The Affordable Care Act, also known as Obamacare, governs most American’s health insurance coverage and requires them all to either obtain health coverage or face penalties.
Individual Obamacare plans can be found through each state’s health insurance exchange and typically receive funding from taxpayers; it is legal for someone to have both Medicare and an Affordable Care Act Marketplace plan at once.
Medicare
Obamacare refers to the Patient Protection and Affordable Care Act signed into law by President Obama in 2010. The ACA included comprehensive health insurance reforms, including mandating that people possess health coverage or pay a penalty; expanding Medicaid (a government program for people with low incomes); and reforms for medically ineligible patients.
However, the Affordable Care Act did not alter Medicare in any significant way. Medicare is a national health insurance program funded by and managed by the Centers for Medicare & Medicaid Services that offers health coverage to seniors and disabled people. Medicare Parts A through D cover medical services provided during hospitalization as well as prescription drug costs while private Medicare Advantage plans provide Parts A & B benefits plus extras like dental or vision coverage.
The Affordable Care Act made it possible for individuals and families to purchase health insurance through private exchanges, or marketplaces, designed specifically for this purpose. Consumers can compare coverage options that best suit their needs and budget in these marketplaces, and also benefit from financial assistance programs designed to assist them afford their selected health plan.
Medicare enrollees cannot sign up for exchange plans unless they qualify for a special enrollment period; since Obamacare plans cannot be added during the same year as having Medicare coverage and most exchange plans require that your existing Medicare coverage end by January 1.
The Affordable Care Act also makes it illegal for insurers to deny or charge more for policies based on your pre-existing condition, and requires all private health plans to cover 10 essential benefits, including emergency services, hospitalizations and prescription drug coverage. All new plans must also be rated bronze, silver, gold or platinum according to cost and quality criteria.
Medicaid
The Affordable Care Act (ACA), commonly known as Obamacare, transformed how millions of Americans obtain healthcare coverage. Prior to Obamacare’s implementation, people often relied on employer health plans or high-cost private marketplaces for health coverage; now they can enroll in a comprehensive health plan at lower cost through either healthcare exchanges created by ACA or their state Medicaid program.
Some states have expanded their Medicaid programs to cover more low-income residents, which has helped reduce the number of uninsured Americans and provided access to cheaper prescription drugs through Affordable Drugs Program of Affordable Care Act.
The Affordable Care Act made Medicare Advantage plans more financially advantageous than original Medicare, offering more flexibility and often including prescription drug benefits. Furthermore, more integrated health services, including vision and hearing benefits were made available due to this change.
As it’s impossible to have both an individual ACA-compliant plan and Medicare at once, once you reach age 65 your individual plan will automatically terminate and you must enrol in Medicare at that point. However, you may choose to continue purchasing coverage via the marketplace as long as your income does not surpass 400% of the federal poverty level and/or you qualify for subsidies.
The Affordable Care Act also established Accountable Care Organizations, or ACOs for short. ACOs are groups of healthcare providers including primary care physicians, specialists, hospitals and post-acute care facilities who collaborate to oversee quality, cost and outcomes for an identified population of patients. Accountable Care Organizations are held accountable through incentives and penalties such as financial bonuses or cuts in Medicare Advantage payments if certain benchmarks are missed; additionally they’re encouraged to share best practices through collaborative learning activities like conferences or workshops.
