Medicare vs Employer Coverage – What Is Right For You?
If you are turning 65 but you’re still working, what do you do about Medicare? That’s a question that a lot of people ask us.
The Brief and Useful History of the Affordable Care Act
The Affordable Care Act (also known as Obamacare) was introduced in 2010 as a way to expand and regulate healthcare coverage. It has not always been seen in a positive light, but the introduction of ACA benefits and plans has helped a lot of people.
A lot of the work done through ACA was done to reform Medicare. Now, people with pre-existing conditions cannot be turned away, and prescriptions cost less. Not only that, but no time limits exist, and more overall screenings are covered.
And, overall, health insurance is less expensive and more affordable to more people. More people have signed up for insurance than ever before, including far more young adults. However, Medicare and this availability do raise taxes, and you are fined if you do not have coverage.
Coverage, Benefits, and Services: The Basics That ACA Plans Require
Another benefit is regulated coverage—ACA-compliant plans are required to meet certain standards of available benefits. All Marketplace health insurance plans must offer these 10 basic benefits:
- Ambulatory services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (adult dental and vision coverage aren’t essential health benefits, but they are often included by many plans)
Getting Ready to Enroll in an ACA Plan
There are a few things you’ll need to figure out about your ACA health insurance application. Because ACA plans are regulated, there are a number of required documents you will have to provide:
- Home and/or mailing addresses
- Basic information (name, age, etc. of everyone applying)
- Social Security Number (SSN)
- Information on the professional/agent helping you sign up and fill out the application
- Immigration document information (only applicable to immigrants)
- Tax filing information
- Employer/income information (including W-2 reported salaries, net income from self-employment, unemployment compensation, alimony, rental income, Social Security benefits, and more)
- Household income estimate
- Insurance information for anyone else in the household with health coverage
ACA plans have an annual open enrollment time, typically at the end of the year. During this time, you can freely make changes to your health care coverage purchased through the ACA’s Health Insurance Marketplace. You can:
- Re-enroll in your current plan
- Choose a plan for the first time
- Choose a new plan to replace your current plan
- Make changes to your existing insurance plan
Typically, changes can only be made year-round in the case of:
- Marriage or divorce
- Birth or a new dependent in your family
- Loss of other coverage
- A move to a new state
- Qualifying for Medicaid or CHIP
