Who Benefits From the Affordable Care Act?

Who Benefits From the Affordable Care Act?

The Affordable Care Act, commonly referred to as Obamacare, is introducing comprehensive reforms that are making health insurance more accessible and affordable for individuals and families. Studies show that having health coverage helps safeguard financial futures against unexpected medical costs that might otherwise become catastrophically expensive.

Individuals can shop and compare Affordable Care Act-compliant health plans on state marketplaces (or exchanges). Under the ACA, these plans become more cost-effective with premium subsidies and cost-sharing reductions for eligible recipients.

Preventive Care

Preventive care helps you remain healthy by identifying potential problems early and treating them more affordably and quickly. Under the Affordable Care Act (ACA), most private health plans must cover preventive services with high levels of scientific evidence without charging copayment or coinsurance fees as long as the provider within your plan’s network provides it.

Today, over 152 million individuals with private health coverage have taken advantage of this requirement and the Affordable Care Act also expands Medicaid’s coverage of preventive services.

The Affordable Care Act also ensures that your health insurance provides comprehensive benefits by prohibiting annual dollar limits on covered services and prohibiting discrimination based on preexisting conditions, while all plans must provide easy-to-understand summaries of their coverage. It has already helped over 5.7 million young adults remain on their parents’ plans until age 26.

Maternity Care

Pregnancy is an integral moment for women’s health, yet many were without access to essential health services prior to the Affordable Care Act (ACA). Women without jobs had limited or no affordable access to private coverage while those who did may lose it at the time of pregnancy or be denied coverage due to preexisting conditions.

The Affordable Care Act has transformed all that, offering all individuals and small-group plans sold through exchanges maternity care as an essential benefit. Women expecting can access coverage during open enrollment periods or special enrollment periods triggered by qualifying events; and existing Marketplace plan holders will automatically gain coverage no matter their income at conception.

Women should keep their Marketplace coverage during pregnancy and enroll their baby in a Medicaid plan if eligible. This will avoid an unintended loss of coverage as well as avoid falling into the Medicaid coverage gap, in which no path exists for affordable coverage in their state.

Behavioral Health

People living with behavioral health conditions need access to care and support just like those suffering physical illness do. Trained providers who can assist them in overcoming barriers like fear of stigma or inability to ask for assistance should also be readily available.

Even with recent advancements, many individuals in need of mental health and substance use disorder (SUD) services do not receive adequate treatment. Before the Affordable Care Act (ACA), large group plans provided generous benefits for SUD treatment while individual and small group markets did not. With its elimination of medical underwriting in these markets by way of ACA policies, behavioral health conditions – including SUD – no longer result in denials of coverage or higher premiums.

Behavioral health integration, more commonly referred to as integrated care or collaborative care, assists those struggling with substance use disorder (SUD) or behavioral health conditions to more efficiently receive effective treatments by linking them with primary care providers who provide appropriate support and treatment services. But this approach alone does not solve all issues facing this population.

Essential Health Benefits

The Affordable Care Act (ACA) mandates that most health plans sold on its marketplaces (individual and small group plans alike) cover 10 specific services known as essential health benefits – these services include maternity care, mental health and addiction treatment services, prescription drug coverage, pediatric dental coverage and pediatric vision coverage.

Preventive Care: Under the Affordable Care Act (ACA), all health plans compliant with its standards must provide preventive services like cancer screenings and diabetes testing free of copays or deductibles – providing over 137 million Americans access to better preventive care, lowering medical bills while helping protect against disease.

Cost Savings: The Affordable Care Act ensures that people purchasing insurance on their own receive assistance to lower premiums and cut costs, potentially benefitting millions with premium tax credits and help for cost sharing if implemented fully.

Value for Your Premium Dollar: Under the Affordable Care Act (ACA), health plans must spend at least 80 percent of premium dollars on medical care and quality enhancement, rather than on administrative expenses like advertising or executive bonuses.

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About the Author: Raymond Donovan