Health Care Reform Updates
Information shared is a result of the Patient Protection and Affordable Care Act (PPACA) which was signed by President Obama on March 23, 2010. PPACA, and the interim and final rules issued since PPACA’s enactment date, will affect the health plans of our members in their plan years beginning on or after Sept. 23, 2010.
To learn more about the Healthcare Reform Bill, visit http://www.healthcare.gov.
Health Care Form: What does it mean for you?
To help you understand the upcoming health care reform opportunities:
Implemented to assist Americans to have access to affordable health care coverage. In 2014, individuals can shop for health insurance coverage through a website at www.healthcare.gov.
This is the only place individuals can apply for a tax credit on the exchange to help them reduce the cost of their monthly premium. The website for individuals will be called the Health Insurance Marketplace or sometimes referred to as the exchange.
Yes, if you meet specific criteria such as being lawfully present in the United States you can purchase insurance on the Marketplace. Only those eligible will be able to apply for the tax credit.
Individuals are required to have a health plan during open enrollment each year to avoid penalties. Open enrollment has expired for 2014 coverage. Next open enrollment will begin November 15 for 2015 coverage. If you do not have health insurance, you may apply if you have a qualifying life event. Learn More >>
The penalty for not having insurance in 2014 is $95 per adult, $47.50 for a child, and up to $285 per family, or 1% of your family income, whichever is greater. For 2015, it will be 2% of your family income.
When you file your income tax return with the IRS.
Yes, if the employee has access to employer-sponsored insurance and decides not to take it, he/she may still enroll in coverage through the individual exchange, but is not eligible for a tax credit unless the employer-sponsored coverage is unaffordable.
You can get individual health insurance today if you have a qualifying life event with Avera Health Plans or healthcare.gov. Learn More >>
2. Most people can get a break on costs. You may qualify for a tax credit and therefore, get lower costs on your monthly premiums and out-of-pocket costs.
3. Gives you control. The Marketplace will provide comparisons of prices and benefits before you enroll. You can take your time to look, learn and research before you decide which plan to provide coverage for you and your family.
Each metal tier is defined by the portion of the claims paid by your plan. For instance, for the Bronze tier, the plan typically pays 60 percent of the cost and you are responsible for the remaining 40 percent through out-of-pocket costs such as co-pays, coinsurance and deductibles.
The graph below shows the value of the metallic tiers:
If you choose a bronze plan, you will pay more when you receive health care but your monthly premiums will be less. If you purchase a gold or platinum, you will pay less when you go to receive services however your monthly premium will be more.
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services
While essential health benefits are minimum requirements for all plans in the Marketplace, our plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
NOTE: Only non-grandfathered plans that are purchased on your own or obtained through a small employer groups with 1 to 50 employees will be required to cover essential health benefits.
Health Insurance Can Be Confusing
Below is a video to help explain some of the most common terms.
Grandfathered Plan: Employers (and individuals) could choose to keep their current health plan “grandfathered” by not changing their health insurance plan. Therefore, it is excused from having to comply with certain rules of the Affordable Care Act. This allows the plan to generally stay as it was before March 23, 2010.
Non-grandfathered Plan: An individual or employer group loses it grandfathered status if the health insurance plan benefits or cost structure is changed.
NOTE: If you are insured under an employer-sponsored self-funded plan, some of these reform updates may not apply. Please contact your company’s Human Resources.