Understanding ACA

The ACA is the Affordable Care Act. Also known as Obamacare. The comprehensive healthcare reform law and its amendments were established in March 2010. The law addresses health insurance coverage, healthcare costs, and preventive care. 

Ascension Personalized Care is one of many health insurance plans available on healthcare.gov. We offer a variety of affordable plan choices designed to be easy to understand and use, so you can focus on your health. It is brought to you by Ascension, a trusted health partner with over 100 years of experience in delivering personalized, compassionate care to people across the nation.

No. The Health Insurance Marketplace is just one of the ways people can shop for healthcare coverage. However, you can only receive income based tax credits and savings if you buy coverage through the exchange.

Every year, the federal government allows individuals and families to register for health insurance during an Open Enrollment Period (OEP). This period runs from November 1 through December 15 (some state exchanges have longer periods, so be sure to check your state guidelines). If you are unable to register for health insurance during this time, you may qualify for a Special Enrollment Period (SEP). A life event must occur for this special enrollment period to happen. These might include:

•        Having a baby or having a child placed with you for foster care or adoption
•        Marriage.
•        You are permanently moving to a new area of residence outside your health insurance coverage, i.e., state.
•        Becoming a US citizen.
•        A significant change in income or loss of job that affects your eligibility for cost-sharing reductions or premium tax credits.
•        Leaving incarceration after the open enrollment period has elapsed.
•        When you turn 26 and are no longer eligible for your parent’s insurance plan.

Health coverage or health insurance can help you manage your health as well as the costs associated. Without health insurance you will be responsible for the full cost of your medical care. Health insurance also encourages you to visit your doctor regularly for check-ups and to identify any health issues early.

Essential health benefits (EHB) are a set of 10 services that each health plan must cover under the Affordable Care Act. These 10 essential health benefits are:

1.        Ambulatory patient services (also known as outpatient care. This includes any services you can get without staying in the hospital.)
2.        Emergency services
3.        Hospitalization
4.        Pregnancy, maternity, and newborn care
5.        Mental health and substance use disorder services, including behavioral health treatment
6.        Prescription drugs
7.        Rehabilitative and habilitative services and devices
8.        Laboratory services
9.        Preventive and wellness services and chronic disease management
10.        Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

A referral is a written order from your primary care provider (PCP) to see a specialist or receive certain medical services. Oftentimes, you need a referral before you can receive medical care from anyone other than your primary care doctor. If you don’t have a referral first, the plan may not pay for the services. The Ascension Personalized Care plan does not require a referral to see a specialist or receive certain medical services.

A prior authorization is an approval from your health plan. It may be required before you are able to fill a prescription or receive a medical service. Please call us at 833-600-1311 to obtain a prior authorization.

You can find all of your plan information by logging into your member portal at ascensionpersonalizedcare.com.