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The Affordable Care Act: What Your Family Can Expect
On March 23, 2010, President Obama signed into law the Affordable Care Act. This legislation will bring about a series of significant changes to our nation’s health care system as well as in California. Some changes are already in place in CA and more will be implemented in California in a gradual process over the next few years.
Two of the most important changes will take effect in 2014
• You will not be declined coverage or cancelled due to a pre-existing health condition.
• You will not be charged higher rates due to gender or health status.
Overview
Below is an overview of a few of the many changes included in the Affordable Care Act designed to give you and your CA family more choices and greater access to health care.
This overview is in three parts: parts one and two review changes for individuals and employers, while part three discusses changes for seniors.
1. In Place Now - 2010
2. Important Changes - 2014
3. Seniors - Medicare and the Affordable Care Act
Note - this overview is solely for informational purposes. For details regarding the Affordable Care Act, please [contact Benefit Studio] or visit www.healthcare.gov.
In Place Now - 2010
Consumer Protections - Coverage limits, rescissions and appeals
• Lifetime dollar limits on health insurance coverage are eliminated. Annual limits will be tightly regulated to ensure access to needed care.
• Insurers will not be able to drop you from coverage due to a mistake on a coverage application - except in cases involving fraud or an intentional misrepresentation of material facts.
• Appeals process will be refined to make it easy to dispute a medical claim denial.
Preventative care
Free preventive health care to help you stay healthy, and avoid or prevent the onset of disease. CA Health plans will now be required to cover certain preventive services without a deductible, co-pay or coinsurance charge. Such services may include mammograms, colonoscopies and other preventive procedures.
Young adults on parent's plan
Young adults in California can continue on their parent’s plan until they turn 26 years of age. This extension may not apply with some group health plans if the child is offered health insurance with his or her employer. Be sure to check with your current insurance provider if you believe you are eligible.
Children with pre-existing conditions
Children with pre-existing health conditions and disabilities will now be able to obtain health coverage. The Affordable Care Act does not allow insurance companies to deny medical insurance coverage to children under the age of 19 due to a pre-existing condition.
Adults with pre-existing conditions - Interim program
Pre-Existing Health Insurance Plan (PCIP), a new temporary health insurance plan will provide new options to those who have been without insurance for at least six months because of a pre-existing condition.
This new program will be operated by the state of California until 2014 when it will no longer be necessary because insurance companies will then be prohibited from refusing to sell coverage or renew policies due to pre-existing health conditions.
CA Employers
Starting in June 2010 health coverage for early retirees (ages 55-64) will be expanded by providing financial help to employer-based health plans to continue to provide coverage to their employees who retire early, as well as their families.
Small group employers - (50 or fewer employees)
Employers with up to 25 employees, who pay average annual wages below $50,000, and provide health insurance, may qualify for a small business tax credit in 2010 of up to 35% (up to 25% for non-profits) to offset the cost of health insurance.
Large group employers - (51+ employees)
Job-based coverage that was in effect on March 23, 2010 is exempted from certain provisions in the Affordable Care Act.
Important Changes - 2014
In addition to the changes that are in place now, there are significant changes that will become effective in 2014 in California.
Individuals and Families
Health insurance companies cannot refuse to cover or charge a higher premium to a person with a pre-existing health conditions (including pregnancy or disability).
Lower income* individuals and families who cannot obtain affordable coverage through their employer may be eligible for tax credits to help pay for insurance.
(*Income equivalent to $43,000 for a single individual or $88,000 for a family of four.)
Small group employers - (50 or fewer employees)
Starting in 2014, the small business tax credit goes up to 50% (up to 35% for non-profits) for qualifying businesses. This makes the cost of providing insurance even lower.
Small group employers are exempt from new employer responsibility policies. They don’t have to pay an assessment if their employees get tax credits through an Exchange.
Large group employers - (51+ employees)
The Affordable Care Act tackles waste, fraud, and abuse and other drivers of health care costs, which will provide employers significant savings in the cost of employee care.
The health law tax credits and the new employer responsibility policies will help level the playing field between different types of employers. More businesses will be able to offer affordable coverage.
CA Seniors - Medicare and the Affordable Care Act
It is important to know that existing guaranteed Medicare-covered benefits will not be reduced or taken away. Also, Medicare subscribers will still be able to choose their own doctor. There are, however, some positive changes that have already been implemented or will be taking effect soon.
Closing the 'donut hole' with a $250 rebate, discounts
In 2010, Medicare Part D subscribers who are paying for drugs in the "donut hole" will receive a one-time tax-free $250 rebate check to help fill the gap in coverage. (Not for those receiving Medicare Extra Help.)
Starting in 2011, to help fill the "donut hole" coverage gap, Medicare Part D subscribers will receive a 50% savings when buying Part D covered brand-name prescription drugs.
Note - between 2010 and 2020, there will be continuous Medicare coverage for prescription drugs.
Preventive care
Starting in 2011, Medicare will cover certain preventive services without charging the Part B coinsurance or deductible. A free annual wellness exam will also be offered.
A stronger Medicare system
Steps will be taken to reduce waste and fraud that will strengthen Medicare and add 12 years to the life of the Medicare Trust fund. This will allow cost savings on Medicare premiums and coinsurance.
For further information regarding Medicare and Prescription Drugs for seniors, please visit www.medicare.gov.
