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HEALTH INSURANCE

FEDERAL LAWS AND PLANS

Confused about all of insurance terms you hear people say when they talk about their new health plan? Struggling to follow along with a broker when they are telling you about your new plan? That ends today! Here are the most important and common terms that everyone should understand.

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The Affordable

Care Act (ACA)

Minimum Essential Coverage (MEC)

The Health Insurance Marketplace (Obamacare)

The comprehensive health care reform law enacted in 2010 by the federal government. Also referred to as Obamacare, Trumpcare, and/or Bidencare. The law includes premium subsidies paid for by the federal government in order to lower the cost of health insurance for individuals and families. It also made it so that plans on the Marketplace could not deny coverage for individuals with pre-existing conditions.

Health insurance which satisfies

the ACA standards for a qualified health plan, which must provide 10 essential health benefits. These benefits are: outpatient care, emergency services, hospitalization, pregnancy/maternity/newborn care, mental health services,

prescriptions, rehab services and

devices, lab services, preventive/wellness/chronic disease services, and pediatric services. Federal law no longer dictates penalties for individuals without minimum essential coverage. Only 4 states and 1 district still enforce a tax penalty for those individuals that are uninsured: MA, NJ, RI, CA, and D.C.

The platform (also known simply as the Marketplace or the exchange) created by the Affordable Care Act for consumers to purchase ACA-compliant health insurance plans. The government only offers premium subsidies for Marketplace plans.

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Medicaid

A joint federal and state

program that provides free or low-cost health coverage to certain groups of individuals. These groups include

low-income individuals and families as well as individuals receiving Supplemental

Security Income (SSI). 

Medicare

Federal health insurance for people 65 or older as well as some people under 5 with certain disabilities and/or conditions.

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