Affordable Care Act 101

Diverse Hands Holding The Word Insurance

The Patient Protection & Affordable Care Act was signed into law on March 23, 2010 by President Barack Obama.

As we continue to watch the news, listen to the radio, hear phrases like “pros and cons,” and read words like “repeal,” “cost” and “value,” it becomes increasingly important to know the facts. It becomes essential to ask the question, “Is health reform good for me and my family?”

  • The Affordable Care Act prevents health insurance companies from refusing to pay for important treatments by claiming the patient had a pre-existing condition.
  • The Affordable Care Act stops the kind of health insurance company abuse that patients endure every day.
  • The Affordable Care Act ensures:• Lifetime limits on insurance coverage are eliminated and insurance companies are banned from dropping people from coverage just because they get sick.• There will be a cap on out-of-pocket expenses, such as co-pays and deductibles.

    • Starting in 2014, people who cannot afford quality health insurance will receive tax credits.

    • Starting this year, Medicare beneficiaries will receive a 50% discount on brand name drugs in the donut hole , and complete closure in 2020.

• Preventive care now requires new plans to cover prevention and wellness benefits at no charge…and exempt from deductibles

• Co-payments for preventative service have been eliminated.

• All Americans are ensured access to free preventive services.

• Community health teams will be provided to improve management of chronic diseases, which will help 50% of African Americans who suffer from them.

• The primary care workforce will be enhanced to ensure that all Americans have access to a primary care doctor.

• New measures have been enacted to help strengthen cultural competency by providing training for health care providers.

In a nutshell, the Affordable Care Act was signed into law to help alleviate the unnecessary burden that hardworking Americans deal with too often.

What Are The Different Types Of Health Insurance?

A man in a hospital gown sitting on an exam tableDifferent types of health insurance plans meet different needs. When you compare options, it’s important to understand how they are structured.

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Health Maintenance

Organizations (HMOs) and Exclusive Provider Organizations (EPOs)

HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn’t in the HMO’s network, you may have to pay the full cost of the services provided.

HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.

Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)

These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.

If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.

High Deductible Health Plan (HDHP)

High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1250 per year for individual coverage and $2500 for family coverage.

If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax you owe.

Catastrophic Health Insurance Plan

A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of “safety net” coverage in case you have an accident or serious illness. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher. This means you must pay thousands of dollars out-of-pocket before full coverage kicks in.

In the Marketplace, catastrophic plans are available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received “hardship exemptions”. Marketplace catastrophic plans cover 3 annual primary care visits and preventive services at no cost. After the deductible is met, they cover the same set of essential health benefits that other Marketplace plans offer. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs.

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