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- The government has laid out the rules and laws that require everyone in the United States to have health insurance
- Anyone without insurance covers and does not fall into the category of the people with exemptions attracts a high penalty, which may be greater than the minimum annual health coverage
- An employer with more than 50 employees is required to obtain the employee health insurance for all the staff or risk getting hefty penalties
- Affordable Care Act requires all the insurance providers to adopt standard insurance policies. They also warn the companies from increasing the premiums or denying coverage to people with pre-existing conditions
Getting sick is very expensive especially when you do not have an insurance cover. It is even worse when you are in the United States where the health care system is very complex and costly.
Due to the high treatment costs, the government introduced the mandatory healthcare for the citizen to protect them from the financial losses after an illness.
Mandatory health care provides the residents with affordable and quality health coverage that satisfies the federal coverage standards. Additionally, the health insurance plans provide the policyholders with a proof of coverage.
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Health Care Coverage
Various health plans offered by different employers include Medicare, Medicaid, Veterans healthcare program, TRICARE, and CHIP, among others. The government expects everyone including the unemployed to have a health insurance coverage.
Different insurance companies provide the minimum coverage to all citizens making it easier to get attractive rates by shopping online. Expatriates should consider getting an insurance cover in the country too. Additionally, there are healthcare rules which would attract a tax penalty if not followed. They include:
– Eligibility Criteria
Everyone needs health coverage. Therefore, the insurance providers may not pay so much attention to the health conditions of a policyholder. They may ask whether you smoke or use tobacco, your age, place of residence, and the number people getting coverage.
They may not charge more premiums for a pre-existing condition such as the genetic diseases, disabilities, gender, or other health conditions and histories.
– Open Enrollment Period
Citizens should buy health insurance during the annual enrollment period. The period runs from the first day of November to January 31 every year.
Other qualifying events include when you lose existing coverage, get a married or a baby or in the instance of divorce.
Anyone who does not have a medical coverage attracts a tax penalty from the government. You should pay the penalty together with the federal income taxes.
The penalties have gone up from $95 in 2014 to $695 in 2016 with a percentage increase of 1 to 2.5 percent respectively.
However, the state exempts some people from the medical coverage and tax penalty. You would receive an exemption for living without medical coverage only if:
- Your household income tax does not meet the tax filing threshold.
- Your religion does not allow you to accept the health insurance policy benefits.
- The incarcerated.
- You are eligible for a hardship exemption.
- You are an illegal immigrant.
- Member of the Indian and Native American tribes.
Health Insurance and Employers
Patient Protection together with the Affordable Care Act has laid out rules that require any employer with over 50 workers to give employee health insurance. Failure to provide the coverage would lead to penalties, which may be as high as $3000 for every uncovered employee.
The penalty is greater than the cost of paying insurance cover, and this encourages the companies to provide coverage to their workers. Some states like Massachusetts and San Francisco have reforms, which penalizes any employer who does not provide coverage to the employees.
The Affordable Insurance Act (ACA)
In the past, most of the people with pre-existing conditions and disabilities received discrimination from the insurance companies. However, ACA laid out some rules that prevented the insurance providers from increasing the premiums or denying coverage to people with preexisting conditions.
Additionally, ACA provides high quality and affordable medical care to everyone with high health-care costs and very low income. All this is in a quest to give coverage to everyone in the country regardless of the previous medical history or the type of condition that they have.
Instead of raising the premiums for the people with pre-existing conditions, ACA has laid a rule that will increase the premiums for the people without medical coverage.
The Four Levels of Insurance Coverage
Privately insured individual should have insurance cover that is at least bronze level. Insurance providers may have various coverage levels that they charge different premiums, but ACA requires them to maintain standard policies and terms.
ACA does not prohibit them from having varying conditions for their policyholders. Insurance companies should provide four levels of coverage including bronze, silver, gold, and the highest, platinum.
The insurance company covers about 60 percent of the total insurance cover for individuals at Bronze level and above 90 percent for the ones at platinum.
However, all the levels should provide coverage for the necessary doctor visits, mental health care, prescription drugs, laboratory test, emergency care, maternity and newborn care, and wellness services among others. Insurance companies determine the premiums by checking on the risks involved as well as the number of the family members covered.
Insurance coverage for Exchange Visitors:
Any exchange visitor holding a J-1 visa and their dependents should have health coverage that meets the US State Department directives in the visa application. The sponsoring agency may provide the coverage but if they do not, you should have the following cover:
- Medical evacuation fee that goes for $10,000
- Deductible fee- no more than $500 for every illness
- $100,000 for every illness
- Repatriation coverage of not less than $7500
Some of the U.S. citizens have not received the mandatory health coverage so well although others recognize its contributions in helping them meet their treatment. The government has laid out rules to ensure that everyone receives medical coverage regardless of their financial status.
People with disabilities and other genetic conditions have also been relieved from the high premiums charged by the insurers.
To find coverage today, enter your zip code below! We offer free online health insurance quotes comparisons with just a few questions to match you with the right providers in your state.
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