The Affordable Care Act.
(ACA), also commonly referred to as Obamacare, was first implemented in 2010. It was developed with the intention of providing affordable health insurance, while also protecting consumers from insurance companies who would increase patient costs or limit care.
An ACA plan may not be the right option for some, but it could be the right option for you. Let’s review the different types of plans and their coverage.
There are four main types of ACA plans that you can choose from.
Let’s go over all four and see if they work for you. We will also review what the plans cover so there are no surprises.
Types of ACA Plans.
Health Maintenance Organization (HMO) Plans.
With an HMO plan, plan members will receive their healthcare services through a specific network of providers. Plan members are also required to choose a primary care doctor and will need referrals to see specialists. You will most likely have no coverage if you receive care outside of your plan’s provider network.
Preferred Provider.Organization (PPO) Plans.
PPO plans allow their members to go to any in-network healthcare provider without needing a referral from a primary care doctor. Plan members also receive some coverage if they go to an out-of-network provider.
Exclusive Provider Organization (EPO) Plans.
With an EPO plan, plan members must only use the doctors, specialists, and hospitals that are within the scope of the plan’s network. Plan members cannot go outside of the network and be covered.
Point-of-Service (POS) Plans.
POS plans have qualities of both HMO and PPO plans. POS plans will have their plan members choose a primary care doctor and receive referrals to visit with in-network specialists. However, POS plans will also grant plan members the flexibility to receive services outside of the plan’s network.
What do ACA Plans Cover?
All ACA Plans are required to provide coverage for ten essential benefits:
- Emergency services.
- Hospitalization.
- Lab services.
- Maternity & newborn care.
- Mental health, behavioral health, & substance abuse disorder services.
- Outpatient services.
- Pediatric services.
- Prescriptions.
- Preventive and wellness services.
- Rehabilitative and habilitative services