NUR 621 The Affordable Care Act has subsidies available; how does one qualify?
NUR 621 The Affordable Care Act has subsidies available; how does one qualify?
The Affordable Care Act (ACA) is a law that addresses healthcare costs, preventive care, and coverage of health insurance by eliminating preexisting health conditions and allows young adults up to age 26 to remain on their parents’ insurance plan (MACPAC, n.d.). ACA is aimed at encouraging preventative cares such as mammograms, colonoscopies, vaccines, labs, etc in hopes to prevent illnesses (Wu, 2019). The ACA was signed in law on March 23, 2010, by President Barack Obama. There are three goals of the ACA which include: allowing more people to have affordable health insurance available to them; to cover all adults with incomes below 138% of the federal poverty level (FPL) by expanding the Medicaid program; and to support medical care delivery methods that are designed to lower healthcare costs (USA.gov, n.d.).
The subsidies are tax credits that are reflected upon a sliding scale by limiting the amount paid within monthly premiums within a percentage of your annual income. Most eligible people that earn 100%-400% of the FPL are eligible for the subsidies by applying through the government-run health insurance marketplace in the state you live through a qualifying licensed agent, and private online Marketplaces that cooperate with the government marketplace (Davalon, 2021). 87% of the 10.7 million people in 2020 that purchased health insurance on the Marketplace received ACA premium subsidies (Davalon, 2021).
Medicare differs from ACA due to Medicaid being a social welfare program that provides free health insurance for poor and qualified individuals with certain disabilities within the U.S (Barba, 2020). Medicare is funded both by the federal government and individual state governments, which the program was created to help provide health insurance to individuals that lacking the money or resources to afford coverage (Centers for Medicare & Medicaid Services, n.d.). The eligibility requirements differ state to state, however each state looks at income, household size, and citizenship status (Barba, 2020). ACA is offered by private insurance companies, businesses, and offers copay coinsurance, and deductibles whereas, with Medicaid it is 100% free to the individual and are required to be on a government-funded insurance plan (NHIA, n.d.).
Barba, R. (2020). What is Medicaid. https://www.healthcare.com/what-is-medicaid-25740
Centers for Medicare & Medicaid Services. (n.d.). Medicaid. https://www.medicaid.gov/medicaid/index.html
Davalon. (2021). Everything to know about Obamacare (ACA) subsidies. eHealth. https://www.ehealthinsurance.com/resources/affordable-care-act/aca-obamacare-subsidies
National Health Insurance Agencies (NHIA). (n.d.). The differences between ACA and Medicaid. Florida Blue. https://nhiains.com/difference-aca-medicaid/
USA.gov. (n.d.). Affordable care act (ACA). https://www.healthcare.gov/glossary/affordable-care-act/
Wu, T., & Raghunathan, V. (2019). The patient protection and affordable care act and utilization of preventive health care services among asian americans in Michigan during pre- and post-affordable care act implementation. Journal of Community Health, 44(4), 712-720. https://doi.org/10.1007/s10900-019-00628-7
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I agree with you that the Affordable Care Act (ACA) seeks to increase the affordability and accessibility of quality healthcare services. The law targets uninsured children and adults. ACA prioritizes preventive care with minimal attention directed to treatment (Meinhofer & Witman, 2018). Preventing some illnesses is cheaper than handling sick people. Therefore, ACA becomes critical in vaccination, assessment of health complications, and preventing sicknesses. The former US President signed the ACA into law in March 2010. The increased outcry from uninsured Americans during the electioneering period compelled the President to introduce ACA. The act aimed at enabling more Americans to access affordable health insurance (Eguia et al., 2018). However, the ACA targeted eligible adults with income below 138%. Arguably, the law targeted low-income earners. Medicare differs from ACA since Medicaid is a social welfare program. The program provides free healthcare insurance to the qualified Americans (Takvorian et al., 2020). Medicaid prioritizes Americans with disabilities. ACA does not specify on people with disabilities. The central government finances ACA while Medicaid is under the federal government and individual state governments.
