The Affordable Care Act, commonly referred to as Obamacare, has brought significant changes to America’s health insurance system. It now requires everyone to have coverage as well as providing subsidies that make health insurance more affordable for many Americans.
It has expanded Medicaid in many states and mandated insurers to cover a broad array of preexisting conditions.
What is Obamacare?
The Affordable Care Act, or Obamacare as it is commonly known, was signed into law by President Barack Obama in March 2010. It established health insurance marketplaces where individuals could purchase coverage on their own and offered financial aid to those with lower incomes to cover costs. Furthermore, preventive care became free for all and prevented insurers from setting lifetime or annual limits on coverage; employers were required to offer health coverage to their employees; young adults can remain on parent plans until age 26.
People who opt out of purchasing insurance must pay a fine; many states and the federal government have declined to expand Medicaid under the Affordable Care Act (ACA), while all plans must cover 10 essential health benefits as mandated by law and insurers are prohibited from denying coverage based on preexisting conditions.
What is Medicaid?
Medicaid is a joint federal-state health insurance program for individuals with limited income and resources, providing coverage for doctor visits, hospital stays, long-term care expenses, as well as any related costs. Medicaid eligibility requirements depend on your income, assets and other factors and each state has different rules about who may qualify.
The Affordable Care Act expanded Medicaid eligibility to adults with incomes below 138 percent of poverty level, leading to an estimated 12.7 million new enrollees. Federal regulations do not prohibit premiums for most Medicaid recipients and limit out-of-pocket expenses to five percent of an individual’s income; however, some states have obtained waivers in order to charge higher premiums or cost sharing arrangements.
Personal property typically isn’t counted when applying for Medicaid; however, there are exceptions. An Irrevocable Burial Trust that includes caskets, burial plots, headstones, crypts and mausoleums may be exempt. Other assets that might not count include equity in real estate, cars or trucks, cash accounts, life insurance policies and most investments.
How can I find out if I qualify for Obamacare or Medicaid?
How Can I Determine Eligibility for Medicaid? To see if you qualify for Medicaid coverage, complete an application with your state health insurance marketplace. Once submitted, they will inform you which categories or subcategories of Medicaid you meet the criteria for, as well as if a Managed Care Organization (MCO) should help administer it for you.
Your state may offer subsidized marketplace plans with lower monthly premiums and cost-sharing reductions to reduce out of pocket medical costs. In addition, low-cost healthcare solutions may be available through community health centers.
Adults eligible for both Medicare and Medicaid are known as being “dual eligible”. Medicare pays out its benefits first before Medicaid picks up any remaining costs.
Most states allow their Medicaid programs to enroll new participants at any time as long as they meet financial and non-financial eligibility requirements. Depending on your state of residence, an application and proof of income or citizenship may be necessary in order to enroll in Medicaid.
How can I find out if I qualify for Medicaid?
Individuals looking to qualify for Medicaid must meet both financial and non-financial eligibility requirements in order to be considered. They also need to be legal residents of both the United States and of their state where they apply.
Medicaid is a joint funding program between the federal government and states, covering a core set of services required by both. States also may opt to cover optional services; New York State Medicaid offers numerous options tailored specifically to its beneficiaries’ needs.
Medicare Savings Programs provide assistance for Medicare premiums and cost sharing payments. There are four programs to choose from, each having different income and resource limitations.
As opposed to Medicare, which has set enrollment periods, people may apply for Medicaid at any time throughout the year – although applicants must reapply each year in order to ensure that their financial circumstances have not altered significantly.
