It’s impossible to turn on the television without hearing a news commentator talking about healthcare. Since the passage of the Affordable Care Act (ACA), the Republican push to repeal the legislation and the election of Donald Trump to the presidency, healthcare is on the minds of many in this country. The ACA was designed to provide health insurance coverage for all Americans and even included a mandate that required you to purchase coverage, yet millions did not obtain insurance even after the marketplaces opened in 2013. Some felt that the IRS penalty imposed on them for not having coverage was less expensive than the premiums they would be required to pay while others assumed that since they were healthy, they didn’t need health insurance at all.
Unfortunately, many of the reasons that people chose not to purchase health insurance are based on misinformation, misunderstanding or plain ignorance about how coverage works. Here are just a few reasons why you need coverage in 2017.
Preventive and Wellness Services
Under the ACA, all policies must pay for preventive and wellness services, something that plans didn’t necessarily cover before. At least 15 free preventive services and one wellness visit must be covered without copays or coinsurance under major medical plans sold after March 23, 2010. These services must be free even if you haven’t met your deductible, and services must be performed in your network to avoid cost-sharing. Preventive services cover immunizations, shots for things like the flu and shingles, and certain screenings and tests. Research shows that preventive care promotes early diagnosis and treatment so that minor health problems don’t become serious issues. Since the passage of the ACA, 76 million people have received preventive care at no out-of-pocket cost.
Outpatient, Inpatient and Emergency Services
Even if you’re healthy, emergencies happen, often at the least convenient times. An emergency appendectomy or a fall in your front yard will send you to the ER. In 2014, CBS News reported that a 20-year old man in California was billed over $55,000 for an appendectomy in 2012. Without health insurance, the cost of that emergency procedure falls to the patient alone. Under the ACA, all insurance plans must cover emergency services, hospitalization and the care you receive before being admitted to the hospital. Laboratory services and prescription drugs must also be covered. This doesn’t mean that these services are free to you, but it does mean that after you hit your deductible, you’ll only be responsible for a small portion of the costs depending on your plan.
Pregnancy Covered from Day One
There was a time when an insurance company could deny coverage to a woman who was already pregnant when she applied for insurance. This could not only leave her without prenatal care, but it could also leave her newborn without coverage after birth. Under the ACA, pregnancy must be covered from the first day of the policy and women cannot be denied coverage due to pregnancy. Coverage must include prenatal and newborn care as well. Insurance companies must also provide breastfeeding support, counseling and equipment at no added cost. This provision includes breast pumps, but your insurer can determine whether it will cover manual or electric pumps; if you will receive the pump before or after birth; and if the unit is rented from a hospital, how long you have to rent the pump.
Mental Health and Substance Abuse Services
The ACA includes one of the largest expansions of mental health and substance abuse coverage in the history of the country. All new plans, on and off the marketplaces and sold via group policies, must cover mental health and treatment for substance abuse. This can include depression screenings and behavioral assessments for children at no cost to you. If you’ve been diagnosed with mental illness, your health plan cannot deny you coverage.
In 2013, people in the United States diagnosed with bipolar disorder may not have been able to get health insurance in many states. The same was true for people suffering from schizophrenia, anorexia, alcoholism and other mental or behavioral issues. Even those who did have insurance did not have coverage for mental health treatment. This denied access to treatment for many, causing breakdowns in families, communities and society in general. Today, insurers have to cover these services, often at no out-of-pocket cost, so families no longer have to suffer when dealing with mental illness or substance abuse.
Rehabilitation Services and Medical Devices
Rehabilitation services and devices are among the essential health benefits mandated by the Affordable Care Act. If you need equipment or resources to help with an injury, disability or chronic condition, your insurance company must cover those devices and services. Without health insurance, payment for those devices or services falls to you or your family. Medical devices can be extremely expensive. An artificial hip or knee can cost $2,000 to $16,000 even without the added cost of implantation, hospital stays and follow-up care with providers. Wheelchairs can cost as much as $4,000 while a simple bathroom grab bar can cost up to $200.
Treatment for Pre-Existing Conditions
If you’ve been diagnosed with an illness in the past, including diabetes, cancer or even high blood pressure, you’re considered to have a pre-existing condition. Before the ACA, an insurance company could deny you coverage due to that condition or charge you astronomically high premiums. This was true even if your condition was under control or you no longer had the illness. Even under the Trump healthcare plan, pre-existing conditions are expected to be covered as long as you do not allow your insurance to lapse.
Free Birth Control
For individuals and families who want to prevent pregnancy, the ACA allows for free birth control. All plans in the marketplace must offer contraception and counseling for women if their healthcare provider prescribes those services. You cannot be charged a copayment as long as you are in your network even if you have not met your deductible. Covered birth control includes:
- Barrier methods (diaphragms or sponges)
- Hormonal methods (birth control pills and vaginal rings)
- Implanted devices (IUDs and other under-the-skin implants)
- Emergency contraception (Plan B and ella)
Male equivalent services, like vasectomies, do not have to be covered, and insurance companies are not required to pay for abortions. There are some religious employers who are exempt from covering birth control on company-offered health insurance plans. If you work for a church or other house of worship, non-profit religious hospital, or institute of higher learning with religious objections, your insurance may not cover certain types of birth control.
Avoid an IRS Penalty
The ACA included the individual mandate, which requires all Americans to have health insurance or face an IRS penalty. Although the law was passed in 2010, the penalty did not begin until 2014 in order to give Americans time to obtain insurance after the marketplaces opened. In order to avoid the penalty, you had to have coverage that includes 10 essential benefits. These include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse disorder services
- Prescription drugs
- Rehabilitative services and devices
- Lab services
- Preventive and wellness services
- Pediatric care, including vision and dental services
There are some exemptions to the requirement. If minimum coverage would cost more than 8.13 percent of your household income or you are not required to file income taxes, you do not have to pay the penalty. If you can demonstrate a hardship that has prevented you from getting insurance or if your coverage lapsed for less than three months, you may also qualify for an exemption. Certain specific groups are also exempt. These include:
- Federally recognized Native American tribes
- People who are incarcerated
- Unlawfully present immigrants
- Members of healthcare sharing ministries
- People with federally recognized religious objections
Tax penalties increase each year. This year, you’ll pay $695 per adult and $347.50 per child, per family or 2.5 percent of your household’s taxable income (whichever is greater) if you don’t get health insurance for 2017.
You may think that it’s less expensive to pay the penalty at the end of the year than to pay premiums throughout the year, but the fact is you can’t predict a sudden health crisis. Research indicates that unpaid medical bills are a leading cause of bankruptcy in the U.S. A recent survey by the Kaiser Family Foundation and The New York Times found that 62 percent of uninsured Americans have cut back on essentials, like food or basic household items, to pay medical bills. More significantly, 51 percent have used up most or all of their savings to cover medical costs. Health insurance can help you avoid these financial catastrophes while also keeping your family healthy with preventive care.