Obamacare and The Affordable Care Act, despite the benefits they brought to millions without insurance, were not without their controversies. Despite the pros and cons of the marketplace, Obamacare, and The ACA, it did bring health insurance to millions of people who couldn’t afford it. In fact, a study performed in 2021, showed that nearly 32 million Americans had purchased insurance through the marketplace and the total number of uninsured people had gone down significantly in many states.
Yet, so many Americans remain unaware of the marketplace completely and choose to remain uninsured. If you or your loved ones are overpaying for insurance or simply have none, you may want to read on. Here are four reasons to purchase insurance in the marketplace.
What Is The Marketplace?
The term, ‘The Marketplace’ can be rather confusing. If the Marketplace is the portal to insurance, what then, are the Affordable Care Act and Obamacare? The ACA was signed into law in March 2010, thus allowing for major changes to health insurance requirements and what health insurance was allowed and not allowed to offer. This law gave birth to the marketplace, a forum for American citizens to purchase affordable plans as well as receive government subsidies and tax credits to make health insurance more accessible to everyone. Obamacare, the term in honor of the president who designed and rolled out the federal act, is a synonym for the ACA, meaning that you can use The Affordable Care Act and Obamacare interchangeably.
All Plans In The Marketplace Are Required To Cover 12 Essential Benefits
One of the massive changes enacted by the ACA was the requirement that health insurance companies were no longer allowed to deny benefits or care for preexisting conditions. In addition to these changes, all insurance plans offered on the marketplace are required to cover primary essential benefits, with 12 overall benefits being mandatory.
Not all illnesses or injuries require emergency or hospital services. Often, you can receive more thorough care during the day at an outpatient clinic or ambulatory center. From ultrasounds to wound care, these services are all covered in a marketplace health plan.
While you should only call 911 in an absolute emergency, sometimes you need an ambulance and you shouldn’t have to worry about whether your insurance company will cover the high costs of something like an ambulance. If it’s an emergency, you’re covered.
In cases where things are serious enough to warrant long-term care in the hospital, the marketplace has your back. Surgeries deemed necessary by your doctor, ICU care, and other hospitalization services are all required benefits.
Pregnancy and Newborn Care
Maternity care while pregnancy and the delivery itself can be costly, upwards of $50,000 depending on the state and hospital providing care. This doesn’t account for the care of your precious newborn either. If you're pregnant or planning to get pregnant, you can breathe easily. All pregnancy, maternity, and newborn care is covered.
Mental Health and Substance Abuse Care
There has been a lot of debate about substance abuse care and mental health coverage but the ACA ensured that anyone who needed mental health services like therapy, medication, or even inpatient treatment was entitled to care. The same goes for substance abuse care like detox and outpatient care.
The need for prescription drugs arises more often as we age, but if you have an illness like Diabetes, the coverage of medication is likely high on your list when you’re shopping for insurance. The ACA only applies to prescription drugs, not OTC medications, so anything deemed necessary by your doctor is covered, in some part, by your insurance plan.
Rehabilitative and Habilitative Services
If something occurs that leaves you needing long-term care, like a TBI or a stroke, your health insurance company is required to cover rehab during your recovery. Also covered are healthcare devices required for your recovery, for example, prostheses for amputees or hearing aids for those with hearing loss.
Seeing your doctor often is just step one in the care process, and it can be expensive. Any laboratory tests that are ordered by your doctor like blood tests are covered by marketplace plans.
The idea that you should only see your doctor when you're sick is a myth. Preventive care, like annual check-ups and screening tests like mammograms, save millions of lives each year. While annual check-ups and many early screening tests are covered by marketplace plans, most Americans skip their annual checkup. Here’s why you shouldn’t.
When it comes to anyone under the age of 18, the coverage that is required becomes much more extensive. In addition to healthcare, dental services and vision are both required to be covered. Keep in mind, that these additional benefits are only available to children under the age of 18 and not to adults.
At one point, breastfeeding wasn’t very common, but now more than 80% of mothers in America breastfeed their children initially. Breastfeeding can be difficult and require further appointments to assist in the process, these and anything your doctor recommends or prescribes, including a breast pump, are covered.
Birth Control Coverage
While private and employer healthcare plans can deny birth control coverage, plans offered on the marketplace cannot. When it comes to birth control, there are special regulations for insurance companies, for example, they must offer certain FDA-approved birth control drugs and devices without charging a copay, even if you haven’t met your deductible, provided you are in-network. Learn more about what is and isn’t covered when it comes to birth control here.
There Are No Pre-existing Condition Exceptions
At one time in America, if your insurance ever lapsed, any chronic conditions like diabetes or even allergies could be deemed a pre-existing condition by your health insurance provider. This meant you’d receive no care for the illness. This was one of the major changes made by the ACA, one that has held strong despite recent changes. If you purchase through the marketplace, you can’t be denied coverage or treatment.
You May Be Eligible For A Subsidy
As of the last census, 14.5 million utilized the marketplace, of that, 13 million people received some sort of subsidy. This means that part, if not the majority of their insurance costs were offset by the government. Who qualifies for a subsidy and how much you get varies greatly depending on a number of factors, including gross income and the number of dependents you claim on your tax return. Many families can qualify for a high-tier insurance plan at $10 or less a month.
You Can Choose The Coverage You Need
The marketplace offers four tiers of plans on its website: bronze, silver, gold, and platinum. The higher the tier, the better coverage, and typically the more expensive it is. But not everyone needs a robust insurance plan that covers everything from paper cuts to major surgery.
If you're healthy and fit and only see the doctor occasionally, you may just want basic coverage for an emergency and annual benefits so you can get your regular yearly physical done with your primary care. Well, the marketplace allows you to choose a plan that's suited for your needs, not just the insurance companies.
The Marketplace Is The Suitable Platform To Choose Insurance, For Most People
With no pre-existing conditions being excluded and with 12 essential benefits being covered in all medical plans, the marketplace is typically the smart choice for insurance shopping. This is before you factor in potential subsidies and tax credits that allow you to save money on your doctor's visits and put that money back into your pocket. While some may find more cost-effective plans through their employer or private options, typically the marketplace offers the most robust options for the majority of Americans.
If you are considering a change in insurance or just want to explore your options, you aren’t alone. Insuraway is more than just an insurance broker, we are a family. Join our family by calling an agent at 1-800-763-4167.
*Subject to change, please refer to Healthcare.gov