By now, practically everyone is familiar with the fact that under the Affordable Care Act, practically anyone can obtain health insurance at a fairly affordable rate. However, individuals with disabilities must understand the benefits afforded by the Affordable Care Act.
First, it used to be the policy that most work-provided or simply privately obtained health insurance plans, under the Affordable Care Act, which became Federal Law in 2010, there are no pre-existing condition barriers to obtaining health insurance.
So, whether an individual is affected by epilepsy, bipolar mental health problems, or any of hundreds of other conditions, an individual cannot be denied a health insurance policy obtained either through the Affordable Care Act due to a pre-existing condition, or a private, or employer-based policy.
However, private insurers, selling healthcare policies on the open market, whether to individuals or individuals through a company insurance policy not only used to take note of pre-existing conditions but in most cases would exclude an individual with a pre-existing condition, or significantly raise the rates.
Why did this happen?
In the case of private insurance policies or company work-related policies, insurance companies, and insurers reasoned that to keep their rates as competitive as possible, limiting or outright excluding those with certain pre-conditions made economic sense.
The reason that insurance companies use this is that if a person has a pre-existing condition, they will tend to need continuous doctor and hospitalization visits for many years. Or in the case, for example of an individual having his or her first heart attack last year, insurance statistics show that one out of five of them will be readmitted to the hospital for a second heart attack within five years.
So, limiting, or even excluding individuals with pre-existing conditions made economic sense. However, conditions were far different with those insurers once the Affordable Care Act took place.
Congress reasoned that health insurance companies were making plenty of profits and that they could afford to include everyone, regardless of pre-existing conditions such as disabilities, even if overall health insurance rates went up slightly.
In the case of those being offered health insurance plans under the Affordable Care Act, Congress not only banned all exclusions for pre-existing conditions, but they also provided certain financial subsidies to those insurers offering policies under the ACT.
Among these subsides, primary among them is the ability to shift profits from primarily healthy individuals, (for example, those in the 18-30) range) to make up for the relatively minority population that does have serious disabilities.
Benefits of the Affordable Care Act for Individuals with Disabilities
The two biggest ones are perhaps the banishment of a lifetime and annual caps on an insurance policy. Before the passage of the Affordable Care Act, it used to be the policy of healthcare insurers to set both annual and lifetime caps on a healthcare policy. For many, that made deciding on a treatment plan a balancing act between the best treatment and less than adequate treatment because of these insurance caps.
In addition, the Federal Government, at least for policies obtained under the Affordable Care Act. In 2024, the maximum out-of-deductible an individual will pay is limited to $9,450 for an individual or $18,900 for a family.
That amount may still be considerable but in the case of many individuals, including those with serious disabilities, having a definitive overall cap an individual or a family will need to pay can be a major financial lifesaver. Another important aspect of the Affordable Care Act is that it encourages and covers several aspects of preventative care.
Preventative check-ups are covered under the ACA, which is great for everyone, but in particular for those who have disabilities. Being under the regular care of a physician is particularly important to individuals affected by a disability. Such regular visits early can go a long way toward keeping individuals with disabilities from exasperating their condition.
This includes access to regular examinations lab resources and FDA-approved medical conditions for physicians, hospitals, and laboratories. In addition, the Federal Government has pumped millions of dollars into ensuring that there are adequate resources for innovations such as medical homes and
care coordination demonstrations in Medicare and Medicaid to prevent disabilities from occurring and progressing and to help the one in 10 Americans who experience a major limitation in activity due to chronic conditions. In addition, billions of dollars have been invested in long-term care initiatives and the expansion in the majority of the states into Medicaid.
Another benefit under the Affordable Care Act benefits both people with and without disabilities, and that is the ability for younger adults to stay on their parents’ healthcare insurance up to the age of 26. This option allows millions of young adults, in their earlier years of adulthood to have more disposable income without worrying about healthcare insurance expenses.
In addition, for those who are on Medicaid and Medicare, there was created a significant level of coordination for the 9 million beneficiaries who are eligible for both Medicare and Medicaid. Individuals in this category, including a substantial number of those with disabilities often have multiple chronic conditions as well as cognitive and mental impairments.
Whether we are considering:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse
treatment - Prescription drugs
- Rehabilitative and habilitative services
and devices - Laboratory services
- Preventive and wellness services and
chronic disease management - Pediatric services, including oral and
vision care
The Affordable Care Act has virtually rearranged health care in general in the United States, and dramatically improved conditions for individuals with disabilities.
