©2011-2023 Less Accounting
Menu
| Term | Definition |
|---|---|
| Individual Mandate | It is now law that all Americans (with some exceptions) maintain a minimum level of health coverage or face a fee. https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014 (The fee structure is complicated and varies with income or time. It usually starts at $95 per adult.) |
| Insurance Exchanges | An exchange was created (called the “Marketplace”) on which individuals and small businesses can “shop” for health insurance. More on this later. |
| Employer Mandate | Employers with 50 or more full-time employees must supply health insurance to their employees and employees’ dependents, or face penalty fees. |
| Mandated Health Care Benefits | Insurance companies are required to provide certain benefits.Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid. |
| Required Pediatric Dental | In the vast majority of states, parents must have dental insurance for their children. Some agents I’ve spoken to recommend having dental included in a plan some say get a supplimentary dental plan. |
| Sup Cat |  |
| Women’s Benefits | Plans must include breastfeeding benefits for new mothers and cover contraceptives. A few religious organizations have filed lawsuits in an attempt to stop this, one being Hobby Lobby. |
| Out-of-Pocket Limit/Max | You cannot pay more than a certain amount annually for medical expenses. I have not found how the government and health insurance agencies plan on monitoring this limit. |
| Guaranteed Issue | Insurance companies cannot charge you more for pre-existing conditions. Insurance companies in your area MUST accept you into a plan at no additional cost. They can only charge more for smoker status, age and location. |
| Medicaid Expansion | Allows states the option to newly expand Medicaid to most adults up to 138% of federal poverty level. |
| Easier-to-Understand Language | Insurance companies are required to use a “Summary of Benefits and Coverage (SBC)” to explain their health insurance plans so they’re easier to understand. |
| Fewer Cancelled Policies | Insurance companies can only cancel your insurance if you were fraudulent in your application or if you didn’t pay the premiums.
|
| Emergency Room Access | Insurance companies cannot require preapproval for emergency room visits, and you can visit ERs outside of your network. |
| Young Adult Coverage | You can remain on your parents’ health insurance plan up until the age of 26. You also have access to catastrophic plans until you’re 30 years old. |
| Insurance Company Profit Monitoring | The Federal Government now regulates how much profit an insurance company can make, and they monitor insurance plan rate increases as well. Read More |
| Coverage Decisions Appeals | Private insurance plans have to tell you why a claim has been denied, and they have to let you know how you can dispute their decision. Read More |
| The healthcare.gov website | This website (also called “The Marketplace” or “The Exchange”) gives you an easy way to compare plans, but you’re still buying from the insurance companies, not the government. The “buy now” button simply links you to the insurance provider’s website to buy the policy. Some states have created their own marketplaces. |
My advice is to use an insurance agent. Their pricing is usually the same as what you’d find on Healthcare.gov and you’re basically getting a person to help you find a policy for free.
Not all health insurance companies are listed on Healthcare.gov, so there may be other options for you beyond what you see on that site. To be listed on HealthCare.gov, insurance companies must cover the majority of counties in the state.
See more plans available to you on ehealthinsurance.com or TheHealthSherpa.com
Simplifying small business bookkeeping since 2011.
©2011-2023 Less Accounting