Health care advocates say the number of people without health insurance has increased dramatically this year due to nationwide layoffs related to the coronavirus pandemic.
For that reason, understanding the Affordable Care Act (ACA) and the benefits it provides has never been more important.
For those who qualify, the ACA can provide quality insurance at affordable rates, says Reginal Swann, who manages a Blue Cross NC Service Center in Charlotte.
In this Q&A, Swann answers some of the basic questions related to the Affordable Care Act.
1. What is the Affordable Care Act (ACA)?
The Affordable Care Act, also known as “Obamacare,” is a health care reform law enacted in March 2010. It has three primary goals:
- Make affordable health insurance available to more people. The law provides financial subsidies (tax credits) for people whose household incomes fall between 100% and 400% of the federal poverty level.
- Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
- Support medical reforms designed to lower the costs of health care.
2. What is the Health Insurance Marketplace?
The federal government operates the Health Insurance Marketplace, available at HealthCare.gov, for most states. (Some states run their own marketplaces.) The federal marketplace provides health plan shopping and enrollment services through websites, call centers, and in-person help.
3. What is the Affordable Care Act annual enrollment period, and when is the deadline?
This is the yearly period during which people can enroll, re-enroll, or change their health insurance plan for the upcoming year. The open enrollment period for 2021 began on November 1 and ends December 15.
December 15 is the last day to enroll in or change plans for 2021 coverage. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period due to a qualifying life event, such as having a baby, change in employment or change in marital status.
4. Who shops for Affordable Care Act coverage? Are children covered?
These are individuals and families purchasing their own medical insurance. They can be entrepreneurs or those who don’t receive medical, dental, or vision coverage through an employer or from a government program.
All Marketplace health plans must cover a set of preventive health services for children up to age 26, without charging a copayment or coinsurance – even if you have not met your yearly deductible. These preventative services can range from health screenings to behavioral assessments.
5. What do the coverage options look like?
Insurance providers offer a variety of plans designed to meet different needs. The plans are broken into categories focusing on networks (EPO, HMO, POS, PPO) and how you split your health care costs with your plan (Metal levels).
Metal levels (Bronze, Silver, Gold, Platinum) show the value of coverage within a plan, allowing you to easily compare plans with different copayments, deductibles and coinsurance.
6. How do subsidies work?
The federal government offers financial assistance (subsidies) to individuals and families who qualify based on their income and household size. Two types of subsidies available: Advanced Premium Tax Credit and Cost Sharing Reductions.
To qualify, you must:
- Be between 100% and 400% of the federal poverty level
- Not be eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program, and Medicare
- Not have affordable access to insurance through an employer
After filling out your Marketplace application and providing your household and income information, you’ll find out if you qualify for a premium tax credit that lowers your monthly health insurance bill. You’ll also find out if, in addition, your income qualifies you for extra savings (cost-sharing reductions).
7. What about people who don’t qualify for an Affordable Care Act subsidy and don’t qualify for Medicaid? Where does Medicaid expansion fit into this?
Not all states have expanded their Medicaid programs to cover these low-income residents. North Carolina is one of those states.
Evidence shows that access to health insurance provides health and economic benefits, protects families from financial ruin, and saves lives. Blue Cross NC supports expanding coverage to as many North Carolinians as possible, including the expansion of Medicaid. We believe providing more North Carolinians with access to affordable, high-quality health care is the right thing to do for our state.
8. What about people who make too much money to qualify for a subsidy? Can they buy insurance through the Health Insurance Marketplace?
If you make too much money to qualify for a subsidy, you can consider affordable options that may be available in your area. While you can buy ACA-complaint insurance without a subsidy through the Health Insurance Marketplace, you also have other options such as buying directly from an insurance company, insurance agent, or broker. You’ll want to consider all your health insurance options to find the best plan for you and your budget needs.
9. Can a person be denied insurance because of a pre-existing condition?
Under current law, you cannot be denied insurance or charged a higher rate because of a pre-existing condition like asthma, diabetes, and high blood pressure.
10. What are some tips or things to consider during Affordable Care Act open enrollment?
Know your plan options and compare:
- Network of providers
- Costs (Copayments, Deductibles and Coinsurance)
- Metallic levels can help you compare plans
- See if you qualify for any subsidies
- Consider you and your family’s current and future needs and health (pre-existing conditions, prescription drugs, etc.) Ultimately, you want to decide which plan is best for you and your family.