Keeping Tabs on Health Care Today: The Benefits of the Affordable Care Act

~ By Herb White, CFP®, MBA ~

Herb White - Weighing Your Financial OptionsFor many families and individuals, health care expenses are a huge part of their budget. Many are underinsured or have no insurance to cover the costs. This year marks the start of the Affordable Care Act (ACA), which provides help to those struggling to afford health care. It also presents an opportunity for families that haven’t been able to manage their overall budgets or save to get their finances under control.

The Affordable Care Act includes a comprehensive package of items and services that individuals should know about, even if you feel you have good health insurance coverage. Some of the medical services that were excluded from coverage in the past are now required. For example, many individuals with chronic diseases were unable to get adequate insurance coverage for rehabilitative services and medical equipment.

Following are the “essential” benefits the government has mandated:

Affordable Care Act Ten Essential Health Benefits That Plans Must Cover Starting in 2014

  • Outpatient care:
    Ambulatory patient services, also known as outpatient care. However, details about the plans’ networks and access to doctors will vary on a state-by-state basis.
  • Prescription drug benefits:
    All individual and small-group plans will cover at least one drug in every category and class in the United States Pharmacopeia. Drugs now will be counted toward your annual out-of-pocket maximum limits.
  • Emergency room coverage:
    Emergency room visits will no longer require preauthorization, and you no longer can be charged for going out of network.
  • Therapy visits:
    Mental health and substance use disorder services. Many plans do not currently cover these services. In some states, coverage may be limited to a certain number of visits.
  • Inpatient care:
    Your insurer must cover your hospitalization, although you could be required to pay up to 20% of the bill if you haven’t reached your out-of-pocket limit.
  • Therapeutic care/chronic diseases:
    Rehabilitative and “habilitative” services are covered. This will particularly help those with chronic diseases, who will now be covered for therapies. The ACA also requires the coverage of rehab therapies and medical equipment, such as walkers and wheelchairs.
  • Physicals, vaccines, wellness visits:
    These are preventive and wellness services. The law requires insurers to cover all of the fifty preventive services recommended by the U.S. Preventive Services Task Force at no extra cost. They include mammograms and screening for diabetes, high blood pressure and colorectal cancer.
  • Laboratory services and scans:
    Prostate exams and Pap smears are covered. You can still be billed for partial costs of diagnostic lab tests as well as for more extensive screenings, such as an MRI.
  • Dental and vision care for children:
    This coverage is considered an essential benefit for children aged 18 and younger whose parents or guardians get insurance through the individual or small-group plans.
  • Care for mothers and children:
    Maternity and newborn care is covered. Insurers will now have to provide prenatal care, childbirth services and aftercare for the newborn infants as part of their standard coverage.

In General
Additional information you should know about: Out-of-pocket costs will be capped at $6,350 for individuals and $12,700 for families, but this won’t go into effect until 2015 for plans using more than one service provider.

Most plans obtained through an employer or on the marketplace cannot deny coverage or charge more because of a pre-existing health condition. These benefits must be covered by non-grandfathered health plans.

Not Just for Underinsured
Even individuals currently with “full” insurance are expected to benefit from the act. Previously only 2 percent of insurers covered all ten benefits but more are expected to expand their coverage. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, which provides standardized plans. Additionally, states expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.

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Provided by courtesy of Herb White, MBA, CFP®, a CERTIFIED FINANCIAL PLANNER™ with Life Certain Wealth Strategies, 8400 E Prentice Ave, #715 Greenwood Village, Colorado,, (303) 793-3999. Securities and investment advisory services offered through Woodbury Financial Services, Inc. Member FINRA, SIPC and Registered Investment Advisor. Life Certain Wealth Strategies and Woodbury Financial Services are not affiliated entities.

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