Essential Health Benefits and Coverage Levels

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Essential Health Benefits and Coverage Levels
Obamacare
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Tags : affordable care act, what is obamacare, obamacare insurance, obama care insurance, the affordable care act, private health insurance, obama care sign up, obama health care plan, health insurance
As a part of the new Affordable Care Act, or health care reform, all individual and small group health insurance plans must include certain essential health benefits as part of their covered benefits. These mandatory benefits are: • Ambulatory patient services • Emergency services hospitalization, maternity and newborn care, mental health and substance abuse disorder services including behavioral health treatment prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventative and wellness services and chronic disease management, pediatric services including oral and vision care. The details of the coverage will vary from plan to plan. Also as part of health care reform beginning in 2014, individual and small group insured health plans will be required to offer health insurance that meets certain levels of coverage. These coverage levels are based upon the actuarial value of the plan, and are represented as the metal levels bronze, silver, gold and platinum. Bronze-level plans will cover approximately 60% of essential health benefits. Silver-level plans will cover approximately 70% of essential health benefits. Gold-level plans will cover approximately 80% of essential health benefits. And platinum-level plans will cover approximately 90% of essential health benefits. If for example, a plan has a silver actuarial value of 70%, the average individual pays for 30% of the cost. These percentages represent an average of total cost, and will vary slightly. The actual amount any particular individual has to pay will also vary, based on the particular plan and the person’s medical needs. Individuals will no longer have to pay a copayment for certain preventative services, such as routine checkups, if they receive these services from a provider within their plan’s network. However, individuals will need to pay for any limits or exclusions on their benefits. These limits may include number of refills for certain drugs, number of visits to certain specialists, number of days covered for certain benefits, as well as additional charges for the use of out-of-network providers There may also be expenses for services not covered by the plan. Individuals may be eligible for premium subsidies if their income is between 100% and 400% of the federal poverty level. Eligibility for subsidies also depends on the employer coverage, if any, that is available to the individual. These subsidies may help lower the cost of their monthly health insurance premiums. The silver level, for example, which is considered to offer the benchmark level of protection, is still a lower amount of coverage than the average employer-provided coverage in 2013. Individuals will not need to pay for certain preventative services, but they will need to plan for out-of-pocket costs and non-covered services. To help individuals pay for out-of pocket costs associated with an illness or injury, consider making supplemental insurance policies available to employees. Learn more about health care reform and supplemental insurance coverage at Aflac.com. Tags: affordable care act, what is obamacare, obamacare insurance, obama care insurance, the affordable care act, private health insurance, obama care sign up, obama health care plan, health insurance exchange

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