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NUR 621 TOPIC 2 DQ 1

NUR 621 TOPIC 2 DQ 1 Topic 2 DQ 1 The Affordable Care Act has subsidies available; how does one qualify? How does this differ from Medicaid? Individuals who may qualify for subsidies from the ACA include; • An employer does not offer affordable health insurance. In this case, affordable insurance means at least 60 percent of covered benefits or the premiums would cost you no more than 9.5 percent of your annual household income after tax credits are applied. • A person who purchases insurance coverage through a government-sponsored marketplace. • Those with an annual household income between 100 and 400 percent of the federal poverty level, depending on your specific state’s requirements (Penner, 2017). Those with income below the federal poverty level may not qualify for subsidies but would qualify for Medicaid the national health program for low-income individuals and families. ACA subsidies are only available on the health exchange. An individual would estimate their income for the year and receive a subsidy based on income level, number of family members, etc. The subsidy is an estimated amount the government pays to the insurance company on your behalf. The following year at tax time you may be required to repay some or all the subsidy if your income was more than estimated. Medicaid differs in that it is aimed at helping those below the 138% poverty level, which is an income around fifteen to sixteen thousand a year. Medicaid is not an insurance plan; it is a government regulation used to pay funds directly to physicians and can only be used if the insurance holder is on the government-funded insurance plan. This coverage is free and funded through federal and state taxes. “One of the major pros of the Affordable Care Act is the rebate system for qualifying individuals stemming from the 80/20 rule. This rule requires insurance companies to spend 80 percent of premiums on healthcare or refund portions of already paid premiums” Frye (2013). Although the price may be a little more than what the populations was expecting, there is a limit being placed on insurance companies as to how much they can spend on health care, and what they do not spend will be refunded. References: Frye, P. (2013). Obamacare Exchanges Rates Explained: Penalty, Facts, Pros, and Cons to Affordable Care Act Bill. Inquisitr. Penner, S. J. (2017). Economics and Financial Management for Nurses and Nurse Leaders. 3rd ed. Springer Publishing Co.

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