Public Health Insurance: Insurance Through Medicaid
and the Affordable Care Act
Medicaid: is a government funded health insurance program providing health coverage to low-income Americans. It is a social welfare program, and it is more difficult to access than coverage through the affordable care act. The criteria to access medicaid varies by the state that you live in, and in theory should require states to provide coverage for all those whose income is at or below 138% of the federal poverty level.
Those who are eligible for medicaid may enroll at any time in the year. Generally medicaid also covers far more cost than does traditional insurance or coverage through the affordable care act, meaning those receiving medicaid coverage pay not deductible or copayments for care.
The Affordable Care Act: is the health care reform law passed by the Obama Administration in 2010. The ACA provides consumers with subsidies to lower healthcare costs in order to make healthcare accessible to more people. Those whose incomes are between 100% and 400% of the federal poverty level qualify to access these subsidies.The ACA also expanded medicaid to include all adults whose income is at or below 138% of the federal poverty level.
Eligibility for Coverage through the ACA: if you are...
1. A citizen of the United States
2. Who is currently living in the United States
3. And you are not currently incarcerated
4. And you do not currently have coverage through medicare.
Then you are eligible for coverage.
Getting a Healthcare Coverage Plan Through the ACA:
Enrolling in Healthcare Through the ACA: Via Healthcare.gov. Each year there is a period for open enrollment during which you can enroll in a healthcare plan through the Affordable Care Act. You will then select an insurance plan through: The ACA Health Insurance Marketplace.
Open Enrollment:
November 1st is the beginning of the open enrollment period each year. This makes it possible for your healthcare plan to begin on January 1st.
January 15th is the close of the open enrollment period each year. If you were to enroll between December 16th and January 15th, your healthcare coverage would begin on February 1st.
The Family and Medical Leave Act/FMLA: This is a federal law which states that employees must be guaranteed up to 12 weeks of job protected leave when they must take time off for serious illness, injury, or disability, if they have just had or adopted a child, or must care for an ailing family member. Your insurance plan, even if it is provided through your job, must continue to provide coverage for you during this time.
Health Savings Account/HSA: This is a savings account which allows you to set aside money from your monthly income before taxes for the purpose of healthcare. This is a way to potentially lower your healthcare costs. These funds cannot be used to pay monthly premiums. You are only eligible to contribute to an HSA if you have a High Deductible Health Plan, meaning one which only covers preventative services before the deductible.
COBRA coverage through the federal government: This is a federal act which requires that insurance coverage continue for a period of time after an event such the death of the covered employee, termination from the position, reduction in hours, entering medicare eligibility, or other event, in order to ensure that those benefiting from the coverage and receiving medical care through it are not cut off from coverage suddenly.
This applies to health plans through private sector employers, by state, and by local government, but does not apply to plans through the federal government.
The Coverage Gap: During the pandemic, coverage through medicaid was expanded to include the many uninsured during that time. During the pandemic, the eligibility threshold for medicare was increased to 138% of the federal poverty level, however certain states will be returning that threshold to pre pandemic standards which will automatically unenroll many from coverage.
Many states however are adopting the expansion permanently in order to ensure that the many Americans who gained coverage during the pandemic continue to be insured through medicaid.
States such as Texas, Florida, and Wisconsin, among others, have not adopted the expansion and so populations in these states will be without coverage shortly.
The Emergency Medical Treatment and Labor Act:
This federal act stipulates that hospitals with emergency rooms treat any individual who enters the emergency room requiring services. Hospitals and emergency rooms cannot turn away any individual who requires treatment or examination for an emergency medical condition. Treatment cannot be delayed to inquire about payment status.
Hospitals must transfer individuals into the hospital for continuing care as necessary to achieve stable medical condition provided it has the capacity to treat the individual or must otherwise formally transfer the individual to a hospital which does have capacity.