Marketplace Insurance Coverage
What is the definition of "Marketplace" coverage?
The Patient Protection and Affordable Care Act: commonly referred to as the Affordable Care Act (ACA) and also known as Obamacare – is a sweeping piece of legislation passed by the 111th Congress and signed into law by President Barack Obama in 2010.
The law was created to improve the affordability and quality of health insurance in the United States.
The premium subsidies which are actually tax credits to offset the cost of premiums for any level of ACA compliant health insurance plan available through the marketplace.
Subsidy eligibility is largely based on income, but there are a handful of other factors, including immigration status, age, and access to government-sponsored or employer-sponsored coverage. Speak to one of our agents for more information.
What do "ACA Marketplace" compliant plans cover?
This insurance provides coverage for illnesses and injuries, along with preventive care. The Affordable care Act requires all major medical plans to cover an extensive list of preventive services for 3 categories of insureds including adults, women and children. This includes services for immunizations and screenings.
Along with preventive services, all major medical plans, per “ACA requirements” must provide at least these 10 categories of essential health benefits:
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Some major medical insurance policies will have added coverage such as dental, vision or medical management programs. How your major medical plan covers these benefits will depend on the number of different programs available.
How are preexisting conditions treated?
All ACA compliant major medical insurance plans do cover preexisting conditions. Under the ACA, health insurance companies can’t refuse to cover you or charge you more due to a preexisting condition, which would be a condition you had prior to applying for new health coverage.
All “ObamaCare” / Marketplace plans must cover treatment for pre existing conditions . Insurance plans can not reject you, charge extra or refuse to pay for essential health benefits for any condition you had before your coverage started.
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