Affordable Care Act: What You Need to Know
By Roy S. Lyons,
income ȧȧ In 2015: the greater of $325/ individual (3 per family), or 2% of income
Managing Director, Marsh There is no doubt that the ACA is the most transformational change in health insurance since Medicare. It’s survived a Supreme Court challenge, presidential election, and continuing congressional attempts at repeal, modification or defunding (40 attempts at last count). One thing is for certain: while there may be delays in implementing certain parts of the law, it is not going away. You’ll need to know the basics to evaluate how it influences your medical insurance buying decisions. The following will help with your decision making process that lies ahead.
ȧȧ In 2016: the greater of $695/ individual (3 per family), or 2.5% of income • Guaranteed Issue – Insurance companies must sell coverage to everyone, regardless of pre-existing conditions, and can’t charge more based on health or gender.
• Penalty – If you elect not to purchase coverage, you are required to pay a penalty
• Health Insurance Exchange – Individuals without access to affordable, employer-sponsored plans that provide qualifying coverage can enroll in plans offered either through the individual insurance market or through Covered California, the state-based exchange with coverage beginning January 1, 2014. Open Enrollment for Covered California commences on October 1, 2013. Since there will be a great deal of traffic and confusion, you may wish to wait until late in October to review your options. If individuals don’t enroll with the exchange during the initial open enrollment period, they will have to wait until next year’s open enrollment period to obtain coverage.
ȧȧ In 2014: the greater of $95/ individual (3 per family), or 1% of
• Subsidies – Individuals and families may qualify for federal tax credits and
Health Care Reform: The Basics for Individuals
Beginning January 1, 2014, new regulations provide most Americans access to affordable health insurance that covers essential care. The regulations that facilitate this include: • Individual Mandate – Most individuals are required to have and maintain health insurance effective January 1, 2014. There are exceptions for certain individuals.
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benefit subsidies only through Covered California. Tax credits are available to those who meet certain income requirements and do not have access to affordable health insurance that meets minimum coverage standards offered through their employer or another government program. Eligibility for tax credits is based on family income and size. Individuals and families who make between 138
Minimum Essential Benefits • • • • • • • • • •
Ambulatory services Emergency services Hospitalization Maternity and newborn care Mental health/substance abuse treatments Prescription drugs Rehabilitative services Laboratory services Preventive/wellness services Pediatric services