Healthcare Law

The Healthcare Reform Bill reforms the healthcare industry by expanding Medicaid and Medicare and creating an insurance exchange pool that provides affordable insurance to low-to-middle income Americans. The bill, often referred to as ObamaCare, includes many provisions that focus on expanding quality, affordable health care coverage helping tens of millions of Americans find coverage.

The new health care bill includes a strong focus on improving employer based health care making it available to more employees. The bill also makes a number of improvements to care for specific groups such as women, seniors and those who did not previously qualify for Medicaid by expanding Medicaid to over 15 million Americans.

The basic idea behind the health care reform bill is that those who can afford to buy health insurance will be able to buy better quality insurance, while more Americans who previously struggled to obtain care will have greater access to it, by the way of Medicaid or subsidized insurance on the health insurance exchanges.

What Marketplace Health Plans Cover

Ten Essential Health Benefits must be offered at no dollar limits on every plan under the Affordable Care Act. All major medical plans sold on the Health Insurance Marketplace, Non-marketplace Plans, small group plans, and Government healthcare options like Medicaid and Medicare starting January 1st, 2014 or later offer services from at least ten categories of Essential Benefits regardless of cost.

Some services are free, but most are simply offered with standard cost sharing. That means many services won't be covered by your plan until you meet your deductible. Only key preventive services and an annual wellness visits are offered without copays or coinsurance. All plans pay 100% for covered in-network essential benefits once you meet your out-of-pocket maximum. Although all plans must offer the same minimum benefits, higher premium plans may cover more non-essential benefits or more essential benefits at better cost sharing. Make sure that your primary care provider, local hospitals, specialists, and drugs you take are in your network, so they are covered at normal cost sharing rates.

The Affordable Care Act's Ten Essential Health Benefits include the following:

  • Ambulatory patient services (Outpatient care)
  • Emergency Services (Trips to the emergency room)
  • Hospitalization (Treatment in the hospital for inpatient care)
  • Maternity and newborn care
  • Mental health services and addiction treatment
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive services, wellness services, and chronic disease treatment
  • Pediatric services  

Healthcare Reform for Small Business

The Affordable Care Act (ACA) offers incentives, such as tax breaks and tax credits via the Small Business Health Options Program (SHOP), to small businesses with the equivalent of less than 25 full-time workers, making less than $50,000 in average annual wages, to help them provide health benefits to employees.

Healthcare Reform for Indivisuals

ObamaCare's individual mandate requires that most Americans obtain health insurance by 2014 or pay a tax penalty. The individual mandate went into effect at the beginning of January 2014 and continues each year. The penalty for not having coverage will be paid on your Federal Income Tax Returns for each full month

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