Obamacare is a federal program intended to assist people in purchasing affordable health care coverage. Available to all American residents who qualify, it offers tax credits in order to reduce premium costs.
Virginia operates its own state exchange, similar to a federal marketplace but independent from federal oversight. While some states have succeeded in lowering costs and expanding markets successfully, others have struggled.
How It Works
Prior to the Affordable Care Act’s passing into law, many Americans lacked affordable health insurance options that allowed them to pay for care when necessary or get coverage that met their needs. Without these affordable options available to them, many were left struggling financially or with inadequate coverage when they required care.
With the Affordable Care Act (ACA), millions of Americans gained access to low-cost or no-cost health coverage via federal and state marketplaces and cost assistance programs, such as advance premium tax credits and cost assistance for low-income individuals and families who qualify. These benefits include advance premium tax credits as well as cost assistance programs.
The Affordable Care Act has also broadened opportunities for Medicaid, the federal program designed to aid low-income individuals and families. Under its expansion, families earning up to 138 percent of federal poverty level may apply for coverage without incurring penalty fees or penalty fees for applying.
Under the Affordable Care Act (ACA), all large employers in Virginia must offer health coverage to their employees or face financial penalties. Tax credits are also available to help small businesses with less than 25 full-time employees cover the costs of providing such insurance coverage.
Essential Health Benefits
The Affordable Care Act mandates that plans provide at least some essential health benefits, including physicians’ services, inpatient and outpatient hospital care, pregnancy and childbirth services, mental health services, dental coverage for children, etc.
Law also mandates that insurance providers cover preventive healthcare and disease management, including vaccinations, screenings and other services to keep individuals healthy.
ACA-compliant health plans cover these services without cost sharing; however, premiums and deductibles may be higher compared to non-ACA compliant coverage.
Small businesses with 50 or fewer full-time-equivalent employees (FTEs) also have access to Affordable Care Act-compliant insurance through health option programs like SHOP. Employers may purchase plans either through employees directly or purchase SHOP plans directly themselves for tax credit savings.
Premiums
Virginia work group that examines insurance costs on state and federal exchanges has published a report showing that premium increases across each region rose between 2016 and 2017 at different rates; even though their increases were lower than in other states, they still were substantial.
Insurance carriers tend to set rates according to factors like your age, health status of household members and earnings. Your zip code could also have an effect on this as some policies might only be available within certain geographical regions.
The Virginia General Assembly can utilize various strategies to tackle premium costs, such as expanding Medicaid to cover more individuals and families; however, many residents likely won’t find these costs manageable even with a state-run exchange in place.
Enrollment
For you to enroll in a health plan under the Affordable Care Act, the open enrollment period generally runs from November 1 through December 15 each year.
Consumers who experience a major life event such as losing coverage due to job changes or moving addresses could qualify for a special enrollment period.
The Affordable Care Act also mandates insurers to offer plans with essential health benefits coverage such as emergency room visits, preventive services and maternity care.
Your income may qualify you for Medicare or Medicaid programs which offer low-cost health coverage at reduced cost, particularly those below specific poverty thresholds or who are elderly.
