What’s the Difference Between ACA Coverage, Obamacare Plans, and Major Medical Health Insurance?
The answer is—there is no difference. Many people use different terms to describe the health insurance plans that are compliant under the Affordable Care Act (ACA), but they all mean essentially the same thing. So let’s learn more about ACA coverage (Obamacare, major medical, qualified plans, or whatever name you prefer to use).
What to know about Obamacare plans
If you’re buying individual health insurance, it may seem confusing with all the options there are for you. And things get even more complicated when one type of coverage is called by several different names.
Whether you love the Affordable Care Act, or hate it, you’ve surely heard about it. In order to keep up with what is going on in the healthcare reform world, eHealth has a timeline for consumers to track the Affordable Care Act from its genesis, to its present form.
There is plenty to know about ACA-compliant health insurance plans, and what makes them different than alternative insurance products available for those who cannot afford or do not want major medical health insurance. Let’s review some of the major points of Obamacare health insurance plans for families and individuals.
- The ten essential benefits
The ten essential health benefits of Obamacare refer to the benefits of standardized health insurance plans. These medical benefits are mandated by the government. They include:
- Laboratory services
- Emergency services
- Prescription drugs
- Mental health and substance abuse disorder services
- Maternity and newborn care
- Pediatric services (including oral and vision care)
- Rehabilitative services and devices
- Ambulatory patient services
- Preventative and wellness services & chronic disease management
- Pre-existing conditions
Before the ACA was passed in 2010, insurance companies were allowed to reject applicants based on pre-existing conditions, or refuse to cover the care for those conditions. This meant that people with a chronic disease or ongoing medical issue had trouble getting insured, or would but have to pay much more for their health insurance coverage than someone without pre-existing conditions. With ACA-complaint major medical plans, you will not be denied based on pre-existing medical conditions. There are still non-compliant health insurance products on the market that will take into account pre-existing conditions, but they are not considered Obamacare plans.
For individuals or families whose income is below 400% of the federal poverty level for their household size, there are government subsidies that can be applied to Obamacare plans. You can still get “Obamacare subsidies” when you shop through eHealth—we can estimate how much you will qualify for in subsidies, and then the government-run Marketplace will make the final decision and supply your subsidy. The nice thing about going through eHealth is that we’ve made the application process a streamlined, simple task and we have licensed agents who can answer your questions and provide personalized, friendly guidance when it comes to things like Obamacare subsidies.
- Protection from fines associated with the individual mandate
Enrolling in a qualified major medical plan will also mean that you won’t be fined for failing to have ACA-compliant coverage. The individual mandate was a part of the Affordable Care Act, and was meant to give people incentive to buy Obamacare coverage, so that the pools of enrollees would be larger, there would be less risk, and therefore insurance companies would be able to charge less per individual. In 2017 though, the penalty associated with the individual mandate was revoked, so for those who don’t have ACA-compliant major medical health insurance in 2018, will not be fined in the 2019 tax season.
Alternative health insurance products: for those who don’t want Obamacare coverage
There are plenty of reasons someone might not want an ACA-compliant health insurance plan:
- Unaffordability – these plans may come at too steep of a cost, especially for those who miss the cutoff for subsidies
- Not needing so many health benefits – for some people who don’t expect to use most of the ten essential benefits, a less comprehensive, but more affordable plan might work better
- Religious reasons – some people opt for Medical Cost Sharing ministries where only the services they believe in are covered
- Not needing long-term coverage – for short periods of being uncovered, a product like short term health insurance is often a better option, since it’s usually more affordable than major medical, designed for short periods, and has a quick enrollment and approval process.
Choosing individual health insurance: whether you call it Obamacare, major medical health insurance, or ACA-compliant coverage
Regardless of what you call it, it’s a good idea to know a little bit about the coverage that is compliant with the rules of the Affordable Care Act.
Whether it’s an Obamacare plan that you decide to buy, or an alternative to ACA-complaint major medical health insurance—eHealth has options for you, and we have online tools and free quotes that will make it easy to find the right plan for your budget and health-care needs.