Understanding Patient Protection in the Affordable Care Act

Improve Hospital Revenue Cycle Management Processes with AssistantsHealthcare is a basic need and right of every American. You deserve to have a health insurance policy that’s affordable and will provide coverage for your personal healthcare needs. In fact, the US spends 17.1% of the country’s gross domestic product to support and supplement such healthcare services.

Before the Patient Protection and Affordable Care Act (ACA) came into law in 2010, however, it would have been very difficult to get comprehensive coverage if you had a pre-existing health condition or were working for an employer who didn’t provide group health insurance. Thanks to a few key stipulations in the healthcare reform, these roadblocks are no longer in the equation.

As a certified Navigator for health insurances, DECO Recovery Management can give you more insight on how ACA protects you in terms of health and finances.

Medicaid Expansion

The ACA expands the Medicare program to make low-income individuals (those earning below 138% of the federal poverty level or roughly $15,000 or $28,000 for an individual and a household of three, respectively) eligible for healthcare benefits. The expansion provides additional Medicaid funding to each state, enabling them to provide federal-funded healthcare services to low-income families.

Only 33 states have expanded Medicaid, though, so not all low-income Americans have access to the program’s healthcare benefits. If you live in a state that opted in on the ACA, are under 65 years old, and with an income level that falls into the new income level minimum, you can enjoy Medicaid benefits.

Healthcare Protection for Young Adults

People with private insurance policies also benefit from the ACA. While it is typical for private insurers to extend coverage to their customers’ children, they limited insurance coverage to minors only. After the ACA became law, insurers now must provide coverage for children 25 years old and younger. Parents can enroll their children in their health insurance policies even if the latter are married, living independently, employed, and already capable of paying for their insurance plans.

Coverage for Pre-Existing Conditions

One of the more controversial aspects of the ACA is it made it illegal for health insurance companies to refuse you coverage or increase your premiums if you have a preexisting condition. If you have an illness that makes you a high-risk customer, you can rest easy because the ACA spreads out the risk to millions of American health insurance holders. As a result, you won’t be shouldering the cost of your healthcare insurance alone.

Protection from Out-of-Pocket Expenses

As an added financial protection for Americans, the ACA sets limits on out-of-pocket costs. As of 2018, the maximum out-of-pocket cost for an individual is $7,350 and $14,700 for a family. Health plans and the cost-sharing nature of the ACA, however, can lower the cap further and ensure that you’re not paying more from your own pocket than what your policy can cover.

The ACA is far from perfect, but the protections it provides for Americans is worth noting. Get yourself an insurance policy, not just because the law requires it, but because you deserve to have access to quality healthcare.

If you’re not yet enrolled in a policy; if your employer doesn’t provide HMO or other forms of group health insurance; or if you live in a state that doesn’t expand Medicaid, consider getting your policy from the Affordable Care Act Marketplace. DECO Recovery Management can help you navigate through it and find an ideal health insurance policy that you can afford.

Get in touch with us today.

Robert Griffin

Robert is the Business Development Manager at DECO Recovery Management. He covers the Southeast region and specializes in ACA related topics. It is DECO’s Mission to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates to provide exemplary service.

Categories: Affordable Care Act

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