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Obamacare Affordable Healthcare Act Insurance

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The Affordable Healthcare Act (ACA)

Comprehensive Health Insurance for All Americans, including South Carolina, Georgia, Florida, and Beyond

The Affordable Healthcare Act (ACA) was designed to ensure that all Americans have access to affordable and comprehensive health coverage. Whether you’re seeking individual insurance or coverage for your family, the ACA provides a public option that makes quality healthcare within reach, especially for those in South Carolina, Georgia, Florida, and the other states we serve.

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What is Obamacare?

The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Barack Obama in 2010. This landmark legislation, spanning over 1,000 pages, was designed to improve the affordability, quality, and access to health insurance for millions of Americans. It primarily aimed to help those who were struggling to afford individual coverage or had pre-existing medical conditions.

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How Does Obamacare Insurance Work?

One of the key objectives of the Affordable Healthcare Act is to reduce the overall cost of health insurance for qualified consumers. To achieve this, all ACA health insurance policies include two essential provisions:

  1. Advanced Premium Tax Credit: This credit is a subsidy paid monthly to insurance carriers on behalf of individuals or families to help cover premium costs. If your household income falls within 100% to 400% of the Federal Poverty Level (FPL), you may qualify for a premium tax credit.
  2. Cost-Sharing Reduction (CSR): Also known as CSR, this provision offers extra savings to individuals or families that meet the financial criteria. The government provides additional payments to the insurance carrier, which in turn reduces your out-of-pocket costs, such as copays, deductibles, and out-of-pocket maximums. CSRs are only available for plans in the Metallic Silver category.

Originally, the ACA included an individual mandate that required all individuals to purchase health insurance or face a financial penalty. However, the Tax Cuts and Jobs Act (TCJA) of 2017 effectively reduced this penalty to zero dollars starting in 2019. Despite this, some states, including California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington D.C., have enacted their own laws that impose penalties on residents who do not have health insurance coverage.

Need Help Navigating Your Options?

Fika Insurance Group, headquartered in Greenwood, South Carolina, and serving South Carolina, Georgia, and other states, is here to guide you through your Medicare Advantage options. Contact us today for personalized assistance.

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Have Questions?

Fika Insurance Is Here For You!

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What’s Covered Under Obamacare (ACA)? 

Before the Affordable Care Act (ACA), consumers faced numerous challenges in obtaining affordable health insurance. These difficulties were largely due to insurance companies imposing restrictions on coverage for pre-existing conditions, outright denial of coverage based on health status, and lifetime limits on policy benefits. However, under Obamacare, these restrictions have been lifted, making coverage more accessible and user-friendly.

In addition to removing these barriers, the ACA established new health insurance standards for all carriers. Now, all insurance companies must include what’s known as the 10 Essential Health Benefits in their Marketplace plans. These benefits include:

  1. Outpatient Treatments
  2. Mental Health and Substance Use Disorder Services
  3. Preventive and Wellness Services
  4. Laboratory Services
  5. Rehabilitative and Habilitative Services 
  1. Prescription Drugs (RX)
  2. Maternity, Pregnancy, and Newborn Care
  3. Hospitalization
  4. Emergency Services
  5. Pediatric Services
Health Insurance Covered Items
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Doctor Talking About Preventive Services Covered Under the ACA
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A Better Standard of Care

The Affordable Care Act (ACA) set a new precedent by transforming how the healthcare system operates. Instead of just treating illnesses, the ACA emphasizes the importance of preventing them. By eliminating unnecessary fees and copayments for preventive care, the ACA makes it easier for Americans to access essential health services without worrying about costs—even before meeting their yearly deductible.

Preventive Services Covered Under the ACA

All Marketplace health plans, along with many other plans, must cover a wide range of preventive services without charging a copayment or coinsurance. These services include:

  1. Blood Pressure Screening
  2. Cholesterol Screening—for adults of certain ages or those at higher risk
  3. Depression Screening
  4. Diet Counseling
  5. Diabetes (Type 2) Screening—for adults aged 40 to 70 who are overweight or obese
    • Diphtheria
    • Hepatitis A
    • Hepatitis B
    • Herpes Zoster
    • Human Papillomavirus (HPV)
    • Influenza (Flu Shot)
    • Measles
    • Meningococcal
    • Mumps
    • Pertussis
    • Pneumococcal
    • Rubella
    • Tetanus
    • Varicella (Chickenpox)
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G-2 Certified
Your Assurance of Quality and Trust

Fika Insurance Group is proud to be G-2 Certified, a mark of our commitment to excellence and integrity in the insurance industry. This certification is your assurance that we adhere to the highest standards of quality and trust, providing you with reliable and trustworthy insurance solutions.

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Covering Children’s Health

The Affordable Care Act (ACA) not only extended coverage to adults but also provided essential protections for children. It allowed young adults to remain on their parents’ insurance plan until the age of 26. This provision applies even if the child is married, living outside the parental home, or eligible for employer-sponsored insurance.

Preventive care was also prioritized for children under Obamacare. Most health plans, including Marketplace and Medicaid coverage, must offer a set of preventive health services for children at no additional cost. Some of these covered services include:

  • Autism Screening
  • Blood Screening for Newborns
  • Iron Supplements
  • Oral Health Risk Assessments for Young Children
  • And more…
Covering Children's Health Insurance
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Women's Health Insurance Benefits

Obamacare & Women’s Health

The Affordable Care Act made significant strides in improving women’s access to affordable health coverage. Before the ACA, women were often charged higher premiums than men. As of 2020, insurance companies can no longer charge women higher premiums based on gender.

Obamacare set new standards for women’s preventive services, which are now divided into two categories:

Pregnant or May Become Pregnant

  • Preeclampsia Prevention
  • Gestational Diabetes Screening
  • Folic Acid Supplements
  • Breastfeeding Support
  • And more…

All Women

  • FDA-approved contraception and birth control, along with contraceptive counseling, are available to women without cost. However, as of 2020, employers are not required to cover birth control. 
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How You Get Enrolled in Obamacare

Given that access to coverage is a central element of Obamacare, the federal government, along with some state governments, created health insurance Marketplaces to simplify the process of shopping for and comparing health plans. The Marketplace Insurance Exchange provides a side-by-side comparison of health insurance plans in your area, including details like monthly premiums, deductibles, and out-of-pocket maximums.

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The Health Insurance Marketplace Plans Are Broken Down Into 4 Categories.

(5) Estimated averages for a typical population. Your costs will vary:

Plan Category   The Insurance Company Pays   Customer Pays
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

Important Enrollment Period Information

You can only enroll in a Marketplace plan during a specific time of year known as the Open Enrollment Period (OEP). For 2024, the OEP runs from November 1, 2023, to December 15, 2023. All plans purchased during this time will go into effect on January 1, 2024.

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Medicare Guide

The team at Fika Insurance Group simplifies the complex world of insurance for you. Whether you need clarity on Medicare, Life, or Health Insurance, we are here to help. By signing up for our monthly newsletter, you'll receive our free audiobook, "Understanding Medicare: Your Complete Guide." Stay informed with expert insights and tips, and make confident decisions about your coverage.