ACA / Dental / Vision - Retire American

Affordable Care Act (ACA)

What is the “Affordable Care Act” (ACA)?

The “Affordable Care Act” (ACA) is the name for the comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”) and its amendments. The law addresses health insurance coverage for individuals and families, health care costs, and preventive care.

The ACA expanded Medicaid eligibility, created a Health Insurance Marketplace, and prevented insurance companies from denying coverage due to preexisting conditions. The Affordable Care Act requires insurers to cover a list of essential health benefits.

The law has 3 primary goals:

Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
- If your income is above 400% FPL, you may still qualify for a premium tax credit.
- If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment Period.

Link to Federal Poverty Levels: https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

Expand the Medicaid program to cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)
Support innovative medical care delivery methods designed to lower the costs of health care generally.

How does ACA determine income?

The Marketplace uses a measure of income called modified adjusted gross income (MAGI) to determine eligibility for savings.

See what's included in MAGI and how to estimate it.

Your total (or “gross”) income for the tax year, minus certain adjustments you're allowed to take. It isn't a line on your tax return. Your total household MAGI amount includes countable income for each person listed on your federal income tax return for the year you're getting help paying for coverage.

Who is responsible for the Affordable Care Act?

The Department of Health and Human Services (DHHS), Center for Medicare and Medicaid Services (CMS), has the responsibility for issuing certain regulations to implement the Affordable Care Act and has also facilitated the development of the information technology necessary to create insurance exchanges.

The ACA can be purchased through different tools depending on your state of residence.

https://www.healthcare.gov/marketplace-in-your-state/

Many states offer insurance through Healthcare.gov or through agencies like RetireAmerican.com and HealthcareAmerican.com. We can help you choose the right plans for your unique needs and can find the amount of subsidy levels you might qualify for when choosing the most advantageous plan for your budget and health needs.

Some states have their own exchange and don’t allow your healthcare to be purchased through Healthcare.gov but would instead require you to purchase the coverage through the state exchange. We at RetireAmerican.com and HealthcareAmerican.com offer assistance through the state exchange to help ensure you are suitably covered at the most budget-friendly coverage offered according to your individual healthcare and budget requirements.

We at Healthcare American have a broad knowledge of how healthcare, dental, and vision coverage work and can help you choose the right plan for you and your family’s individual needs. Please give us a call and let us help you choose the right plan for your healthcare, dental, and vision needs.

Dental/Vision Coverage

In addition to healthcare, we also offer secondary coverage for vision and dental. These coverages offer many benefits to ensure you have an all-around healthy body and mind.

Most dental insurance coverage breaks down into four distinct classes, based on the necessity, severity, and complexity of the work needed. Your portion of the cost depends on which class the procedure is categorized as by your insurance provider. Outlining dental insurance coverage can be confusing because a dental procedure may be considered Class I under one provider’s policies but be considered Class II or III by another.

Each vision insurance plan offers different levels of coverage, starting with basic eye healthcare and wellness needs such as vision exams, prescription glasses, and contact lenses, usually performed by doctors and care providers within the network. More comprehensive plans may also provide discounts for elective surgical procedures such as LASIK vision correction, additional allowances for out-of-coverage providers and health professionals, or lens enhancement alternatives for prescription glasses.

Vision insurance is typically offered as a value-added benefit connected to an existing health insurance plan and can also be purchased as a stand-alone discount plan. These plans offer the advantage of low insurance premiums and are therefore a good option for consumers on a budget.

The other available option is incorporating vision care as a benefit plan that acts as a rider to your existing health insurance coverage. Vision benefit plans usually take the form of preferred organizations (PPOs), or health maintenance organizations (HMOs). PPOs have a specific network of eye doctors you are allowed to use, which charge a fixed rate below retail prices; if you go out-of-network, costs are usually substantially higher. HMOs only allow their customers to access care from within their network of healthcare providers to access their discounted rates. In any case, both HMOs and PPOs provide eyewear and eye care at discounted rates, for an annual premium or membership fee. In some cases, customers must also pay a small deductible or fixed dollar amount before the insurance will start coverage.

When evaluating different vision plans, it is crucial to determine which provides the benefits and discounts that best meet your specific needs, which will save you the most, and whether it has quality assurance mechanisms and simple claims procedures. Also, remember that even if one of the options above is not included and must be paid for out-of-pocket, you may still find that the components that are covered result in a significant reduction in your overall cost.