What is the Affordable Care Act (ACA)?
The ACA is a U.S. law that aims to provide more Americans with access to affordable health insurance, reduce healthcare costs, and improve healthcare quality.
What are the individual health insurance mandates?
The ACA required individuals to have health insurance or pay a penalty, but the penalty was reduced to $0 in 2019 for most states.
What is Medicaid, and who qualifies for it?
Medicaid is a joint federal-state program providing health coverage for low-income people. Eligibility depends on such factors as income, family size, and disability.
What is Medicare?
Medicare is a federal health insurance program for people 65 years or older and some younger individuals with disabilities.
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Can I be denied health insurance because of pre-existing conditions?
Under the ACA, health insurance cannot be denied, and the charges for coverage cannot be higher, if there are pre-existing conditions.
What is the Health Insurance Marketplace?
The Marketplace is a program under which individuals can buy and sign up for affordable health insurance plans created under the ACA.
What are essential health benefits (EHBs)?
EHBs are the 10 categories of health care that Marketplace plans are required to cover, which include hospitalizations, maternity and newborn care, and prescription medications.
What are the differences among HMO, PPO, and EPO plans?
HMO (Health Maintenance Organization) needs the use of network providers and the need for a referral for specialist care. PPO (Preferred Provider Organization) offers greater flexibility but costs more. EPO (Exclusive Provider Organization) is similar to a PPO, but typically it does not provide out-of-network care unless you have an emergency.
What is a premium?
A premium is your monthly payment to your health insurance company to pay for your coverage.
What is a deductible?
A deductible is the amount you have to pay for healthcare services before your insurance begins to pay.
What is co-insurance?
Co-insurance is the percentage of healthcare costs you pay after you meet your deductible, like 20% of the bill for a doctor’s visit.
What is a co-payment (copay)?
A co-payment is a fixed amount you pay for a covered healthcare service, like $25 for a doctor’s visit, with the insurance covering the rest.
Can my health insurance be canceled?
Insurance companies cannot cancel your health insurance due to illness, but you may lose coverage for reasons like non-payment or moving out of a service area.
What is a grace period for health insurance premiums?
A grace period is the time after the premium due date during which your coverage remains active even if payment is late.
What is a network provider?
A network provider is a doctor, hospital, or healthcare facility that participates in your insurance plan’s network and offers services at a reduced rate.
What is short-term health insurance?
Short-term health insurance provides temporary coverage for those in transition or waiting for other coverage options, but it often offers less comprehensive benefits.
What are the penalties for not having health insurance?
Even though the individual mandate penalty was reduced to $0 at the federal level, some states may impose a penalty for not having health insurance.
How do health insurance subsidies work?
Subsidies reduce the cost of health insurance premiums based on your income, making coverage more affordable.
What is a health savings account (HSA)?
A health savings account is a tax-advantaged account where you can save money for medical expenses. You can contribute to an HSA if you have a high-deductible health plan.
What is the difference between an employer-sponsored plan and an individual plan?
Employer-sponsored plans are offered through your employer, whereas individual plans are purchased by the individual, usually through the ACA Marketplace or directly from an insurer.
