The Patient Protection and Affordable Care Act passed in 2010, and the health care and health insurance landscapes have been changing ever since. However, 2014 marks a big year with most of the health care reform law’s key provisions taking effect.
Here is a summary of what this year means for Obamacare and you:
Individual major medical health insurance coverage sold on and off state-based and federally facilitated health insurance exchanges must now cover a set of health care services known as essential health benefits—aka EHBs. These 10 categories include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care.
Open enrollment for 2014 coverage began on Oct. 1, 2013, and state-based and federally facilitated health insurance exchanges known as the Health Insurance Marketplace launched. January 1, 2014, marked the first effective dates for plans sold on the exchanges and all new plans are considered minimum essential coverage, fulfilling the Affordable Care Act requirement that most Americans have health insurance or face a tax penalty called the shared responsibility payment.
Coverage is now divided into four metal levels—Bronze, Silver, Gold and Platinum. Catastrophic coverage is available to those under 30 and some who qualify based on hardship.
In the individual and small group market, insurers can no longer deny people coverage or increase their rates based on health history and/or gender. Rates may be based on age with a maximum 3:1 ratio, geographic area, family and tobacco use with a maximum 1.5 to 1 ratio. This rule also applies to Medicaid and the Children’s Health Insurance Program known as CHIP.
Some states opted to expand their Medicaid programs to cover more individuals and families, and federal funding has been enhanced. Medicaid provides free or low-cost care to individuals under age 65 who are not eligible for Medicare and have incomes up to 133 percent of the federal poverty level. Visit healthcare.gov/do-i-qualify-for-medicaid, scroll down, and select your state from the menu to learn more about the Medicaid program in your area and learn more about eligibility.
Medicaid-participating hospitals may now make presumptive eligibility determinations for all Medicaid-eligible populations. This means such facilities may give temporary Medicaid and CHIP coverage that allows immediate access to medical care.
Individuals and families may qualify for premium tax credits or cost-sharing subsidies depending on household income level and the type of health insurance coverage they select. Tax credits are available to those with incomes between 133 percent and 400 percent of the federal poverty level. Cost-sharing subsidies are available to those who purchase a Silver plan with incomes up to 250 percent of the federal poverty level.
Use healthedeals.com’s Health Care Reform Calculator to estimate your tax credit eligibility.
New plans and existing group plans can no longer limit how much they will pay for your coverage when it comes to essential health benefits—this applies annually and over the policy’s lifetime. Plans with effective dates before January 1, 2014, may still impose yearly $2 million cap on what they spend on your care. Note that insurers may still place a dollar limit on lifetime and annual spending for benefits that are not considered essential health benefits.
Employers with fewer than 25 full-time equivalent employees making $50,000 a year or less may qualify for the Small Business Health Care Tax Credit. The credit is worth up to 50 percent of employer contributions toward employee premium costs—up to 35 percent for tax-exempt employers. Eligible employers must pay at least 50 percent of full-time employees’ premium costs. Learn more at IRS.gov.
By law, most Americans must now have major medical insurance that qualifies as minimum essential coverage. Those who fail to do so may face a tax penalty called the individual shared responsibility payment. This penalty will increase over time. Some individuals may qualify for hardship exemptions—learn more at HealthCare.gov/exemptions.
In 2014, all Americans will be given until March 31, 2014 to obtain coverage without a penalty. However, after that date and in future years only a single coverage gap of less than three months is permitted before a penalty is applied.
Open enrollment for health plans sold on and away from Obamacare exchanges closes on March 31, 2014. After that, coverage may only be obtained through a special enrollment period should certain qualifying life events that include but are not limited to moving to a new state, having a baby, getting married or getting divorced. Medicaid and CHIP may be applied for year-round.
The open-enrollment period for health insurance coverage beginning January 1, 2015, and later is tentatively set for Nov. 15, 2014, through February 15, 2015.
For more information about 2014 and Obamacare, download the free healthedeals.com e-book Your Guide to Obamacare Health Plans.
Questions about health insurance coverage? Not sure if you should buy on or away from the new exchanges? Visit healthedeals.com to look at options and browse our articles, or contact a healthedeals.com health insurance agent at 888-839-7679.