Patient Protection and Affordable Care Act (PPACA) is a federal law written by congress and signed by President of US in 2010. The law was established to cover medical expenses to most of the non-insured citizen of the United States. The PPACA (Patient Protection and Affordable Care Act) or Affordable Care Act also is known as "the ObamaCare".

What is Affordable Care Act or ObamaCare?

What is Included in Affordable Care Act or ObamaCare?

Affordable Care Act or ObamaCare came into existence on 23rd March 2010, after President Barack Obama signed the law of Patient Protection and Affordable Care Act. The objective of Affordable Care Act or ObamaCare supporting health care is to enhance the healthcare coverage to the citizens of United States who are not insured or partially insured.

Individual Mandate-

The law suggests it is mandatory that all individual and their families qualified for private health insurance should pay the calculated reasonable share of income. If such a group of individuals and families failed to get insurance coverage then there will be penalty charged and collected during filing of tax returned. All Citizens of America should be covered by medical healthcare insurance.

Affordable Premium-

Affordable Care Act or ObamaCare also offers a health insurance at reasonable fees depending on annual income. The lowest premium is offered to individual earning below poverty level of income. The law makes a provision for uninsured employee or unemployed individuals to be eligible for private health insurance or federal and state health insurance policies. The law is written to accommodate annual earning of every employee in calculating the annual premium to be charged for insurance benefits.

Pre-existing Conditions-

In Affordable Care Act or ObamaCare, no one will be denied insurance coverage because of pre-existing conditions. Individual suffering with chronic disease like asthma, severe arthritis, back pain and migraine headaches are considered suffering with pre-existing diseases. Individual cannot be denied or eliminated from medical insurance coverage provided under Affordable Care Act or ObamaCare during the suffering with severe chronic illnesses. The Obama Care makes it relatively easy to get insurance coverage for individual with history of minor or major pre-existing illnesses. Individuals who have prior conditions, for example, cancer or asthma will find it quite easy to get a reliable health care coverage because of the 2010 enactment of Affordable Care Act or Obamacare. The recent published reports by US government suggest in 2014, more Americans were covered with healthcare coverage than in year 2010. Those people, who were earlier denied to have medical coverage because of their pre-existing condition and have been uninsured for more than six months, will get insured now with Affordable Care Act or ObamaCare. Pre-Existing Condition Insurance Plan (PCIP) mainly aims at grown-ups who were not able to get medical coverage earlier because of their previous medical condition, for example, diabetes or tumour. As of 2014 and later, they will have the access to enrol in the Affordable Care Act or ObamaCare plan.

Screening and Preventing Services-

Patient who are insured under Affordable Care Act or ObamaCare will not be paying any out of pocket expenses for screening and preventive services, which are recommended by physician. Such test includes mammograms (screening of the breast) and colonoscopies.

Insurance Coverage of Young Adults and Teenagers-

Under Affordable Care Act or ObamaCare, young adults or teenagers can continue on their parent's health plans until they are 26 years of age. This is applicable for those who are not living with their parents, out of school, not fiscally dependent on their parents and unemployed. Unemployed or student under 26 years who were on different plan later can come back on parent's insurance policies for certain annual payment. Group plans, which began before the commencement of Affordable Care Act or ObamaCare, remain unaffected.

Chronic Diseases-

The goal of the Affordable Care Act or ObamaCare is to analyze conceivably chronic and severe infections on time so that proper treatments can be provided for most effective results. Patient can choose insurance coverage offered by participating insurance provider and patient cannot be denied because of history of suffering with chronic diseases

Children's of Low Income Family

Children of low-income family are covered under Medicare for physician fee, hospital services and treatment by participating in state funded Medicaid.

Affordable Care Act or ObamaCare & Employer Employing Less Than 50 Employees-

Employers with less than 50 employees get tax credit and other financial aid if decided to participate in Affordable Care Act or ObamaCare. The expense involved in giving medical coverage using Affordable Care Act or ObamaCare are tax deductible. Some small organizations also offering credit to employee as a benefit, which makes it easier to buy the health coverage at an affordable price. Small firms employing 25 employees and paying average salary of $ 50,000 are expected to offer health care coverage under Affordable Care Act or ObamaCare. Expected tax credit will be 35 percent for non-profit organizations and 50 percent for small firms

Market Place

The federal government established a toll free telephone line known as Market Place. Market place provides a list of private medical insurance provider who has agreed to participate in Affordable Care Act or ObamaCare. The market place guides un-insured employees to select one of the four affordable plans as defined by Affordable Care Act or ObamaCare. Each state has a list of different private insurance provider who have agreed to participate to offer health insurance according to directions set by PPACA (Obama Care). The choices of medical insurance policies directed by Affordable Care Act or ObamaCare can be purchased over market place or outside market place. The insurance companies set most of the outside market place stations. The plans are often difficult to understand and face to face interview helps to understand all the pros as well as cons of each plan. Most prefer to meet Market Place Plan administrator employed by insurance provider or federal or state government.

Choice of Medical Insurance Plan in Affordable Care Act or ObamaCare-

Private health care insurance under the Affordable Care Act or ObamaCare offers four levels of medical insurance policies known as "Metal Insurance Policies". The 4 levels of "Metal Insurance Policies" are recognized as bronze, silver, gold and platinum. Individual interested in participation with health insurance under Obama Care Act can call toll free number of Market Place to discuss pros and cons of offered 4 insurance policies. The 4 metal policies are available through participating private health insurance provider. The policies are offered directly to un-insured employees and their families who were not insured by employer employing less than 55 employees.