Eguia, E., Cobb, A. N., Kothari, A. N., Molefe, A., Afshar, M., Aranha, G. V., & Kuo, P. C. (2018). Impact of the Affordable Care Act (ACA) Medicaid expansion on cancer admissions and surgeries. Annals of surgery, 268(4), 584. doi: 10.1097/SLA.0000000000002952
Meinhofer, A., & Witman, A. E. (2018). The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion. Journal of health economics, 60, 177-197. https://doi.org/10.1016/j.jhealeco.2018.06.004
Takvorian, S. U., Oganisian, A., Mamtani, R., Mitra, N., Shulman, L. N., Bekelman, J. E., & Werner, R. M. (2020). Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer. JAMA network open, 3(2), e1921653-e1921653. doi:10.1001/jamanetworkopen.2019.21653
ACA provides subsidies and cost sharing subsidies to qualified persons to reduce the cost of coverage. The people who qualify for the ACA subsidies are those whose net income ranges from 100-400 percent of federal poverty line. The federal poverty line of a person is rated as 128,800, and it depends up on the number of people in a given household. (Davalon,2021). The qualified person must be living in the US either as a legal resident or a citizen and the beneficiary should not be present in incarceration.
Affordable care act provides subsidies, and these subsidies are used to pay the health insurance premiums for those who are struggling to afford the insurance coverage (Norris,2021). The people that qualify for ACA are protected from the rising cost of premiums and the subsidies are designed to decrease or increase depending on the premium proportions. This helps the people of middle- and lower-income levels to afford health insurance policies.
To eligible for Medicaid subsidies, our income must be between 100-400 percent of federal poverty line, similar to the eligibility rate for ACA. The qualification of Medicaid subsidies depends on whether the state that the person lives has expanded the plan or not (Health care. Gov,2021). However, in states that have already expanded the Medicaid program, one can qualify depending on the state poverty level. This threshold is kept at 133% at federal level and 138 % in state level (Garfield and Orgera,2021). The eligibility for subsidies for individuals in the state that failed to expand Medicaid will be limited and such people might struggle to receive financial support on the health insurance even if they are below the poverty level.
Davalon. (2021). Everything to know about Obamacare (ACA) Subsidies. eHealth. https://www.ehealthinsurance.com/resources/affordable-care-act/aca-obamacare-subsidies.
Garfield, R. and Orgera, K. (2021). The coverage gap: Uninsured poor adults in states that do not expand Medicaid. KFF. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.
HealthCare.Gov. (2021). Medicaid expansion & what it means for you. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/.
Norris, L. (2021). Will you receive an ACA premium subsidy? Health Insurance.org. https://www.healthinsurance.org/obamacare/will-you-receive-an-aca-premium-subsidy/
I concur with you that ACA aimed at providing insurance to many uninsured Americans. Before resuming his first term in office, President Obama promised Americans affordable and quality healthcare services (Lee & Porell, 2020). Therefore, ACA was part of the government’s commitment to lowering healthcare costs for many uninsured Americans. Before the law, most insurers dismissed Americans with preexisting conditions. As a result, the number of uninsured Americans increased. ACA aimed at eliminating the restrictions. Medicaid is extensive public healthcare insurance that targets low-income Americans and people living with disabilities (Caswell & Waidmann, 2019). The eligibility factors for both ACA and Medicaid are different. ACA engages insurers whereas Medicaid interacts directly with community health centers and other healthcare facilities. The federal and state governments through their metrics determine the poverty levels before enlisting qualified Americans for Medicaid (Loehrer et al., 2018). The American healthcare sector has transformed since the introduction of ACA and Medicaid. The increased affordability rate for healthcare services has enabled Americans to access quality healthcare services.
Caswell, K. J., & Waidmann, T. A. (2019). The affordable care act medicaid expansions and personal finance. Medical Care Research and Review, 76(5), 538-571. https://doi.org/10.1177/1077558717725164
Lee, H., & Porell, F. W. (2020). The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status. Medical Care Research and Review, 77(5), 461-473. https://doi.org/10.1177/1077558718808709
Loehrer, A. P., Chang, D. C., Scott, J. W., Hutter, M. M., Patel, V. I., Lee, J. E., & Sommers, B. D. (2018). Association of the Affordable Care Act Medicaid expansion with access to and quality of care for surgical conditions. JAMA surgery, 153(3), e175568-e175568. doi:10.1001/jamasurg.2017.5568