What does the Individual Mandate say?

The individual mandate, officially called a “shared responsibility fee,” is part of what is known as the individual shared responsibility provision. The provision explains that “The federal government, state governments, insurers, employers and individuals are given shared responsibility to reform and improve the availability, quality and affordability of health insurance coverage in the United States. Starting in 2014, the individual shared responsibility provision calls for each individual to have minimum essential health coverage (known as minimum essential coverage) for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.”

 

What if I have a grandfathered health insurance plan?

If you have a grandfathered plan, you have the option to switch to a Marketplace plan and enjoy the rights and protections that other plans have to offer. Grandfathered plans are group or individual health plans that were created or purchased on or before March 23, 2010.  These plans are exempted from many changes required under the Affordable Care Act.

 

Under ObamaCare, all health plans must:

  • End lifetime limits on coverage.
  • End arbitrary cancellations of health coverage.
  • Cover adult children up to age 26.
  • Provide a Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and costs.
  • Hold insurance companies accountable to spend your premiums on health care, not administrative costs and bonuses.

 

Grandfathered plans don’t have to:

  • Cover preventive care for free
  • Guarantee your right to appeal
  • Protect your choice of doctors and access to emergency care
  • Be held accountable through Rate Review for excessive premium increases

 

In addition to the above, grandfathered individual health insurance plans don’t have to:

  • End yearly limits on coverage
  • Cover you if you have a pre-existing health condition

 

Some grandfathered plans offer protections they’re not required to. To find out if your plan is grandfathered, check your plan’s materials and/or check with your employer or your health plan’s benefits administrator.

 

Does the Marketplace offer dental plans?

Yes. You can get dental coverage in the Health Insurance Marketplace as part of a health plan or by itself through a separate, stand-alone dental plan. If you choose a separate dental plan, you’ll pay a separate, additional premium for the dental plan. Under ObamaCare, dental coverage for children is an essential health benefit, which means it must be available to you as part of a health plan or as a free-standing plan. Insurers don’t have to offer adult dental coverage though. You do not need to have dental coverage to avoid the penalty.

 

Does ObamaCare cover preventive care?

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Yes, all Marketplace plans and many other plans under ObamaCare must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked.

2. Alcohol Misuse screening and counseling.

3. Aspirin use to prevent cardiovascular disease for men and women of certain ages.

4. Blood Pressure screening for all adults.

5. Cholesterol screening for adults of certain ages or at higher risk.

6. Colorectal Cancer screening for adults over 50.

7. Depression screening for adults.

8. Diabetes (Type 2) screening for adults with high blood pressure.

9. Diet counseling for adults at higher risk for chronic disease.

10. HIV screening for everyone ages 15 to 65, and other ages at increased risk.

11. Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:

  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus
  • Influenza (Flu Shot)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, Diphtheria, Pertussis
  • Varicella

12. Obesity screening and counseling for all adults.

13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk.

14.Syphilis screening for all adults at higher risk.

15.Tobacco Use screening for all adults and cessation interventions for tobacco users.

 

Note: This applies only when these services are delivered by a network provider.

 

What is the “guaranteed issue”?

The guaranteed issue, which is part of The Affordable Care Act, makes it necessary for health plans to let you enroll, regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll.

 

What is the “guarantee renewability” or “guaranteed renewal”?

The guarantee renewability, which is part of The Affordable Care Act, requires health insurance issuers to offer to renew or continue coverage at the option of the policyholder as long as they continue to pay premiums. Except in some states, guaranteed renewal doesn’t limit how much you can be charged if you renew your coverage.

 

Where can I read the full-text of ObamaCare or the Affordable Care Act?

 

To read the full-text of the law visit:

Affordable Care Act
Reconciliation Act

 

What is the Coverage Gap?

 

The Coverage Gap is a period of 3 consecutive months in a year where you are exempt from the Tax Penalty during these months for not having insurance coverage.

ObamaCare By State