OBAMACARE HEALTH REFORM IN 10 QUESTIONS

Since it was signed in March 2010, the Patient Protection and Affordable Care Act, better known as Obamacare, has been creating a stir in the American political arena. Effective January 1, 2014, this health reform requires all people paying taxes in the United States to have health insurance fulfilling certain criteria. Although a recent decree, dated January 2017, aims to challenge the Obamacare, the law has not been repealed for the time being. Here are 10 questions and answers to better understand the Obamacare health reform.

 

1. What is the "Obamacare" law?

The Patient Protection and Affordable Care Act, known as Obamacare, is a law passed by the US Congress. It was promulgated by President Barack Obama on March 30, 2010 and provides for the reform of the US health care system. Since January 1, 2014, all Americans must have health insurance. Any resident or non-insured citizen is subject to financial penalties. However, a decree to weaken Obamacare was signed on 20 January 2017 by President Donald Trump. The application of penalties could be quickly relaxed.

 

2. What is the purpose of this health reform?

The Obamacare health reform aims to reduce inequalities by making access to care universal. Nearly 50 million Americans with no social security coverage will be eligible for health insurance.

 

3. Who is affected by the Obamacare health reform?

Americans or permanent residents whose employer does not provide health insurance as well as those who do not benefit from any health cover managed by the US government (Medicaid and Medicare) are the first to be concerned by the Obamacare reform. They had until March 31, 2014 to take out health insurance. Individuals already covered individually but whose police did not meet the requirements of Obamacare were invited to change insurers. Financial assistance was given to Americans with limited resources..

However, other categories of the American population are also affected by the reform:

  • low-income earners (incomes up to 138% of the poverty line) can benefit from Medicaid, if the state in which they reside has chosen to opt for the extension of the program,
  • Business owners employing more than 50 employees must take out insurance for their employees.

4. What are the exemptions?

Prisoners, Amerindians, illegal immigrants, members of a recognized religious sect, rejecting all forms of insurance, or members of a health care sharing ministry are not affected by the Obamacare law. For example, a member of Medi-Share, Samaritain Ministries or the Amish community will have no penalty to pay if they are not insured.

 

5. What is the financial penalty for residents and US citizens who do not have so-called "ACA-compliant" health insurance?

Taxable citizens or residents who did not subscribe to ACA-compliant health insurance in 2016 are liable to a fine of USD 695 per adult and USD 347.50 per child, or 2.5% of annual income in the same year. above the minimum threshold for their situation. The penalty that applies is the higher of the two amounts. Please note that the amount of the penalty is in any case limited to the cost of the average national premium for a "Bronze" coverage (minimum coverage), ie USD 2,085 in 2016. The fine is then increased each year. It is possible to estimate the amount of the penalty to be paid at https://taxpolicycenter.org/taxfacts/acacalculator.cfm. The Executive Order signed by President Donald Trump on January 20, 2017 could minimize or exempt you from additional taxes if you have not purchased an ACA-Compliant contract. .

 

6. What guarantees must be included in insurance solutions to comply with the requirements of Obamacare?

Prisoners, Amerindians, illegal immigrants, members of a recognized religious sect, rejecting all forms of insurance, or members of a health care sharing ministry are not affected by the Obamacare law. For example, a member of Medi-Share, Samaritain Ministries or the Amish community will have no penalty to pay if they are not insured.

  • ambulatory services,/li>
  • emergency services,
  • hospitalization,
  • childbirth and care of the newborn,
  • mental health,
  • medical prescriptions,
  • rehabilitation services,
  • laboratory analyzes,
  • prevention and management of chronic diseases,
  • pediatric services (including ophthalmic and auditory care).

For all of these guarantees, no ceiling of reimbursement can be fixed.

 

7. What principles must be respected by insurers ?

To comply with the Obamacare law, insurers must: provide the insured with an easily understandable summary of their guarantees, respect the Medical Loss Ratio, in other words, 80% of the customer premium must be used to make reimbursements and improve the quality of care, 20% to cover administrative and marketing costs, refund part of the customer premium in case of non-compliance with the Medical Loss Ratio, justify any price increase 10% and more, give the possibility to the insured to appeal in case of litigation concerning a refund, cover dependent children up to 26 years under the police of their parents, cover any person wishing to make sure, what regardless of health status and without applying a surcharge, take care of preventive care free of charge.It is also prohibited insurers: to terminate a contract because too much consumption of the insured, to apply a co-payment for emergency care received outside the partner network, to apply annual ceilings and ceilings by contract on the 10 essential guarantees.

 

8. What are the possible coverage levels ?

Each insurance solution has 4 different coverage levels: Bronze, Silver, Gold and Platinum. These levels correspond to the average percentage of health expenses that will be borne by the insurer. Thus, with Bronze coverage, 60% of the insured's health expenses are covered, compared to 90% with Platinum coverage.

 

9. How insurance premiums are calculated ?

The amount of premiums varies according to the level of coverage chosen. Bronze insurance is logically less expensive than a Platinum solution. If the coverage levels offered are the same across the country, the amount of the contributions may be different from one state to another, or even from one city to another. Other factors, such as age or smoking / non-smoking status, can also influence the cost of health insurance.

 

10. What are the advantages of taking out a French Expat Company solution in the event of expatriation in the United States?

Obtaining health insurance that does not meet the requirements Obamacare is in no way illegal. However, if you are taxed in the United States, you may have to pay an additional fee. By choosing French Expat Company, you choose a cover tailored to your expatriate profile. On the one hand, you choose the guarantees you need among the guarantees of health expenses, repatriation assistance, civil liability, death benefit and daily allowances. On the other hand, you are covered without deductibles both in the United States and in the rest of the world for the duration of your choice. You can also freely choose your health professional and care facility. With our direct payment service for hospitalization, you do not move an agent if you are admitted to the hospital. Similarly, by using our partner networks in the United States, you can benefit from third-party payment from 490,000 physicians and 57,000 pharmacies. Finally, our solutions allow you, if you wish, to benefit from a management of your optical and dental care. As for the amount of your contributions, it does not evolve according to your personal expenses.