6 key facts you need to know about Obamacare
The Affordable Care Act (“Obamacare”) requires all major medical plans sold today to cover 10 essential health benefits: outpatient care, emergency services, hospitalization, pediatric care (including vision and dental), lab services, rehabilitative care, maternity care, mental health care, prescription drugs & preventive care.
NO CAPS ON COVERAGE
Under Obamacare, insurers cannot set caps on coverage (annual or lifetime). Instead, there are caps in place on how much you have to spend out of pocket. In 2018, the out-of-pocket max (set at the federal level) is $7,350 for individual policies. Your plan can have a lower cap, but no plan has a higher one. That’s the most you’ll spend for covered care in a year if you have a major medical policy.
If your income falls between 100 and 400% of the federal poverty limit (FPL), you qualify for advance premium tax credits, which will reduce your monthly premium. You qualify for extra assistance (cost sharing reductions) if you earn between 100 and 250% of the FPL.