Health Insurance and the Affordable Care Act

Healthcare Insurance and Affordable Care Act






Health Insurance and the Affordable Care Act

Individual coverage on health insurance is very important and comes in two forms. One is by the government usually known as market place and another is via the insurance companies or agents of the insurance companies also know as off the marketplace. In the US is usually based on what you earn that is the income and measured in percentage to determine whether you can qualify a marketplace or off market place. There are guidelines that are set and updated yearly due to sizes of families and poverty levels. When individuals apply for health insurance from marketplace they may qualify for tax credit which lowers their premium that they pay monthly all this depends on an individual income (Uberoi, Finegold & Gee, 2016).

The government body handling this then determines how much an individual earns and the tax credit qualification. Lawful citizens in the United States are the only ones who can qualify insurance from the marketplace the rest can get it directly from insurance companies.

Obtaining insurance directly from the insurance companies usually comes with its package since they offer plans off the marketplace and creates a platform for more choices to individuals. Health insurance is of great value for all individuals and it has a variety of benefits and advantages. It aids in protecting finances in a number of ways like preventing you from medical cost that come abruptly, and penalties if you under coverage and needs some premium and lastly enables an individual to obtain medical care with discounted rates (Morrisey, 2008). 

Health insurance majorly creates protection when it comes to individual’s health hence the need of quality healthcare, critical healthcare and most of all healthiest lifestyle. The possibility of this when individuals can access networks of healthcare providers. Individuals are advised to use the medical covers to access medications during emergencies and incase of chronic conditions. Encouraging of regular checkups and preventive care are the practices that individuals are advised to carry out despite being well. In businesses health insurance enables the employer retain the workers since it acts as motivating factor to the employees since it’s a great benefit and compensation package. The employer doesn’t suffer unexpected personal medical expense which may ruin the operation of the business (Morrisey, 2008). One is help to retain the hired workers for a good time. Health insurance has different plans for example that deals with monthly premiums, sharing of costs and one that is out of network cost. Normally individuals who take marketplace insurance are able to save money unlike the off marketplace individuals. The different plans are accompanied by a network of health providers that suits specific insurance companies chosen by the insurance company, failure to do so one is likely to incur more costs to purchase healthcare services from the providers that are off the network.

A monthly premium is a plan where an individual will be required to pay premiums each month for coverage whether you use it or not. To get lower average cost sharing the monthly premium for the plan should be higher. Cost-sharing is where one purchases the health services using insurance where it will help cater for some amount of the hospital bill then the individual pays for the remaining amount. Types of cost-sharing includes co-payment is fee for service of healthcare plan, deductible refers to the amount paid for some period of time before the healthcare insurance starts to cater for bills and finally co- insurance is the amount one pays for healthcare service that is covered by the plan. Health insurance with affordable care act help individuals to meet the appropriate plans and meet efficient medical needs. The Affordable Care Act requires various health insurance companies to present their correct packages based on their benefits and values of the plan (Uberoi, Finegold & Gee, 2016). In Washington the catastrophic plan is also available and helps to cover essential health benefits, this requires high deductibles and also covers free preventive services. Another plan is that of out of pocket maximums where the amounts of cost sharing are required to be paid in one year only

The act requires the health insurance plan to provide allowance for the essential health benefits in a certain year, if the bill exceeds it then the insurer pays for all of the costs of the year, no cost sharing costs can be incurred as long as you offered the service by healthcare providers in your plans network. One won’t be forced to pay because the maximums are on the lower side.

Due to the existence of Affordable Care Act the caps that used to exist before on the amount of the insurance company coverage pay no individual suffers to pay on top of total costs above the caps, the act has enabled individuals have a lifetime benefit limits since most of the plans are not allowed to have annual benefit limits or ones that are lifetime.


Uberoi, N., Finegold, K., & Gee, E. (2016). Health insurance coverage and the Affordable Care Act, 2010-2016. Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

Morrisey, M. A. (2008). Health insurance (pp. 118-19). Chicago: Health Administration Press.