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About the Affordable Care Act

The Affordable Care Act was passed by Congress in 2010. The law is officially known as the Patient Protection and Affordable Care Act and is also unofficially called “Obamacare.”

The goal of the Affordable Care Act was to make health insurance available and more affordable for all Americans. Under the Affordable Care Act, insurance companies cannot deny you coverage because of preexisting medical conditions. They also cannot drop you for simply becoming too costly to insure.

Government Plans are those plans directly established by the Affordable Care Act. All of these plans have the same amount of coverage because, per the Affordable Care Act, all Government Plans need to cover the Essential Health Benefits. The Essential Health Benefits include emergency/hospitalization care, preventative care, maternity/pediatric care, mental health services, prescription drug coverage, lab work, and more.

There are five tiers of Government Plans: Bronze, Silver, Gold, Platinum, and Catastrophic. Again, all plans provide the same amount of coverage; the only difference is the cost. Bronze Plans have premiums that cost less per month/year, but you will pay more out-of-pocket when you have medical services. These plans are good for otherwise healthy people, who do not anticipate medical services beyond basic preventative care. Platinum Plans are the exact opposite. You pay more per month/year, but less out-of-pocket. These plans are best for those who have an ongoing medical issue that requires regular medical services. Catastrophic Plans are a “just-in-case” plan for those who need coverage in the event of a major medical issue such as a hospitalization. You must be under 30 or undergoing some form of income hardship to qualify for this plan.

If you meet certain income criteria, you can qualify for a subsidy. Subsides can significantly lower the costs of Government Plans.

Government Plans are only available during Open Enrollment. The only exception is if you missed Open Enrollment, and experienced a major life change, known as a “Qualifying Life Event” you could be eligible sign up for a Government Plan outside of Open Enrollment.

If you do not have coverage through your employer, it is crucial that you get a Government Plan. Not having a Government Plan will likely lead to a fine. The Affordable Care Act authorizes such fines in the form of tax penalties that are collected on federal tax returns. The reason for the fine is to encourage all Americans to get health insurance. The less uninsured people in the market, the lower the costs of health care and insurance will be for everyone. The fines have increased and are the greater of the two: a) 2.5% of household income or b) $695 per adult / $347.50 per child with no household limit.

Even though the law was extensive, there are still health plans available that are not supported by the he Affordable Care Act. These plans are Non-Government Plans, and are sometimes referred to as “Private Plans” or “Short Term Plans.” These plans may not protect you from fines and you could be denied coverage for preexisting conditions. However, the plans are generally inexpensive and provide necessary health coverage until the next Open Enrollment.

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