A study conducted by the Kaiser Family Foundation found that one in every five insured adults has reported being unable to receive necessary medical treatment due to high medical costs. Similarly, the study indicated that six out of ten people without insurance could not access the required medical care due to high medical bills. Despite over 90% of the U.S. population having some form of insurance coverage, approximately 8.6% of adults still face medical debt every year.
The Affordable Care Act (ACA) was enacted in March 2010 as an attempt to address medical insurance problems faced by American citizens. The act seeks to increase access to insurance coverage for most Americans from birth to retirement. It also aims to reduce the number of uninsured Americans by about 31 million and seeks to enhance the quality and fairness of health insurance. The following are a few rights and protections under the ACA that have played a significant part in improving healthcare for most American citizens.
Protection for People With Pre-Existing Medical Conditions
Before the implementation of the Affordable Care Act, individuals with pre-existing medical conditions faced numerous challenges when it came to obtaining insurance coverage. They were often denied coverage altogether and had to bear high out-of-pocket expenses for their medical care. However, the ACA, which came into effect on January 1, 2014, made it illegal for insurance providers to disqualify individuals with pre-existing medical conditions from obtaining coverage. The ACA also prohibits insurers from raising premiums or imposing lengthy waiting periods for treatment. This provision of the ACA complements the Genetic Information Nondiscrimination Act (GINA), which also prohibits discrimination by employers and insurance companies based on genetic characteristics. This includes inherited genetic mutations that raise the risk of individuals developing certain medical conditions like cancer.
Right to Choose Your Doctor
Research has shown that having a primary medical care provider with whom you frequently book appointments can bring numerous benefits. For starters, it ensures that you receive the recommended preventive healthcare, which, in turn, reduces the likelihood of hospitalization. Consequently, this helps save time and costs in the long run. Unfortunately, prior to 2010, insurers were not in favor of their clients choosing their preferred doctor. However, with the introduction of the Affordable Care Act, individuals with insurance can now select any available primary medical care provider for their treatment. Specifically, the ACA allows parents to choose their preferred pediatrician for their children and prohibits employers and insurers from requesting obstetrical or gynecological care referrals.
Restrictions of Annual and Lifetime Dollar Limits on Coverage
The Affordable Care Act prohibits health insurance providers and group health plans from imposing annual or lifetime dollar limits on essential health benefits like mental health and substance disorder use services, preventive and wellness services, and laboratory services. However, some health plans that were in existence before the ACA was enacted, known as grandfathered plans, are exempted from the ACA’s annual limit policies. Nevertheless, it is worth noting that insurance companies can still place annual and lifetime dollar limits on services that are not considered essential health benefits.
Prohibition on Revoking Coverage
Before the enactment of the Affordable Care Act, if you made an accidental mistake while filling out your health insurance paperwork when you became sick, your insurance company had the right to revoke your insurance immediately. However, under the current ACA regulations, insurance companies are not permitted to rescind your insurance unless there is proof of fraud. They are also allowed to revoke your insurance if it is proven that the mistake made in the paperwork was intentional.
Coverage for Young Adults
Recent statistics reveal that approximately 30% of young adults in the U.S. do not possess any health insurance coverage. One of the key reasons behind this is the difficulty in acquiring employer-based healthcare plans for young adults. Despite the popular notion that young adults do not require as much healthcare as older adults, studies indicate that one in six young adults suffer from chronic illnesses, such as cancer or diabetes. Sadly, due to the lack of insurance coverage, nearly half of them struggle to afford medical expenses in case of unexpected illnesses.
Additionally, before the enactment of the ACA, some health plans and insurers used to exclude children from their parent’s health policies once they turned 19. However, under the ACA, health plans and insurers are required to allow young adults to remain under their parent’s policies until they reach the age of 26, regardless of their marital status.
Explanation of Benefits and Coverage
Under the Affordable Care Act, insurers and health plans are required to ensure that clients are informed about the benefits they are entitled to receive when they sign up for a particular plan. To accomplish this, they must provide clients with easy-to-understand and standardized information. The summary of benefits and coverage (SBC) should outline the primary benefits covered by the plan, along with any limitations, exclusions, and cost-sharing requirements. It should also clearly state whether the plan meets the minimum essential coverage and value standards. Additionally, it should include examples that illustrate how the plan would cover different health scenarios and how much the client would have to pay.
Restrictions on Adjusting Premiums and Instances Where Adjusting Premiums Is Allowed
The Affordable Care Act has established rules that forbid insurers and health plan providers from increasing premium rates based on a person’s health status. However, under specific circumstances, insurers can raise the premium. For example, people who use tobacco may be charged up to one and a half times more than non-smokers. Additionally, the number of family members covered under the same plan can affect the rates charged. The fewer people covered under the plan, the lower the rates. Insurers may also adjust rates depending on their location, as some states have higher or lower charges. They may also charge more for older adults compared to younger adults. However, the coverage for older adults should not exceed three times what younger adults are being charged.
Although the ACA has helped many Americans obtain better health insurance options, it has some drawbacks. For starters, since the ACA requires insurance companies to cover individuals with pre-existing conditions, insurers have significantly increased premiums. Additionally, several tax laws have been passed to fund the ACA, mainly affecting those with higher incomes. Moreover, due to the ACA’s requirement for employers to insure their workers if they have more than 50 employees, certain businesses have resorted to cutting employees, affecting their productivity. However, the ACA has undoubtedly brought relief to Americans. Recent statistics show that millions of people have been able to access affordable and quality insurance since the enactment of the ACA.