If you have any questions regarding your eligibility for these changes or would like to learn more about the Affordable Care Act, please contact Benefit Studio or your health care provider.
Two of the most important changes will take effect in 2014
• You will not be declined coverage or cancelled due to a pre-existing health condition.
• You will not be charged higher rates due to gender or health status.
Overview
Below is an overview of a few of the many changes included in the Affordable Care Act designed to give you and your CA family more choices and greater access to health care.
This overview is in three parts: parts one and two review changes for individuals and employers, while part three discusses changes for seniors.
1. In Place Now - 2010
2. Important Changes - 2014
3. Seniors - Medicare and the Affordable Care Act
Note - this overview is solely for informational purposes. For details regarding the Affordable Care Act, please [contact Benefit Studio] or visit www.healthcare.gov.
In Place Now - 2010
Consumer Protections - Coverage limits, rescissions and appeals
• Lifetime dollar limits on health insurance coverage are eliminated. Annual limits will be tightly regulated to ensure access to needed care.
• Insurers will not be able to drop you from coverage due to a mistake on a coverage application - except in cases involving fraud or an intentional misrepresentation of material facts.
• Appeals process will be refined to make it easy to dispute a medical claim denial.
Preventative care
Free preventive health care to help you stay healthy, and avoid or prevent the onset of disease. CA Health plans will now be required to cover certain preventive services without a deductible, co-pay or coinsurance charge. Such services may include mammograms, colonoscopies and other preventive procedures.
Young adults on parent's plan
Young adults in California can continue on their parent’s plan until they turn 26 years of age. This extension may not apply with some group health plans if the child is offered health insurance with his or her employer. Be sure to check with your current insurance provider if you believe you are eligible.
Children with pre-existing conditions
Children with pre-existing health conditions and disabilities will now be able to obtain health coverage. The Affordable Care Act does not allow insurance companies to deny medical insurance coverage to children under the age of 19 due to a pre-existing condition.
Adults with pre-existing conditions - Interim program
Pre-Existing Health Insurance Plan (PCIP), a new temporary health insurance plan will provide new options to those who have been without insurance for at least six months because of a pre-existing condition.
This new program will be operated by the state of California until 2014 when it will no longer be necessary because insurance companies will then be prohibited from refusing to sell coverage or renew policies due to pre-existing health conditions.
CA Employers
Starting in June 2010 health coverage for early retirees (ages 55-64) will be expanded by providing financial help to employer-based health plans to continue to provide coverage to their employees who retire early, as well as their families.
Small group employers - (50 or fewer employees)
Employers with up to 25 employees, who pay average annual wages below $50,000, and provide health insurance, may qualify for a small business tax credit in 2010 of up to 35% (up to 25% for non-profits) to offset the cost of health insurance.
Large group employers - (51+ employees)
Job-based coverage that was in effect on March 23, 2010 is exempted from certain provisions in the Affordable Care Act.
Important Changes - 2014
In addition to the changes that are in place now, there are significant changes that will become effective in 2014 in California.
Individuals and Families
Health insurance companies cannot refuse to cover or charge a higher premium to a person with a pre-existing health conditions (including pregnancy or disability).
Lower income* individuals and families who cannot obtain affordable coverage through their employer may be eligible for tax credits to help pay for insurance.
(*Income equivalent to $43,000 for a single individual or $88,000 for a family of four.)
Small group employers - (50 or fewer employees)
Starting in 2014, the small business tax credit goes up to 50% (up to 35% for non-profits) for qualifying businesses. This makes the cost of providing insurance even lower.
Small group employers are exempt from new employer responsibility policies. They don’t have to pay an assessment if their employees get tax credits through an Exchange.
Large group employers - (51+ employees)
The Affordable Care Act tackles waste, fraud, and abuse and other drivers of health care costs, which will provide employers significant savings in the cost of employee care.
The health law tax credits and the new employer responsibility policies will help level the playing field between different types of employers. More businesses will be able to offer affordable coverage.
CA Seniors - Medicare and the Affordable Care Act
It is important to know that existing guaranteed Medicare-covered benefits will not be reduced or taken away. Also, Medicare subscribers will still be able to choose their own doctor. There are, however, some positive changes that have already been implemented or will be taking effect soon.
Closing the 'donut hole' with a $250 rebate, discounts
In 2010, Medicare Part D subscribers who are paying for drugs in the "donut hole" will receive a one-time tax-free $250 rebate check to help fill the gap in coverage. (Not for those receiving Medicare Extra Help.)
Starting in 2011, to help fill the "donut hole" coverage gap, Medicare Part D subscribers will receive a 50% savings when buying Part D covered brand-name prescription drugs.
Note - between 2010 and 2020, there will be continuous Medicare coverage for prescription drugs.
Preventive care
Starting in 2011, Medicare will cover certain preventive services without charging the Part B coinsurance or deductible. A free annual wellness exam will also be offered.
A stronger Medicare system
Steps will be taken to reduce waste and fraud that will strengthen Medicare and add 12 years to the life of the Medicare Trust fund. This will allow cost savings on Medicare premiums and coinsurance.
For further information regarding Medicare and Prescription Drugs for seniors, please visit www.medicare.gov.
If you have any questions regarding your eligibility for these changes or would like to learn more about the Affordable Care Act, please contact Benefit Studio or your health care provider.