The least expensive plan under Affordable Care Act or ObamaCare is bronze and most expensive plan is platinum. It is often difficult to understand the details of the four plans under Affordable Care Act or ObamaCare. Each plan has restriction defined co-pays and deductible as well as limitation of utilizations of physician and hospital services. Lower the plan level higher the restrictions, deductibles and co-pays. Each plan gives tax credit when income is below threshold level. These plans are also available outside Affordable Care Act or ObamaCare. Private Medical Insurance Companies participating in Affordable Care Act or ObamaCare must offer at least 2 of the 4 plans. One of the 2 must be a silver plan. The act also dictate health insurance contributions of the elderly must not be more than three times as high as the health insurance contributions of young people in the same insurance group.

  • Bronze Plan- Qualifies for tax credit and has lower premium. Bronze ObamaCare Plan is the lowest health care insurance plan, includes higher, co-pays, deductibles and restriction of choosing physician and facilities. Affordable Care Act or ObamaCare mandate all participating health insurance provider must offer a minimum standard of defined benefits.
  • Silver Plan- individual who decides to participate in silver plan of Affordable Care Act or ObamaCare qualifies for both Tax Credits and Cost Sharing subsidies. Silver plan is the second lowest health care insurance plan. Silver plan covers close to 70 % of the services and 70% cost sharing value for seeing physician of their choice and treatment. Expensive and non covered benefits often are not covered. Considering the cost saving in premium, silver plan of Affordable Care Act or ObamaCare is beneficial for younger employees and their families who may qualify for Cost Sharing Reduction Subsidies. Employee earning 100% to 250% of the federal poverty level will most likely find the best value plan in the Silver metal level. Depending upon your region and your plan a Silver plan can have a wide range of costs, benefits, and network.
  • Gold Plans- Gold plan under Affordable Care Act or ObamaCare covers close to 80% of the medical benefits. The enrollee or employee pays remaining 20%. The 80% figure is based on the government's expectation of healthcare usage. The 20% of healthcare costs paid by the enrollee would be in the form of out-of-pocket deductibles, copayments, and coinsurance fees. The monthly premium for the Gold Plan, however, is paid in addition to the out-of-pocket costs. The Gold Plan is one of the two plan types along with the silver plan that an insurance company must offer in order to participate in a health insurance exchange.

Out-of-Pocket Costs for Gold Plan Enrollees. The premium for Gold Plan differs in age group of 30, 40, 50 and 60. Premium becomes higher with older age group. Premium becomes lower with higher co-pays and higher deductibles. In some instances premium of Gold Plan of one insurance provider may be lower than Silver or Bronze plan. Thus it is important to compare premium of various plan and benefits with all insurance providers participating in Affordable Care Act or ObamaCare.

  • Platinum Plan- Platinum plan is more expensive than Gold Plan. Platinum plan covers most medical expenses 100% if participants chooses a manage care plan. Premium depends on co-pays and deductibles. The plan premium increases with older group. The plan provides better coverage but also cost higher premium. The premium also depends on the overall health of participants and enrollees. Chronic illnesses and frequent ER visit may drive the premium higher and thus the Affordable Care Act or ObamaCare has provisions to monitor the health of enrollee and increase of premium. The monthly premium for a silver, gold and platinum plan depends on the insurance provider, copays, deductibles, age, history of smoking and area of residence.

Medicaid: State Owned Medical Insurance Policy

Obama Care Act offers Medicaid to un-insured employee and their family earning income of up to 133% of administrated poverty line. Most state agreed to support Affordable Care Act or ObamaCare and provide Medicaid as an alternative medical insurance policy over to 4 metal policies. Residents who have to spend more than 9.5% of their income for health insurance contributions will be allowed to enter the health insurance policy provided by the state government. This authority should establish, in cooperation with private insurance at least two group insurance, of which at least one non-profit works. Medicaid on an average pays less to physician and hospitals. Affordable Care Act or ObamaCare stipulates higher payment by Medicaid to physician. Physician often avoids Medicaid patients because of substantial lower payment for services. Affordable Care Act or ObamaCare wants to avoid physician participation with Medicaid section of Obama Care Act. By 2014, all participating Medicaid state policies must include following services-

  • ER visits,
  • Hospital cost
  • Maternity Care
  • Infant and paediatric care
  • Mental health care
  • Preventive care

Financial Aids

Affordable Care Act or ObamaCare expects all employees to be able to pay for subsidized premium and participate with medical insurance policies offered under act. Under Obama Care Act individual or family qualified for one of the 4 metal medical insurance coverage are eligible for financial aid. The details of financial aid packages are yet not clear. Federal government secures the cost of financial aid by adding additional taxes on income and deductibles. The criteria for enrolee to be eligible for financial aid is depended on annual income and pre-existing condition.

Fines or Penalties-

Uninsured employee or residents who have decided not to participate in medical health plan provided under Affordable Care Act or ObamaCare will be charged a fine up to 2% of income. The fine is excused if individual is unable to participate because cannot afford in spite financial aid or for religious reasons. Similarly fines or penalty will be assigned to companies employing more than 49 full-time employees and decides not to provide health insurance for employees.

Written, Edited or Reviewed By:


Last Modified On: October 1, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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