A study conducted by the Kaiser Family Foundation found that one in every five insured adults has reported being unable to receive necessary medical treatment due to high medical costs. Similarly, the study indicated that six out of ten people without insurance could not access the required medical care due to high medical bills. Despite over 90% of the U.S. population having some form of insurance coverage, approximately 8.6% of adults still face medical debt every year.
The Affordable Care Act (ACA) was enacted in March 2010 as an attempt to address medical insurance problems faced by American citizens. The act seeks to increase access to insurance coverage for most Americans from birth to retirement. It also aims to reduce the number of uninsured Americans by about 31 million and seeks to enhance the quality and fairness of health insurance. The following are a few rights and protections under the ACA that have played a significant part in improving healthcare for most American citizens.
Protection for People With Pre-Existing Medical Conditions
Before the implementation of the Affordable Care Act, individuals with pre-existing medical conditions faced numerous challenges when it came to obtaining insurance coverage. They were often denied coverage altogether and had to bear high out-of-pocket expenses for their medical care. However, the ACA, which came into effect on January 1, 2014, made it illegal for insurance providers to disqualify individuals with pre-existing medical conditions from obtaining coverage. The ACA also prohibits insurers from raising premiums or imposing lengthy waiting periods for treatment. This provision of the ACA complements the Genetic Information Nondiscrimination Act (GINA), which also prohibits discrimination by employers and insurance companies based on genetic characteristics. This includes inherited genetic mutations that raise the risk of individuals developing certain medical conditions like cancer.
Right to Choose Your Doctor
Research has shown that having a primary medical care provider with whom you frequently book appointments can bring numerous benefits. For starters, it ensures that you receive the recommended preventive healthcare, which, in turn, reduces the likelihood of hospitalization. Consequently, this helps save time and costs in the long run. Unfortunately, prior to 2010, insurers were not in favor of their clients choosing their preferred doctor. However, with the introduction of the Affordable Care Act, individuals with insurance can now select any available primary medical care provider for their treatment. Specifically, the ACA allows parents to choose their preferred pediatrician for their children and prohibits employers and insurers from requesting obstetrical or gynecological care referrals.
Restrictions of Annual and Lifetime Dollar Limits on Coverage
The Affordable Care Act prohibits health insurance providers and group health plans from imposing annual or lifetime dollar limits on essential health benefits like mental health and substance disorder use services, preventive and wellness services, and laboratory services. However, some health plans that were in existence before the ACA was enacted, known as grandfathered plans, are exempted from the ACA’s annual limit policies. Nevertheless, it is worth noting that insurance companies can still place annual and lifetime dollar limits on services that are not considered essential health benefits.
Prohibition on Revoking Coverage
Before the enactment of the Affordable Care Act, if you made an accidental mistake while filling out your health insurance paperwork when you became sick, your insurance company had the right to revoke your insurance immediately. However, under the current ACA regulations, insurance companies are not permitted to rescind your insurance unless there is proof of fraud. They are also allowed to revoke your insurance if it is proven that the mistake made in the paperwork was intentional.
Coverage for Young Adults
Recent statistics reveal that approximately 30% of young adults in the U.S. do not possess any health insurance coverage. One of the key reasons behind this is the difficulty in acquiring employer-based healthcare plans for young adults. Despite the popular notion that young adults do not require as much healthcare as older adults, studies indicate that one in six young adults suffer from chronic illnesses, such as cancer or diabetes. Sadly, due to the lack of insurance coverage, nearly half of them struggle to afford medical expenses in case of unexpected illnesses.
Additionally, before the enactment of the ACA, some health plans and insurers used to exclude children from their parent’s health policies once they turned 19. However, under the ACA, health plans and insurers are required to allow young adults to remain under their parent’s policies until they reach the age of 26, regardless of their marital status.
Explanation of Benefits and Coverage
Under the Affordable Care Act, insurers and health plans are required to ensure that clients are informed about the benefits they are entitled to receive when they sign up for a particular plan. To accomplish this, they must provide clients with easy-to-understand and standardized information. The summary of benefits and coverage (SBC) should outline the primary benefits covered by the plan, along with any limitations, exclusions, and cost-sharing requirements. It should also clearly state whether the plan meets the minimum essential coverage and value standards. Additionally, it should include examples that illustrate how the plan would cover different health scenarios and how much the client would have to pay.
Restrictions on Adjusting Premiums and Instances Where Adjusting Premiums Is Allowed
The Affordable Care Act has established rules that forbid insurers and health plan providers from increasing premium rates based on a person’s health status. However, under specific circumstances, insurers can raise the premium. For example, people who use tobacco may be charged up to one and a half times more than non-smokers. Additionally, the number of family members covered under the same plan can affect the rates charged. The fewer people covered under the plan, the lower the rates. Insurers may also adjust rates depending on their location, as some states have higher or lower charges. They may also charge more for older adults compared to younger adults. However, the coverage for older adults should not exceed three times what younger adults are being charged.
Although the ACA has helped many Americans obtain better health insurance options, it has some drawbacks. For starters, since the ACA requires insurance companies to cover individuals with pre-existing conditions, insurers have significantly increased premiums. Additionally, several tax laws have been passed to fund the ACA, mainly affecting those with higher incomes. Moreover, due to the ACA’s requirement for employers to insure their workers if they have more than 50 employees, certain businesses have resorted to cutting employees, affecting their productivity. However, the ACA has undoubtedly brought relief to Americans. Recent statistics show that millions of people have been able to access affordable and quality insurance since the enactment of the ACA.
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