. The Financial Aspect section explains these changes in more detail.
Federal assistance for purchasing insurance is not a new concept; as most farmers’ today buy subsidized crop insurance from private insurers with financial assistance from the government to protect against unforeseen crop losses.
There are other major changes to health insurance plans that will be sold in the country. The federal government has created a list of minimum medical benefits that must be covered by a health insurance plan anywhere in the country; and added many other options that help people get and keep health insurance coverage. Some examples of these new changes are; 1) everyone is guaranteed to be able to purchase a health insurance plan no matter how healthy they are at the time; 2) kids can stay on their parents health insurance plans up until they are 26 years old; 3) health insurance plans will be sold on a "community rate" basis, which means no more different rates for men and women; and age brackets will be in one-year increments; and 4) if a State allows it, an insurance company can charge a smoker up-to 50% more for their health insurance than the rate they charge a non-smoker.
A very important new change is the creation of Essential Health Benefits. Basically, Essential Health Benefits (EHB's) are a list of medical services that the federal government says must be covered in every health insurance plan that someone buys after January 1, 2014 as the minimum list of covered health insurance benefits. A health insurance plan can cover more than these minimum covered benefits, but the health insurance plan cannot cover fewer than these minimum covered benefits. In addition, each State can decide whether or not they want more benefits to be covered before an insurance plan is sold in their State. Therefore, it is important that State's decide early if they are going to require health insurance plans sold in their State to cover additional benefits or medical services for the people that live in their State.
Essential Health Benefits
Ambulatory Services, like out-patient surgery.
Emergency Services, like emergency room care.
Hospital Care, inpatient hospital stays.
Maternity and Newborn Care.
Mental Health, like substance abuse and behavioral health.
Rehabilitative and Habilitative Care.
Preventative and Wellness Care, including disease management.
Pediatric Services, including Dental and Vision care for kids.