Define plain-language summary of benefits

Reference no: EM132160630

Question: The Affordable Care Act (ACA) also known as Obamacare was signed on March 23, 2010. It has two parts known as the Patient Protection and Affordable Care act, and Health Care and Education Reconciliation Act. The ACA is a type of health coverage that allows lower income families and individuals more affordable. With this, it also puts certain limits on what the insurers may or may not do with respect for the eligibility and coverage to those who need it (Obamacare Basics: What is the Affordable Care Act?, 2018). It is to allow people to have coverage, so they can have preventative care at a lower rate. But for those who don't have coverage will be penalized with a fee when tax season comes around. Those individuals that didn't have any coverage that year have an option to pay that fee with their taxes if they can't pay any other way. If you already have coverage, nothing will happen, but you can explore the options for what the ACA has to offer and make a switch if you would choose to do so, but you won't be eligible for any subsidies if you do switch. The goal and mission of the ACA is to make healthcare coverage more accessible and affordable to Americans (Obamacare Basics: What is the Affordable Care Act?, 2018).

If an individual had purchased a plan through ACA after March 23, 2010, there are provisions that impacted those plans. Those provisions are:

1. The insurers are required to provide the individuals with a standardized, plain-language summary of benefits;

2. Rate increases of more than 10% must be publicly justified; 80% of premiums must be spent on actual health care services

3. Insurers may not cancel your plan in response to an illness

4. Certain types of preventative care must be covered at no additional cost to the patient

5. Patients are free to choose any physician within the plan's network and may use an out-of-network emergency room without penalty.

6. Annual and lifetime dollar limits on care are prohibited.

7. Patients are granted the right to appeal whenever an insurer denies payment for health care services.

(Obamacare Basics: What is the Affordable Care Act?, 2018)

A big change that I would make to this is to remove the penalty fee to those who don't have coverage throughout the year at any time. I would make this change because there are people who live in the U.S. that are citizens that can't afford the "affordable" health coverage that the ACA has. Even if you do fall between the necessary percentages of 100% and 400% for income for the federal poverty level (Affordable Care Act (ACA), 2018). For those who fall under the 138% poverty level are supposed to be eligible for Medicaid (Affordable Care Act (ACA), 2018), but again, Medicaid also has a limit as to what you can't exceed for your income too in order to be eligible.

The reason why I feel so strongly about this is because four years ago when I became a single mom of two very young kids, I didn't have health coverage and I needed coverage, so I didn't have to pay the penalty when I filed my taxes. I didn't work enough hours to be eligible for coverage through my employer at the time and what I did make for income, I wasn't eligible for Medicaid in Nebraska. With this, I had to explore what my options were through the ACA. With that, I wasn't going to be able to afford that either because of my income being too low along with other expenses I had to pay for myself and my kids. I was very frustrated because they say it's made to be "more affordable" to those who need coverage and it really wasn't So when tax time came, I was slapped with a penalty fee because I didn't have coverage for any part of that year in 2014. It is unfortunate that things like this have to happen.

Reference no: EM132160630

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