What does Obamacare include?

Asked by: Nannie Weber  |  Last update: January 29, 2025
Score: 4.6/5 (8 votes)

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.

What is covered under Obamacare?

The ten categories encompass a broad spectrum of care, including preventive services, prescription drugs, hospitalization, maternity and newborn care, mental health and substance use disorder services, and pediatric care, among others.

What is not included in the Affordable Care Act?

What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.

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.

How much is Obamacare a month for a single person?

Monthly premiums for Affordable Care Act (ACA) Marketplace plans vary by state and can be reduced by premium tax credits. The average national monthly health insurance cost for one person on an Affordable Care Act (ACA) plan without premium tax credits in 2024 is $477.

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Why do people not like Obamacare?

Despite these positive changes, a near majority of Americans still oppose the ACA, even though they approve of most of its features. They oppose the mandate that all Americans must have health insurance (the individual mandate), and they oppose a government role in health care.

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)

Is Obamacare for low income people?

Obamacare is designed to make healthcare affordable for people regardless of their income. Individuals at all income levels can sign up for health insurance under Obamacare.

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 disqualifies you from the premium tax credit?

For tax years other than 2021 and 2022, if your household income on your tax return is more than 400 percent of the federal poverty line for your family size, you are not allowed a premium tax credit and will have to repay all of the advance credit payments made on behalf of you and your tax family members.

What pre-existing conditions are not covered?

Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.

Is bloodwork covered by insurance?

Preventive vs. Diagnostic: If the blood work is part of preventive care (such as routine screening tests), many insurance plans cover it fully. However, if the blood work is for diagnostic purposes (e.g., to investigate a symptom or monitor a known health condition), it might come with out-of-pocket costs.

Who actually pays for Obamacare?

The federal government covers 90% of the cost of Medicaid expansion. Individual Mandate: The ACA also originally included an “individual mandate” or requirement for most people to maintain health insurance.

What are the negatives of Obamacare?

Cons:
  • The cost has not decreased for everyone. Those who do not qualify for subsidies may find marketplace health insurance plans unaffordable. ...
  • Loss of company-sponsored health plans. ...
  • Tax penalties. ...
  • Shrinking networks. ...
  • Shopping for coverage can be complicated.

What is the difference between Obamacare and marketplace insurance?

The federal Health Insurance Marketplace, which is also called the "Marketplace" or "Exchange," is the website where individuals can browse various health care plans available under the Affordable Care Act, commonly known as "Obamacare," as well as compare them, and purchase health insurance.

What states refuse Obamacare?

The Affordable Care Act, also known as Obamacare, was enacted in 2010, but 10 states have not expanded Medicaid, the federal-state program that provides health care for low-income people. They are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

Can you be turned down for Obamacare?

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 the best HealthCare insurance?

Investopedia's analysis ranks Kaiser Permanente as the best health insurance company for 2025 because of its blend of affordability and low customer complaints. UnitedHealthcare and Aetna also earned top marks. We evaluated nine insurers using dozens of criteria, such as customer satisfaction, plan types, and costs.

What is the average deductible for Obamacare?

KFF also reported the average 2024 deductible for marketplace plans sold via HealthCare.gov, (combined for medical and prescription drugs) by metal rating: $7,258 for Bronze plans, $5,241 for Silver plans, $1,430 for Gold plans, and $97 for Platinum plans.