When the Affordable Care Act, also known as ObamaCare, was passed in 2010, it marked the beginning of a new era in health insurance. Then Vice President Biden reportedly murmured in the President’s ear on a hot mic, “this is a big f——ng deal.”

The public knew that important health insurance laws had been tried and failed by many previous administrations. What does the ACA do for Martin and Palm Beach Counties residents?

NOTE – The 2022/ 2023 Open Enrollment Period when you can sign up for Obamacare runs from November 1, 2022 through January 15, 2023. Learn more about Obamacare for Palm Beach and Martin County residents.

Pre-Existing Conditions

The most publicized and obvious way the ACA protects patients is by removing the pre-existing condition exclusion. Insurance companies have used this idea to refuse coverage, leave people out of range, cancel coverage, or raise premiums for decades. It has long been a source of financial hardship for many people and families.

But beginning on January 1, 2014, Obamacare eliminated it. The first death blow came on March 23, 2010. A law went into effect that made it illegal for insurance companies to refuse or exclude coverage for children under 19 years old because of pre-existing conditions. This did not apply to individual policies bought before March 23, 2010, which were grandfathered. This law took effect on September 23, 2010, and was the first to take effect.

Here is a List of Some of the Main Components of ACA:

  • Any Palm Beach or Martin County resident who does not currently have health insurance coverage through their employment, Medicare, or Medicaid is subject to a tax or fee.
  • “Assured issue” is a factor for all new individual health insurance plans. ” “Guaranteed issue” means that all applicants, regardless of their gender or health status, must pay the same premium.
  • To boost the percentage of people who have health insurance, there are requirements, subsidies, and tax credits for individuals and businesses.
  • Small businesses can be eligible for subsidies if they buy insurance through the exchange.
  • If the government pays for an employee’s medical treatment, companies with more than 50 employees but no insurance provider may be subject to a shared responsibility payment. The income threshold for families and individuals to qualify for Medicaid has been raised to 133% of the federal poverty level. Nevertheless, the Supreme Court permitted states to reject the Medicaid expansion (there will be a coverage gap for these people in the states that opt out).
  • Annual and lifetime coverage caps on health insurance policies are no longer in effect.
  • The way that Medicare is reimbursed has changed from “fee-for-service” to “bundled payments.”

Until they turn 26, children are still protected under their parent’s health insurance coverage.

Application Mistakes

The law now also forbids insurance firms from terminating coverage due to honest application errors. Residents of Martin and Palm Beach Counties and people across the country were affected by this in the past. This clause has received much less attention and publicity. It reminds us of the days when the insurance company would ask for old information not long after we filed a claim for services given to a new patient. In the end, we found out they wouldn’t pay the claim because the patient already had a health problem, a ‘pre-existing condition’. If the patient answered “no” to one or more questions on the application, for example whether they had ever seen signs or symptoms of a specific condition, the insurance company would conclude that this showed the client knew about their condition and wasn’t forthcoming on the insurance application.

Based on the signs and symptoms listed in the application, the insurance company assumed that the patient had the problem before the date of coverage, even though this could not be proven. The patient didn’t know that these symptoms could be related to the condition(s) for which coverage was denied.

Obamacare Questions? Health Insurance Questions?

There is a lot to consider regarding health insurance and healthcare coverage. Consult with an experienced expert like Absolute Best Insurance. With Obamacare health insurance offices in Port St. Lucie, Boca Raton and Greenacres our experienced, friendly and helpful health insurance agents will provide the answers you need objectively and without obligation. Call them today at 561-420-0280.