What Everyone NEEDS to Know About Healthcare Reform


No matter where you stand politically on the Affordable Care Act

(ACA), you need to be prepared. How the law will affect you depends greatly on whether or not you are currently insured and the type of insurance you have. Some aspects of the law, including Medicaid expansion and roll out dates for the Health Insurance Market Places, will vary from state to state.

Overview – This seven-minute video from the Henry J. Kaiser Family Foundation covers the basics of the law. Nearly everyone will see some changes to their health coverage. The AARP offers detailed Health Law Fact Sheets for every demographic.

Employer Provided Insurance– If you already receive insurance at work you will notice several changes to your current plan.

  • Insurance companies will be required to cover prescription drugs, maternity and newborn care, mental health care, preventive care, laboratory services, hospitalization, emergency care and rehabilitation services.
  • Dependent children may now remain on their parent’s policy until age 26.
  • Out-of-pocket fees will be limited under the ACA.
  • Insurance companies will no longer be allowed to set lifetime or yearly dollar limits on the benefits you receive.
  • Your policy cannot be terminated because you are sick.
  • You cannot be denied coverage or charged more for pre-existing conditions.
  • Your paycheck will now show how much your employer contributes to your insurance premium.

Medicare – If you already have Medicare you will retain your coverage. There are some changes and new benefits to the program designed to cut waste and enhance benefits. In addition, the new law extends the Medicare Trust fund until 2029.

  • Doctor, hospital and rehabilitation coverage will be protected from cuts.
  • The prescription drug doughnut hole will close gradually until 2020, when it will be fully eliminated. Medicare Part D recipients will still be responsible for out-of-pocket co-payments and premiums.
  • Some preventative screening tests and wellness checkups will be added at no additional cost.
  • The ACA includes provisions to fight fraud and waste in Medicare to help offset some of the additional costs to the program.

Medicaid – Medicaid is a state and federal partnership designed to provide health coverage to those who are unable to bare the cost.

  • The greatest change to Medicaid will involve new eligibility standards designed to help those who cannot afford insurance receive Medicaid coverage. Previously, adults without dependant children were not eligible for Medicaid; under the ACA that will change.
  • The ACA expands Medicaid to offer coverage to Americans under age 65 with income at or lower than 133 percent of the federal poverty level. This is $15,282 for an individual and $29,726 for a family of four in 2013.
  • A recent Supreme Court decision allowed states to opt out of the expansion. So far only 24 states and the District of Columbia have agreed to the expansion. Click here to learn where your state stands on Medicaid expansion.

Uninsured or Self Insured – If you do not meet the requirements for Medicaid or Medicare and you do not receive insurance from your employer you will be required to purchase insurance or pay a penalty.

  • Many states have set up exchanges where you can purchase insurance. In states where no exchange has been set up, the federal government will do so.
  • Visit www.healthcare.gov to find the insurance health exchange available in your state. Because the website is new and demand is high, expect some delays and glitches to go along with the roll out. There are open phone lines available for assistance.
  • Open enrollment through health care exchanges began on October 1st in some states. The open enrollment period ends on March 31, 2014. Under the ACA, individuals are supposed to have insurance coverage by January 1, 2014. This means people using the exchanges will need to select and enroll in a plan by mid-December to have coverage in place before the deadline.
  • Depending on your income you may be eligible for tax subsidies to help cover the cost of insurance.
  • Insurance plans are rated bronze, silver, gold and platinum. Bronze plans have the lowest monthly premiums, but potentially higher out-of-pocket expenses should you become ill and incur major medical expenses. Platinum plans have much higher monthly premiums, and, in turn, far lower co-pay and deductible amounts.
  • Review plans carefully to determine what best suits the needs of you and your family. Beware: some plans may have extremely limited lists of physicians and hospitals that you may utilize. Review the network available for your policy before you sign up.
  • If you refuse to purchase insurance you may incur a tax penalty. For 2014 the penalty will be $95 per person or 1% of your income whichever is greater. The amount is set to increase each year. By 2016, the penalty will be $695 per person or 2.5% of income.

Many additional aspects of the law are still coming into focus and it is possible some parts of the law will be amended. If you need assistance call your LegalShield provider law firm and speak with an attorney.


Republished from https://sites.legalshield.com/cp/newsletter/issue12_v2.html#Story1


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