How many categories are in the Affordable Care Act?
Asked by: Ona Welch | Last update: June 2, 2025Score: 4.9/5 (70 votes)
What are the 10 categories of essential health benefits?
The Affordable Care Act requires non-grandfathered health insurance coverage in the individual and small group markets to cover essential health benefits (EHB), which include items and services in at least the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization ...
What are the 4 categories of health insurance?
The 4 “metal” categories: There are 4 categories of health insurance plans: Bronze, Silver, Gold, and Platinum. These categories show how you and your plan share costs. Plan categories have nothing to do with quality of care.
What are 5 mandated benefits under the ACA?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
Does social security count as income for Obamacare?
Include both taxable and non-taxable Social Security income. Enter the full amount before any deductions. Include all unemployment compensation that you get from your state.
How Does The Affordable Care Act Work?
What is the 50/30 rule in the Affordable Care Act?
The Affordable Care Act's “shared responsibility” provisions (also referred to as the "employer mandate" or "play or pay") generally require that “applicable large employers” or ALEs (those with 50 or more full-time employees working at least 30 hours per week or their equivalents when adding together part-time hours) ...
Does Obamacare cover surgery?
All plans offered in the Marketplace cover these 10 essential health benefits: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services. Hospitalization (like surgery and overnight stays)
What is the 9.5 rule in Obamacare?
The 9.5% threshold for health insurance costs
The Health Reform bill established 9.5% as the amount of income used for health insurance beyond which, it would not be an affordable. This means that if you make $40K annually, the bill subsidizes health insurance premiums beyond just short of $4K.
Who qualifies for Obamacare in 2024?
Using 2024 federal poverty levels, a family of four would qualify for subsidies with a household income of $31,200 to $124,800 or more. A single person would qualify for subsidies if they made $15,060 to $60,240 or more. (Federal poverty level amounts are higher in Alaska and Hawaii.)
What is the best health insurance company to go with?
- Best Overall and Best for Self-Employed: Kaiser Permanente.
- Best Widely Available Plans: UnitedHealthcare.
- Best for Low Complaints and Best for Chronic Conditions: Aetna.
- Most Affordable: Molina Healthcare.
Can preexisting conditions be denied?
Coverage for pre-existing conditions
No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you're enrolled, the plan can't deny you coverage or raise your rates based only on your health.
What is covered under the Affordable Care Act?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Does Obamacare cover eye surgery?
It's much simpler if your vision coverage is embedded in your ACA coverage. Many ACA plans offer some vision care coverage. They may even cover the costs of medically necessary cataract surgery. That's a good thing because the cost of cataract surgery without insurance can be very high.
What are the four categories of legally required benefits?
- Social Security and Medicare.
- Unemployment insurance.
- Workers' compensation insurance.
- Family and Medical Leave Act (FMLA) protections.
How much does a 3 day stay in the hospital cost?
It's easy to underestimate how much medical care can cost: Fixing a broken leg can cost up to $7,500. The average cost of a 3-day hospital stay is around $30,000.
What is the 13 week rule for ACA?
Classifying Rehires under the ACA
An employee will be considered to be a terminated and rehired employee if the employee has a period of 13 consecutive weeks during which the employee is not credited with an hour of service.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.
What is the 80 20 rule for ACA?
The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.
Who is not eligible for Obamacare?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
Can you get a refund if your only income is Social Security?
You would not be required to file a tax return. But you might want to file a return, because even though you are not required to pay taxes on your Social Security, you may be able to get a refund of any money withheld from your paycheck for taxes.
Do 401k withdrawals count as income for Medicare?
You may not be rich, but your 401(k) and regular IRA withdrawals become taxable income, and you may look rich to Medicare. If you take out too much tax-deferred money, it can cause your Medicare monthly premiums to go up. This is called IRMAA (income related monthly adjustment amount).