By: Marti Lolli
Affordable Care Act
Health Care Reform
They’re all different names used to refer to the same legislation that took effect in 2010. The objective is to ensure all Americans have access to affordable health care.
Four years later – with one open enrollment period complete – there is still confusion about what this new law means. Here are the top 5 things you need to know:
- Purchasing a Health Plan
Everyone has access to health care but there are different ways of getting it. You can get coverage through an employer, get Medicaid or Medicare coverage, if qualified, or purchase an individual plan for yourself or your family.Individual plans are available through the Health Insurance Marketplace, an insurer or by working with an insurance agent. The Marketplace offers a new way to get affordable health coverage. Individuals – and agents – can compare plans based on price, benefits and other features.
- Affordable Options
You might be eligible for a subsidy. The Affordable Care Act provides financial assistance for individuals and families making up to 400 percent of the federal poverty level. If your family of four makes between $23,550 and $94,200, there might be some additional financial resources available to help reduce the cost of the premium or out-of-pocket expenses.How it works: The federal government pays a tax credit directly to the insurance company to reduce a person’s monthly payment. Consumers living at 250 percent of the federal poverty level have their out-of-pocket expenses reduced. The federal government covers all or a portion of these expenses directly.
- Essential Benefits
The new ACA plans are robust. Each plan must include 10 essential health benefits:
- maternity and newborn care
- prescription drugs
- pediatric services including dental and vision
- rehabilitative and habilitative services
- mental health and substance use disorder services
- laboratory services
- ambulatory patient services
- wellness and chronic disease management service
- emergency services.And no one can be denied coverage based on a pre-existing condition.
- Tax Penalties
The law requires Americans to have health insurance. If they fail to secure a health plan, individuals will be forced to pay a penalty.In 2014, the fee is $95 per adult or one percent of their annual salary, whichever is higher. The penalties increase in severity. In 2015, the fee is $325 per adult or 2 percent of annual salary, increasing to $625 or 2.5 percent annual salary in 2016.
- Change is Inevitable
The Affordable Care Act is a very complex piece of legislation. Changes are going to continue to happen. It is important for health plans, providers and patients to remain flexible and adaptable.The best way to navigate in this ever-changing arena is to be educated. Seek out information. Speak to an insurance agent. Ask questions. Do your homework.
About the Author: Marti Lolli leads development of health care products to meet the needs of employers and consumers. She is also responsible for setting health care reform strategies and tactics for commercial, individual and government programs. Marti works across the company to identify opportunities and risks within the Affordable Care Act (PPACA) and its associated regulations as they are issued, as well as ensuring that corporate strategies and tactics are implemented.