Introduction
The formation of an Essential Health Benefit (EHB) package that covers EHBs (as determined by the Secretary of the Department of Health and Human Services (the Secretary)) is mandated under the Health Care Law. The law mandates that EHBs include at least the following 10 main categories and are equal in scope to the benefits provided by a typical employer plan. The components of insurance plans include: ambulatory patient services, where services can be offered to patients as an outpatient without being admitted to the hospital. It also includes emergency services, hospitalization, and both maternity and newborn care services, where care is given before and after the child is born.
Besides, offering services regarding mental health and substance use disorders by offering counseling and psychotherapy services, prescription drug services. In addition, rehabilitation and habilitation services and devices that are to help people who have disabilities or with chronic conditions recover both mentally and physically. Other services include laboratory services and preventive and wellness services that include managing chronic diseases (Assistant Secretary for Public Affairs (ASPA) 1). Therefore, pediatric services in healthcare organizations encompass oral and vision care.
Health Insurance Marketplace
This refers to finding and buying health insurance and applying for both children’s health insurance programs and Medicaid. The importance is allowing the users to find a health insurance plan that is in line with their budget without difficulty. Qualified health plans offer private and affordable coverage to qualified individuals and employers.
Law regarding pre-existing conditions and the ability to get insurance
Health insurance companies cannot refuse to give coverage or charge an individual more based on them having a pre-existing condition. Such conditions might include asthma, diabetes, pregnancy, and cancer. The exception, however, is the ‘grandfathered’ health plan, which does not cover pre-existing conditions.
Individuals can stay on their parent’s insurance until they turn 26 years old, and it does not matter if they are parents themselves, married, attending school, or staying with their parents. This is significant because it gives individuals enough time to plan themselves and even obtain jobs before they can be independent. The cost of the penalty for an individual who chooses not to have health insurance as of 2016 was $695, or 2.5% of the income (Obamacare.net). This is no longer in place, as individuals who do not have health coverage do not pay a tax penalty.
- Exemption; individuals who are thirty years or older need an exemption in order to enroll in the catastrophic plan that offers a lower price cover for injuries. Those under the age of 30 years, however, do not need an exemption and can be as affordability or hardship exemptions.
- Marketplace Navigator; this is an individual or an organization that is trained to help small businesses, consumers, and employees during their search for health coverage in the marketplace. They help by also offering eligibility and enrollment forms that are unbiased and offer free services.
- The Cadillac tax refers to an inexpensive health insurance plan arising from a way of controlling medical costs in the United States. The tax was to be implemented in 2018, and it was opposed by the labor unions on the basis that it would be a disruption to healthcare plans (Wikipedia contributors). President Biden was trying to expand the affordable care act and fix the family glitch loophole in the act. The republican and democratic parties are not in agreement with the suggested changes as they think it will negatively impact the people and business operations. I tend to, however, believe that the changes would cause more benefit than harm and that they should be carried on with.
The employer mandate of the affordable care act applies to only employers who employ more than fifty full-time equivalent employees. In the mandate, employers have to offer affordable medical coverage to workers and their dependents. The cover does not, however, have to be offered to spouses of full-time employees. An employee is considered full-time if they cover at least thirty hours of service per week in a month which reflects around 130 hours in one calendar month. In 2016, this mandate applied to 60% number of full-time employees.
Conclusion
I have learned that the insurance marketplace allows users to find health coverage that is in line with their budget without difficulty. The Affordable Care Act helps most individuals to obtain medical coverage and be treated for their conditions at a cheaper cost as compared to those without the coverage.
I think that the Affordable Care Act expands access to health coverage and helps provide access to people with different conditions to health services without having to worry about medical costs. All these are essential for a strong health response especially demonstrated during the pandemic. Its implementation offers major benefits to the people as the Federal Government requiring to purchase healthcare coverage might be costly to people who cannot afford it and, thus, should be free of charge.
Works Cited
Assistant Secretary for Public Affairs (ASPA). “Pre-Existing Conditions.” HHS. 2022. Web.
Obamacare.net. “Obamacare Employer Mandate.” Obamacare. Web.
Wikipedia contributors. “Cadillac Insurance Plan.” Wikipedia, 2022. Web.