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HEALTH INSURANCE

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AFFORDABLE CARE ACT

Obama Care is the unofficial name for The Patient Protection and Affordable Care Act, a health reform law signed on March 23, 2010, by President Barack Obama. ObamaCare (the Affordable Care Act) is a US healthcare reform law that expands and improves access to care and curbs spending through regulations and taxes.

The Affordable Care Act’s primary focus is on providing more Americans with access to affordable health insurance, improving the quality of health care and health insurance, regulating the health insurance industry, and reducing health care spending in the US.

 

Enroll in a health plan during open enrollment to avoid the fee and get lower costs and new benefit

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HOW DOES AFFORDABLE
CARE ACT WORK?

Frequently asked questions

IS AFFORDABLE CARE ACT A HEALTH INSURANCE?


ObamaCare doesn’t create health insurance – it regulates the health insurance industry and helps to increase the quality, affordability, and availability of private insurance.




WHAT HAPPENS IF I ALREADY HAVE A HEALTH INSURANCE?


Most people who currently have health insurance can keep it.




WHEN CAN I OBTAIN MY PRIVATE HEALTH INSURANCE?


You can obtain Private Health Insurance during each year’s annual open enrollment period in the Health Insurance Marketplace.




WHAT HAPPEN IF I DON’T OBTAIN COVERAGE AND MAINTAIN COVERAGE THROUGHOUT EACH YEAR?


If you don’t obtain coverage and maintain coverage throughout each year or get an exemption, you must pay a per-month fee on your federal income tax return for every month you are without health insurance.




HOW LONG CAN I GO WITHOUT HEALTH INSURANCE?


Due to a coverage gap exemption that applies to all Americans, you can go without insurance for up to 3 months in a row without coverage.




IS THERE ANY OTHER EXEMPTIONS THAT I CAN QUALIFY FOR?


Beyond the coverage gap exemption, there are around 20 other exemptions that you can qualify for. Please contact us for more details about these exemptions.




WHAT HAPPEN IF I PURCHASE MY HEALTH INSURANCE BY THE 15TH A MONTH?


Insurance purchased by the 15th of each month will start on the first of the next month.




HOW MUCH WILL BE MY COST?


The cost of your marketplace health insurance works on a sliding scale. Those who make less, pay less.





 
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MEDICARE

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WHAT IS MEDICARE?

Medicare is a federal health insurance program that pays for a variety of health care expenses. The Centers administer it for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health & Human Services (HHS).

 

OUR SERVICES

Medicare benefits people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Similar to Social Security, Medicare is an entitlement program.
Most U.S. citizens earn the right to enroll in Medicare by working and paying their taxes for a minimum required period. Even if you didn’t work long enough to be entitled to Medicare benefits, you might still be eligible to enroll, but you might have to pay more.

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THERE ARE FOUR (4) MAIN PARTS UNDER MEDICARE:

PART A: HOSPITAL INSURANCE


Medicare Part A or Hospital Insurance (HI) helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.




PART B: MEDICAL INSURANCE


Medicare Part B or Medical Insurance (MI) helps pay for doctors’ services, outpatient care, medical supplies, and preventive services.
For example, Medicare Part B covers:

  • Durable medical equipment (canes, walkers, wheelchairs, etc.)
  • Physician and nursing services
  • X-rays, laboratory and diagnostic tests
  • Certain vaccinations
  • Blood transfusions
  • Renal dialysis
  • Outpatient hospital procedures
  • Some ambulance transportation
  • Immunosuppressive drugs after organ transplants
  • Chemotherapy
  • Certain hormonal treatments
  • Prosthetic devices and eyeglasses
You pay a monthly premium for this part of Original Medicare. The fee can be higher for people with high incomes. A different government program, Medicaid, can help cover Medicare Part B premiums for low-income beneficiaries. Part B beneficiaries are usually responsible for a portion of their health care costs. You’ll have to pay a deductible each year before your Medicare Part B benefits kick in, and then you’ll generally pay 20% of the bill when you go to a participating Medicare doctor. Medicare pays the full cost of many lab tests and services requested by your doctor.




PART C: MEDICARE ADVANTAGE PLANS


A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.




PART D: PRESCRIPTION DRUG COVERAGE


A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.