Obamacare


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With the passage of The Patient Protection and Affordable Care Act (ACA) on March 23, 2010 the small business and individual healthcare markets changed dramatically.  Gone were the traditional health plans many Americans were used to and in their place came 4 basic plans tiers:  Bronze, Silver, Gold & Platinum.  The plan summaries can be found below.

California opted to create its own exchange called Covered California.  Covered California offers 4 plan tiers similar to the Federal Plan; Bronze, Silver, Gold & Platinum.  The plan summaries can be found below.

PLAN
Bronze 60
Silver 70
Gold 80
Platinum 90
(Benefits in Blue are Subject
to Deductibles)
(Copays in Black are Not
Subject to any Deductible
and Count Toward the
Annual Out-of-Pocket
Maximum)
www.hyehealth.com
Deductible
$5000 deductible for
medical & drugs
$2000 medical
deductible $250 brand
drug  deductible
no deductible
no deductible
Preventative Care Copay
(Deductible does not apply)
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
Primary Care Visit Copay
$60
3 visits per year
$45
$30
$20
Specialty Care Visit Copay
$70
$65
$50
$40
Urgent Care Visit Copay
$120
$90
$60
$40
Generic Medication
$19
$19
$19
$5
Lab Testing Copay
30%
$45
$30
$20
X-Ray Copay
30%
$65
$50
$40
Emergency Room Copay
$300
$250
$250
$150
High cost and infrequent
services (e.g. Hospital Care)
30%of your plan’s
negotiated rate
20% of your plan’s
negotiated rate
HMO
Outpatient Surgery –
$600
Hospital – $600/day
up to 5 days
PPO – 20%
HMO
Outpatient Surgery
– $250
Hospital – $250/day
up to 5 days
PPO – 10%
Preferred brand copay after
Drug Deductible (if any)
$50
$50
$50
$15
Maximum Out-of-Pocket For
One
$6,000 –
$7,000
$6,000 –
$7,000
$6,000 –
$7,000
$4,000 –
$5,000
Maximum Out-of-Pocket For
Family
$12,000 –
$14,000
$12,000 –
$14,000
$12,000 –
$14,000
$8,000 –
$10,000
Some of the more important changes in the Affordable Care Act (ACA) include:
  • The creation of a new Health Insurance Marketplace for individuals, families, and small businesses to get health coverage.
  • The requirement that insurance companies must cover people with pre-existing health conditions.
  • The inability for health insurance companies to arbitrarily cancel your health insurance just because you get sick.
  • The preservation of coverage on family plans for young adults under age 26
  • The end of lifetime and yearly dollar limits on coverage of essential health benefits.

A Division of