The Affordable Care Act (ACA) bars insurance companies from denying coverage or charging extra for pre-existing conditions. Furthermore, this law prohibits lifetime and annual dollar limits on health benefits as well as cost sharing for essential benefits in nongrandfathered small group and individual market plans – using similar budgeting methodologies as found within the Internal Revenue Code to determine income.
1. Pre-existing conditions
Prior to the 2010 passage of the Affordable Care Act (ACA or Obamacare), preexisting conditions posed a considerable barrier in finding affordable health coverage. New health plan applicants could either be rejected outright, or charged significantly higher premiums depending on where they lived and their medical history.
Under the Affordable Care Act (ACA), all Marketplace plans must cover pre-existing conditions from day one of coverage; grandfathered plans in individual market may still exclude pre-existing conditions temporarily for limited periods.
Pre-existing conditions refers to any illness or injury that existed prior to enrolling in health insurance policy. Pre-existing conditions include both visible diseases such as diabetes or cancer and invisible ones like high blood pressure and asthma.
2. Dental and vision coverage
Although ACA regulations don’t specifically mandate dental coverage, state laws mandate its inclusion either within medical health plans or as a stand-alone plan. Dental coverage must also be provided as an essential health benefit for children as part of essential health benefits and offered to all family members including stepchildren enrolled within a family plan.
Studies have confirmed that the Affordable Care Act’s policies led to decreases in financial barriers and increases in private dental coverage and use. Furthermore, dependent mandate and the option to remain on parents’ dental plans until age 26 has increased coverage among young adults.
3. Drug coverage
Drug addiction treatment is one of ten essential health benefits covered by individual and small group plans that meet Affordable Care Act standards, so when searching on the federal exchange make sure you ask for a copy of its drug formulary that indicates which medicines will be covered.
The Affordable Care Act made significant inroads into prescription drug affordability and access. While not changing overall drug pricing systemiclly, rebates from pharmaceutical companies were implemented as a method to lower out-of-pocket costs as well as encouraging patients to switch over to cheaper generic versions of medications.
The Affordable Care Act also permitted Medicare to negotiate drug prices for brand drugs with no direct competition and insulin products, lowering out-of-pocket costs for millions of seniors and people with preexisting conditions. Furthermore, this Act closed Medicare Part D’s doughnut hole by 2020.
4. Mental health and drug abuse services
People living with severe mental illnesses such as anxiety disorders, depression or schizophrenia tend to have an increased risk of substance abuse. Co-occurring mental health conditions and substance abuse issues are not uncommon and treatment for both is frequently necessary.
The Affordable Care Act builds on MHPAEA by mandating that private health plans in exchanges and Medicaid provide coverage of SUD treatment at parity with coverage of other medical conditions; however, due to limited data and varied methods for monitoring it is unclear whether insurers comply with this rule.
If you suffer from both mental illness and substance use disorder, seek assistance immediately. Talk therapy and medications may provide effective solutions. Treatment programs include residential programs, intensive outpatient programs (IOP), partial hospitalization programs or home services – whatever works for you is what matters.
5. Preventive care
Since the implementation of the Affordable Care Act’s preventive services coverage policy, several changes and updates have occurred. New recommendations – such as lung cancer screenings and depression screenings for those at risk for HIV transmission as well as PrEP access for those at high risk – have been added while existing recommendations – such as cervical and mammogram screenings for women as well as flu shots for all – have been modified accordingly.
Today, preventive health services are included as part of your health plan at no additional cost; simply see any doctor in your network! However, on Thursday a lawsuit was filed challenging the requirement that most health plans cover evidence-based prevention without cost sharing; if successful this would rollback gains made towards keeping Americans healthier and avoiding disease and unnecessary costs down the road.
