25 Things That Are Awesome About Obamacare

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  1. Guarantee issue – In the past, insurers could deny policies to people who had health conditions they deemed too risky to cover. This could have been anything from a history of cancer to – and this happened to me – seasonal allergies. Under Obamacare, insurers have to sell policies to anyone who wants to buy one.
  2. No annual coverage caps – In the past, insurers could set an annual limit on what they’d pay for care. This doesn’t seem like a big deal until you get a diagnosis like cancer or have a baby in the NICU and they you reach the limits alarmingly fast and the remainder of your costs are out of pocket. Obamacare ends this practice.
  3. No lifetime coverage caps – Just like Number 2 but it applies to cap insurers placed on payouts over a lifetime. I know a girl who reached her $1 millino lifetime cap by age 12 because of a leukemia diagnosis at 8. Thanks to Obamacare, she can continue to get health care covered by insurance.
  4. No gender rating – Insurers used to charge women more for policies on the grounds that pregnancy and childbirth raise their healthcare costs. Obamacare prohibits this on the grounds that pregnancy and childbirth are essential for propagating the species and not luxuries.
  5. No recission – In the past, insurers would find reasons to cancel policies of people who were very sick and costing a lot of money. That’s illegal now.
  6. Maternity care coverage mandate – Maternity care mandates used to vary by state – some states mandated maternity coverage, others didn’t and insurers could make you pay extra for a rider to cover it. This was problematic for people who opted out of the rider and got pregnant unexpectedly and didn’t have coverage. Obamacare mandates maternity coverage in all policies.
  7. Cancer screening coverage mandate – Procedures such as colonoscopy and mammography were, like maternity care, subject to state regulations. Under new plans in Obamacare, cancer screenings are required coverage.
  8. No copay for cancer screenings – Not only are cancer screenings covered, they’re covered 100% for patients with the new plans ┬áso they don’t have to pay money over and above premium costs.
  9. No copay for preventative care – Just like cancer screenings, preventative care such as diabetes screenings and birth control in the new plans don’t require additional payments.
  10. Readable benefits summaries – Ever read an old health insurance policy? No, because they’re indecipherable. If you’re lucky, you got a good summary of benefits from HR at work. Now insurers have to provide readable explanations of benefits.
  11. Lactation support coverage mandates – In the past, insurance seldom covered visits to lactation consultants or the cost of breast pumps. Under Obamacare, lactation services are covered and insurance will cover the cost of a pump.
  12. Medical-loss ratio – This is one of the most important things in the bill. Obamacare mandates that insurers spend about 80% of premium dollars on health care as opposed to business overhead. If an insurers spends less than 80% of premium dollars on health care, they have to issue refunds to policy holders.
  13. Universal definitions of acceptable coverage – In the past, there was no real definition of insurance. It varied by state and policies could be full of preconditions for benefit payment that led to huge out of pocket expenses. Obamacare sets basic definitions for insurance and creates a tiered framework for four levels of plan available on the exchanges.
  14. Premium subsidies based on income – If you meet certain income requirements, the federal government can provide premium payment assistance. Since everyone has to buy insurance, the government will chip in to keep it affordable.
  15. Death panels – Right now a group of medical experts is convening to determine the fate of Sarah Palin. Ok, that’s a joke.
  16. Premium increase limits – There is a review process for rate increases to make sure they’re based on actual costs and not an insurer’s desire for higher profits.
  17. Extension of dependent benefits to age 26 – Children can now stay on their parents’ insurance plans until they’re 26.
  18. Mental health coverage – Under Obamacare, mental health care is considered essential coverage and all policies will include it.
  19. Employee choice – This is delayed for technical reasons but next year, small businesses will be able to let employees pick their own plans and contribute to premiums through the exchanges rather than purchasing a group plan with one-size-fits-all coverage.
  20. Help picking coverage – There are people trained to help you select coverage through the exchanges. These people are called navigators. Early reports are that there are flaws in this system and not every navigator is a good navigator so please be aware when receiving assistance. If it sounds fishy, find another navigator.
  21. Non-exchange markets – You don’t have to use the exchange – the state- or federal-run marketplace of standard plans – to buy a policy. You can go directly to an insurer or use an insurance broker to buy your plan.
  22. Keep your doctor – If you love your doctor, you can make sure to have a plan through an insurance company for which your doctor is in-network. You can change policies to follow your doctor if they leave or join different networks. You just have to wait until open enrollment period to make policy changes.
  23. Keep your insurance – If you have a great policy, it’s yours to keep for as long as you like it or are eligible for it through an employer, as the case may be. You can sit back and gloat that you don’t have to do any paperwork between now and January 1.
  24. Change your insurance – If you current insurance sucks, you can get a better plan. The market is open to all consumers. And if you lose coverage due to job loss, you can get a new plan even if it’s not open enrollment period.
  25. Peace of mind – I don’t know about you, but I’ve always been beholden to an employer-based plan. Loss of job would mean loss of insurance. That always terrified me, especially since I had kids. The new marketplace that has to let me purchase insurance regardless of my health history and the premium support structure means I can always safeguard my kids’ health. That’s priceless.

Photo credit: shho via www.sxc.hu

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1 comment for “25 Things That Are Awesome About Obamacare

  1. October 11, 2013 at 12:08 pm

    Great list! The only thing I want to point out is that not everyone can keep their current policy. You had to purchase it before the law passed and since the law passed made no changes to your policy. Otherwise you are going to be forced out (in the individual market). Not sure how many people it impacts, but that is definitely a thing. Not an insurance companies being evil thing, but a in the law thing.

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