Most likely, you’ve heard of the Affordable Care Act, also known as ObamaCare or the ACA. But what is it really, and how does it affect you?
Summed up, the Affordable Care Act was a law passed in 2010 by the Obama administration in an attempt to ensure all Americans have access to affordable health insurance. The idea was to make insurance more affordable, expand the Medicaid program to cover more low income adults and their families, and to encourage new ways of delivering healthcare. In order to achieve this, the act created an online marketplace called the exchange where consumers can shop, compare, and enroll in health plans at one central location. In addition, all the the insurance providers and plans available through the online market exchange need to meet certain criteria (cover basic health services, i.e. ‘minimum essential coverage’…see below for more info) in order to sell to consumers.
How the ACA may affect you…
Due to the ACA, many Americans now qualify for financial assistance to enroll in a health insurance plan through the online marketplace at Healthcare.gov. In the state of Minnesota, we have a version of this called MNsure. MNsure was created in order to fulfill the requirements of the ACA, while providing specific coverage options for Minnesotans. Since the installment of the ACA, the uninsured rate in the U.S. has decreased by 6.9%, with 92% of Americans having coverage in 2017. In Minnesota from 2013 to 2015, uninsurance rates dropped from 8.2% to 4.3%. If the Affordable Care Act continues to be upheld, the amount of Americans without insurance is projected to decrease from 60 million in 2012, to 27 million in 2022. However, there are still many Americans, including Minnesotans, who do not have insurance coverage. In fact, in Minnesota, 349,000 people did not have coverage in 2017. The vast majority of individuals who fall within this category qualify for financial assistance through Minnesota’s marketplace, MNsure.org, and may not even be aware.
Here’s some key components of the ACA and MNsure you should know about:
Additional Resources:
MinnesotaCare is a state run health program for low income minnesotans, its income limits are higher than Medical Assistance. The program is paid for by a tax on hospitals, health care providers, Basic Health program funding, and premiums from enrollees.
The health plans available for MinnesotaCare enrollees vary from one county to another. However, most counties carry at least two to three options.
To qualify for MinnesotaCare, an applicant must meet the following requirements:
The premiums enrollees must pay are on a sliding scale. Those on the lower end of the income limit for the program tend to pay little to none, while those on the higher end can pay up to the maximum of $80. MinnesotaCare does not have an asset limit.
However, exceptions are made for some members, those include:
Keep in mind that MinnesotaCare health coverage will not commence until the first premium has been paid, and coverage always begins the month following the month the premium has been paid on. Coverage will continue so long as the member is making his/her premium payments in a timely manner.
Once enrolled, members receive a packet in the mail with information about carriers and a bill for their premium if one exists.
Health insurance terminology can be daunting at first glance, but don’t fret. We’ve compiled the most common terms you will encounter on any health insurance marketplace.
Remember, you can always contact Bloomington with any questions you may have about terminology, enrollment, terms of coverage, and more. The more in-the-know you are, the more confident you’ll feel about your healthcare options.
A deductible is the amount that the individual policy owner must pay towards health coverage before insurance begins to pay towards your care.
For instance, if your deductible is $1,000, you are responsible for paying the $1,000. Anything beyond that amount will be covered by your insurance provider. For individuals with coinsurance, any costs that exceed the amount of the deductible will be split between provider and policyowner.
Deductibles vary in price depending on the plan you choose but do not change once you have signed to a plan.
The term ‘co-insurance’ is often used interchangeably with the term ‘copayment’. While coinsurance functions in a similar way as a copayment, it is actually a separate term.
The term co-insurance refers to healthcare costs that you share with your insurance provider. The rate is usually a fixed percentage and is paid after you have paid your deductible. For example, you may pay 35% of the cost of your care while your insurance provider pays the other 65% after reaching your deductible.
It’s important to note that the rate is limited by your out-of-pocket maximum. If you reach your out-of-pocket maximum, your health insurance will cover the rest of the expenses for the rest of the plan year.
In general, healthcare plans with high premiums have lower coinsurance rates while plans with low premiums will have higher coinsurance rates.
A co-pay is a flat fee paid by a policy holder to the provider before receiving a service. You will most commonly see copays for visits to the doctor, lab tests, certain types of specialist care, and prescriptions.
In general, plans with higher premiums will have lower co-pays while plans with lower premiums will have higher co-pays.
Cost-sharing reductions refer to discounts that can be applied to deductibles, copayments, and coinsurance for lower healthcare costs.
It’s important to note that not all plans are eligible for cost-sharing reductions. Only Silver plans are eligible for CSR. Qualifying applicants may be eligible for both CSR and premium tax credits.
An insurance premium refers to the monthly cost of your health insurance. A premium does not cover additional expenses such as doctors visits, prescriptions, deductibles, or coinsurance.
Plans with low premiums are not right for everyone, especially if you have a family or a chronic medical condition that requires frequent visits to the doctor.
A maximum out-of-pocket expense is the maximum amount you are required to pay towards services that are covered in a plan year. Any expenses that exceed this amount and are covered by your insurance will be paid for by your insurance provider. You may be responsible for expenses that exceed this amount that are not covered by your insurance.
Out-of-pocket expenses include deductibles, coinsurance and copayments. Your monthly premiums do not count as part of your out-of-pocket expenses.
In general, plans with higher premiums will have lower out-of-pocket expense thresholds while plans with lower premiums will have higher out-of-pocket maximums.
An insurance premium tax credit is a credit that can be applied towards your monthly premium to lower the cost of your monthly health insurance costs. This is only available through the marketplace.
Eligibility for this credit is determined based on your household size and income. You may be eligible for a premium tax credit if your household income falls between 100% and 400% of the federal poverty level.
You do not have to use your tax credit towards your insurance premium. You can request it instead in the form of a tax refund at the end of the year. Conversely, if you use more credit than you are given, you are required to pay the difference on your next tax return.
MNSure is the state-level health insurance marketplace for Minnesota. You can shop for plans offered by healthcare insurance companies such as Blue Cross Blue Shield, Health Partners, UCare, and Medica. MNsure is the only place Minnesotans can apply for financial help to reduce the cost of their monthly insurance premium and out-of-pocket costs. The majority of Minnesotans who enroll through MNsure qualify for financial help.
There are three healthcare programs available through MNsure, including:
Medicaid: A joint state-and-federal program designed to provide healthcare for low-income adults.
Minnesota Care: A state-run healthcare program designed to provide health coverage for low-income Minnesotans.
Qualified Health Plans (QHP): A federally-certified healthcare plan that provides the required essential health benefits, also known as “minimum essential coverage”. These plans also adhere to federal limits on cost sharing (e.g. deductibles, co-pays, maximum out of pocket) and meet other requirements under the Affordable Care Act.
MNSure is the state-level health insurance marketplace for Minnesota. You can shop for plans offered by healthcare insurance companies such as Blue Cross Blue Shield, Health Partners, UCare, and Medica. MNsure is the only place Minnesotans can apply for financial help to reduce the cost of their monthly insurance premium and out-of-pocket costs. The majority of Minnesotans who enroll through MNsure qualify for financial help.
There are three healthcare programs available through MNsure, including:
Medicaid: A joint state-and-federal program designed to provide healthcare for low-income adults.
Minnesota Care: A state-run healthcare program designed to provide health coverage for low-income Minnesotans.
Qualified Health Plans (QHP): A federally-certified healthcare plan that provides the required essential health benefits, also known as “minimum essential coverage”. These plans also adhere to federal limits on cost sharing (e.g. deductibles, co-pays, maximum out of pocket) and meet other requirements under the Affordable Care Act.
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