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The Affordable Care Act – ACA

The Patient Protection and Affordable Care Act, also known as the ACA or Obamacare, was enacted by Congress in March of 2010. The act encompasses three main goals: to provide affordable healthcare options to more people, to expand the Medicaid program, and to support innovative medical care advancements that lower the general cost of healthcare services

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To be considered ACA compliant, plans must include ten essential health benefits, including emergency services, hospitalizations, and preventative and wellness services.

Outpatient Care

or Ambulatory patient services – outpatient care is a broad category that includes services you receive without going to a hospital. For example, wellness and prevention doctors’ appointments, diagnostic services, treatments, and rehabilitation.

Hospitalization

insurance plans are required to cover hospitalization, such as overnight stays and surgeries. This does not mean that your plan will cover the entire hospital bill, however. The average hospital stay costs over $10,000 so the amount you owe will depend on your plan’s co-payment, deductible, or co-insurance.

Pregnancy, Maternity, & Newborn Care

qualified health plans must cover these categories both before and after birth. Insurance companies cannot deny coverage or charge women more.

Mental Health & Substance Abuse Services

Pre-existing mental and behavioral health conditions must be covered, including behavioral health treatment such as counseling and psychotherapy. Insurance plan copays will apply.

Prescription Drugs

Under the health care law, at least one prescription drug must be covered for each category and classification of federally approved drugs. Limitations do apply.

Rehabilitative & Habilitative Services & Devices

Health plans must cover services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills. Examples include physical therapy or wheelchairs.

Laboratory Services

qualified insurance plans must cover lab services that help a doctor diagnose an injury, illness, condition, or monitor the effectiveness of treatment.

Preventive & Wellness Services & Chronic Disease Management

this includes services such as immunizations, screenings, physicals, and counseling.

Pediatric Services

include well-child visits, immunizations, oral and vision care (adult dental and vision coverage are not essential health benefits)

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Financial help for Health Insurance coverage through Marketplaces.

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Aetna CVS Health


Amerihealth Caritas


Anthem ACA


Blue Cross and Blue Shield of South Carolina


Christus Health


Cigna IFP


HealthFirst


Medica


Oscar Health


Priority Health


 

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Ambetter Health


BCBS TX


Caresource


Molina Healthcare


UHC ACA


 

 

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Contact a Pinnacle Financial Service representative today for assistance.

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