By now, practically everyone is familiar with the fact that under the Affordable Care Act, practically anyone can obtain health insurance at a fairly affordable rate. However, individuals with disabilities must understand the benefits afforded by the Affordable Care Act.
First, it used to be the policy that most work-provided or simply privately obtained health insurance plans, under the Affordable Care Act, which became Federal Law in 2010, there are no pre-existing condition barriers to obtaining health insurance.
So, whether an individual is affected by epilepsy, bipolar mental health problems, or any of hundreds of other conditions, an individual cannot be denied a health insurance policy obtained either through the Affordable Care Act due to a pre-existing condition, or a private, or employer-based policy.
However, private insurers, selling healthcare policies on the open market, whether to individuals or individuals through a company insurance policy not only used to take note of pre-existing conditions but in most cases would exclude an individual with a pre-existing condition, or significantly raise the rates.
Why did this happen?
In the case of private insurance policies or company work-related policies, insurance companies, and insurers reasoned that to keep their rates as competitive as possible, limiting or outright excluding those with certain pre-conditions made economic sense.
The reason that insurance companies use this is that if a person has a pre-existing condition, they will tend to need continuous doctor and hospitalization visits for many years. Or in the case, for example of an individual having his or her first heart attack last year, insurance statistics show that one out of five of them will be readmitted to the hospital for a second heart attack within five years.
So, limiting, or even excluding individuals with pre-existing conditions made economic sense. However, conditions were far different with those insurers once the Affordable Care Act took place.
Congress reasoned that health insurance companies were making plenty of profits and that they could afford to include everyone, regardless of pre-existing conditions such as disabilities, even if overall health insurance rates went up slightly.
In the case of those being offered health insurance plans under the Affordable Care Act, Congress not only banned all exclusions for pre-existing conditions, but they also provided certain financial subsidies to those insurers offering policies under the ACT.
Among these subsides, primary among them is the ability to shift profits from primarily healthy individuals, (for example, those in the 18-30) range) to make up for the relatively minority population that does have serious disabilities.
Benefits of the Affordable Care Act for Individuals with Disabilities
The two biggest ones are perhaps the banishment of a lifetime and annual caps on an insurance policy. Before the passage of the Affordable Care Act, it used to be the policy of healthcare insurers to set both annual and lifetime caps on a healthcare policy. For many, that made deciding on a treatment plan a balancing act between the best treatment and less than adequate treatment because of these insurance caps.
In addition, the Federal Government, at least for policies obtained under the Affordable Care Act. In 2024, the maximum out-of-deductible an individual will pay is limited to $9,450 for an individual or $18,900 for a family.
That amount may still be considerable but in the case of many individuals, including those with serious disabilities, having a definitive overall cap an individual or a family will need to pay can be a major financial lifesaver. Another important aspect of the Affordable Care Act is that it encourages and covers several aspects of preventative care.
Preventative check-ups are covered under the ACA, which is great for everyone, but in particular for those who have disabilities. Being under the regular care of a physician is particularly important to individuals affected by a disability. Such regular visits early can go a long way toward keeping individuals with disabilities from exasperating their condition.
This includes access to regular examinations lab resources and FDA-approved medical conditions for physicians, hospitals, and laboratories. In addition, the Federal Government has pumped millions of dollars into ensuring that there are adequate resources for innovations such as medical homes and
care coordination demonstrations in Medicare and Medicaid to prevent disabilities from occurring and progressing and to help the one in 10 Americans who experience a major limitation in activity due to chronic conditions. In addition, billions of dollars have been invested in long-term care initiatives and the expansion in the majority of the states into Medicaid.
Another benefit under the Affordable Care Act benefits both people with and without disabilities, and that is the ability for younger adults to stay on their parents’ healthcare insurance up to the age of 26. This option allows millions of young adults, in their earlier years of adulthood to have more disposable income without worrying about healthcare insurance expenses.
In addition, for those who are on Medicaid and Medicare, there was created a significant level of coordination for the 9 million beneficiaries who are eligible for both Medicare and Medicaid. Individuals in this category, including a substantial number of those with disabilities often have multiple chronic conditions as well as cognitive and mental impairments.
Whether we are considering:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse
treatment - Prescription drugs
- Rehabilitative and habilitative services
and devices - Laboratory services
- Preventive and wellness services and
chronic disease management - Pediatric services, including oral and
vision care
The Affordable Care Act has virtually rearranged health care in general in the United States, and dramatically improved conditions for individuals with disabilities.
){kind=link}