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Health Care Buzz: 12 Year Anniversary of the Affordable Care Act | Local


March 23 is the 12th anniversary of the Affordable Care Act (ACA, aka ObamaCare). Wow! After a long struggle for passage, we have benefited from the coverage and protection it has offered.

1) Insurance plans cannot “rate” you or deny coverage based on any pre-existing conditions.

2) Children (even married) can have coverage thru their parent’s plans until age 26.

3) There is no ceiling on the amount of coverage an insurance plan covers for ongoing care.

4) The creation of the Exchange/Marketplace for individual and family coverage.

5) The inclusion of the ten essential elements for all insurance plans sold.

Ambulatory patient/outpatient care

Inpatient hospitalization

Maternity and newborn care

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Mental health services and substance/addiction treatment

Preventative services, wellness services and chronic disease management.

Rehabilitation services and devices.

  • No waiting periods, no exclusions.

According to the U.S. Department of Health and Human Services (HHS), during open enrollment to join the Exchange/Marketplace plans, a record-setting nearly 6 million new consumers signed up for coverage.

This includes 2.8 million people who newly enrolled during the special enrollment period/SEP (for moving, new job/no coverage, loss of job, retirement before 65) used outside the normal open enrollment period. Under the recent American Rescue Plan (ARP) more families were able to take advantage of the credits to help with premiums. Nationwide, 2.8 million more consumers are receiving tax credits in 2022 compared to 2021. Without the funding provided by the ARP, the average monthly premium would have been $59 per month higher.

The uninsured rate fell after implementation of the ARP, SEP and other outreach efforts. The uninsured rate for the U.S. was 8.9% for the third quarter of 2021 (July -Sept 2021), down from 10.3% for the last quarter of 2020. There is also another new SEP opportunity for low-income consumers with household incomes under 150% of the poverty rate – approximately $19,000 individual and $40,000 for a family of four for 2022.

Let’s talk about the Great Retirement that is still occurring. Many individuals who are not yet 65 (eligible for Medicare) are retiring without health insurance. The Exchange/Marketplace is the perfect place to find insurance and since the credits are income based, be sure to complete the easy online application form to see all the plan options being offered in your state and any possible financial considerations. For Idaho: www.yourhealthidaho.org or call 855-944-3246. Every state has one!

Day Egusquiza is the president and founder of the Patient Financial Navigator Foundation Inc. — an Idaho-based family foundation. For more information, call 208-423-9036 or go to pfnfinc.com. Do you have a topic for Health Care Buzz? Please share at [email protected].