The Affordable Care Act, or ObamaCare, introduced changes to the U.S. healthcare system. Every citizen should know these health insurance requirements for quick accessibility. In this blog, we will find out the ACA requirements for individuals. Moreover, what are the rules for qualifying for every requirement, and what are the consequences of compliance?
Components of the ACA
The Affordable Care Act requires health insurance for these:
Individual Mandate
The individual mandate was one of ObamACAre’s main tenets, forcing most Americans to have ACA insurance eligibility or face a penalty. However, the Tax Cuts and Jobs Act of 2017 repealed the penalty beginning in 2019. Additionally, some states have their own requirements and consequences for failing to have health insurance.
Essential Health Benefits
The plan of ACA minimum essential coverage should cover the following benefits:
- Ambulatory patient services
- Emergency service
- Hospitalization
- Maternity and newborn care
- Outpatient mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services
- Dental and vision care – children
What Are The Pre-existing Conditions?
The ACA’s most significant protection is the ban on pre-existing condition exclusions or premium increases. Moreover, it ensures that everyone will receive the healthcare they require, irrespective of their medical history.
What Are The Eligibility and Enrollment Requirements?
Here are the significant ACA requirements for health plans:
Marketplace Plans
Individuals can purchase ACA-compliant health insurance through this Insurance Marketplace. It offers a range of plans categorized by metal tiers, including packages like Bronze, Silver, Gold, and Platinum. Each tier offers a different ratio and balance between premium and out-of-pocket expenses.
Subsidies and Tax Credits
There are a few ACA insurance income limits. However, the ACA also offers subsidies for those with lower incomes to reduce the cost of health insurance. It has premium tax credits and cost-sharing reductions depending on income and household size. To be eligible, income must be between 100% and 400% of the federal poverty level. The person cannot be eligible for other forms of affordable coverage, such as Medicaid and employer-sponsored plans.
Medicaid Expansion
The ACA allowed states to expand Medicaid coverage for individuals with incomes of not more than 138% of the FPL. This expansion was intended to expand coverage to more of the low-income population of the United States of America. However, Medicaid expansion is not practiced in all states, so different states offer different coverage plans.
The Compliance and Penalties Involve
While the mandate surcharge at the federal level was abolished, it is very relevant to further cooperation with the ACA standards and requirements, especially in business and insurance. Employers with 50 or more whole-time employees must offer ‘minimum essential’ health coverage that meets specific suitability criteria or face penalties. These employers must also provide the IRS and their employees with coverage information.
State Mandates
Others have joined the rest by enacting state-level individual mandates in California, Massachusetts, and New Jersey. They have all demanded that their residents obtain minimum acceptable health plans or suffer the consequences at the state level. This simply means that to avoid such unpleasant consequences, businesses must ensure that they are conducting their operations as the state’s laws provide.
Conclusion
Employer-sponsored insurance and insurance marketplaces need a basic understanding of ACA health insurance requirements and be aware of scenario changes as they evolve. Whether you are a consumer who wants to purchase the policy or an employer who has to facilitate insurance for your employees, understanding your responsibilities and options offered by the ACA will help you as a consumer and an employer in decision-making procedures and save you from penalties.
