Most likely, you’ve heard of the Affordable Care Act, also known as ObamaCare or the ACA. But what is it really, and how does it affect you? Summed up, the Affordable Care Act was a law passed in 2010 by the Obama administration in an attempt to ensure all Americans have access to affordable health insurance. The idea was to make insurance more affordable, expand the Medicaid program to cover more low income adults and their families, and to encourage new ways of delivering healthcare. In order to achieve this, the act created an online marketplace called the exchange where consumers can shop, compare, and enroll in health plans at one central location. In addition, all the the insurance providers and plans available through the online market exchange need to meet certain criteria (cover basic health services, i.e. ‘minimum essential coverage’…see below for more info) in order to sell to consumers.
How the ACA may affect you…
Due to the ACA, many Americans now qualify for financial assistance to enroll in a health insurance plan through the online marketplace at Healthcare.gov. In the state of Minnesota, we have a version of this called MNsure. MNsure was created in order to fulfill the requirements of the ACA, while providing specific coverage options for Minnesotans. Since the installment of the ACA, the uninsured rate in the U.S. has decreased by 6.9%, with 92% of Americans having coverage in 2017. In Minnesota from 2013 to 2015, uninsurance rates dropped from 8.2% to 4.3%. If the Affordable Care Act continues to be upheld, the amount of Americans without insurance is projected to decrease from 60 million in 2012, to 27 million in 2022. However, there are still many Americans, including Minnesotans, who do not have insurance coverage. In fact, in Minnesota, 349,000 people did not have coverage in 2017. The vast majority of individuals who fall within this category qualify for financial assistance through Minnesota’s marketplace, MNsure.org, and may not even be aware.
Here’s some key components of the ACA and MNsure you should know about:
All plans sold on MNsure include the following consumer protections:
No discrimination based on pre-existing conditions or gender
No annual dollar limit on coverage
No lifetime limit on coverage
A cap on out-of-pocket costs
Allows young adults to stay on their parent’s health insurance plan until age 26, unless they have access to coverage through their employer
Requires that 80-85 cents of every dollar you pay for health insurance is spent on delivering or improving health care-or you get a refund from your insurance company
Provides a standard, plain language summary of your plan called a summary of benefits and coverage
For an insurance plan to be eligible for the market exchange, they must provide what is called Minimum Essential Coverage (MEC). Under MEC, all 10 of the following essential benefits must be covered:
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services
Rehabilitative and habilitative services and devices
Wellness and preventative services
Pediatric services, including oral and vision care
The ACA has what is called an open enrollment period (OEP) when people can shop for and enroll in health coverage. Many of the plans through the market exchange require you sign up during this period to ensure coverage for the upcoming year.
If you are under certain income limits (primarily low income) or you have an extenuating circumstance, you may be eligible to enroll outside of the open enrollment dates.
OEP timeline varies across states, in Minnesota, it typically runs from November to January.
Briva Health is a formal partner of MNsure. Briva staff are expert MNsure certified navigators and can provide free in-person and over the phone enrollment assistance to Minnesotans needing to enroll through MNsure. For more information about Briva or to set up an appointment with a navigator call 1855-566-7873 or visit brivahealth.com.