What Is The Affordable Care Act? What Is Open Enrollment?

Link to Open Enrollment

Fun Medical MGD©The Patient Protection and Affordable Care Act (ACA), or “Obamacare” as it’s popularly known, is a federal statute signed into law on March 23, 2010. Despite its prevalence in the news and media, many don’t truly understand what the ACA actually is or how it relates to open enrollment. So, what is the Affordable Care Act?

Fundamentally, this act represents the most significant overhaul of the US healthcare system since Medicare and Medicaid. The ACA puts you in charge of your health care. The initial goals of the ACA were to develop comprehensive health insurance reforms that increased not only the affordability of healthcare, but the quality of services as well.

This legislation was designed to roll out in stages. When first implemented in 2010, the Patient’s Bill of Rights was one of the first items to be enacted. This Bill of Rights includes a set of protections that applied to health coverage six months after the enactment of the ACA.

Among other things, the Patient’s Bill of Rights includes:

  • Ending pre-existing condition exclusions for children under 19.
  • Young adult coverage under parental health insurance up to the age of 26.
  • Ending lifetime limits on coverage.
  • Requiring insurance companies to publicly justify any “unreasonable” premium increases or rate hikes (over 10%).
  • Covering preventive care at no cost to consumers.
  • The choice of primary care doctor within your plan’s network.

Numerous other reforms were set to roll out over the next four years and beyond (into 2020):

  • In 2011, people with Medicare received certain preventive services for free.
  • The 2012 calendar year saw provisions enacted that provided incentives for physicians to join together to form Accountable Care Organizations, like Meritage Medical Network. These groups allow better coordination of patient care and improvement of quality, the goal being to reduce health care system costs and help to provide better preventative care for Medicare patients.
  • In 2013, open enrollment in the Health Insurance Marketplace, an online system that allows you to compare health insurance options and choose the right coverage for you, began on October 1,2013. These websites, which allow consumers to compare prices and coverage and to purchase health insurance, exist throughout the U.S. Some states have opted to let the federal government run their exchange, but in California, our health exchange is operated by the state, and California was the first state to set up an exchange. It is called “Covered California.”
  • 2014 has seen more development and access to the insurance marketplaces, often called “exchanges,” to streamline processes. Also, tax credits for middle- and low-income families have been implemented that cover a significant portion of the cost of coverage. Plus, the new open enrollment period for purchasing, switching, or updating your insurance coverage will run from November 15, 2014 to February 15, 2015.

In 2015, a new provision will tie physician payments to quality, not quantity; payments will be modified to reflect a pay scale that values higher quality of care, including preventive efforts.

With all of these changes and provisions, what does the ACA mean for you? It means reduction of cost through tax relief efforts for premiums. It means capping out-of-pocket expenses for healthcare. It means access to a variety of insurance options and the ability to select options that work best for you and your family. This year, if you are already insured through your employer and you’re happy with your coverage, you can keep the coverage you have. If you are uninsured, the ACA provides a chance to find affordable coverage easily. And if you want to switch plans, even if you are insured through your employer, that’s an option too.

Through the ACA, patients are provided with more information about not only their insurance, but their doctors as well. Increased transparency in the system is created through regulations that require disclosures of costs and that require specific areas of coverage to make your insurance work for you. In short, the ACA provides better value, better health for you and your family, and better options for maintaining that health.

If you want to learn more about your insurance and health care options during this open enrollment period, visit our homepage – www.meritagemed.com. You can even download our free guide: “Everything You Need to Know About Open Enrollment – Simplified.”

Link to Open Enrollment
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