Understanding the Affordable Care Act

Insurance 101 presentation

More details for Shepherd’s Clinic patients

The Affordable Care Act (ACA, also known as Obamacare) went into effect in 2014, and is an option for Shepherd’s Clinic patients who would like to purchase insurance and move their medical care to the MedStar clinic that is also based at 2800 Kirk Avenue. More information about plans can be found on the Maryland Health Connection website.

Shepherd’s Clinic will be offering insurance counseling for patients to help them understand details, and to sign for the ACA during the session. The full document used during previous information sessions (including pricing, types of plans, and best choices for different scenarios) can be downloaded here.

 

Types of Insurance

Medicare
Insurance for patients who are 65 years and above, US citizens or legal residents.
Medicaid
For patients who make up to 133% of the Federal Poverty Level. This insurance is at no cost, with possibly small co-payments for medication.
Private insurance
1. Individual policy that the patient purchases
2. Employment-based insurance: provided by the employer, where the patient usually pays part of the premium

Basic Healthcare Definitions to Know

Premium
The amount that must be paid every month for your health insurance or plan whether you use your insurance or not.
Co-pay
A fixed dollar amount you pay each time you see a doctor or fill a prescription. Your insurance card tells you how much your co-pay is for doctor visits and medications.
Co-insurance
This is another amount you will need to pay when you have special tests or procedures. You also pay coinsurance when you visit the ER or are admitted to the hospital. It’s a percentage of the cost of services, usually 20%.
Deductible
The amount you pay before insurance will begin paying for care, in addition to what you pay for your premium. Deductibles start over every January 1.
Tax credits
When you have a premium, you pay part of it, and the government pays the rest as a tax credit or subsidy.
Open Enrollment
The time period when you can enroll in health insurance for the next year.