Information on Health Care Reform
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. Beginning in 2014, individuals and small businesses with 50 or fewer employees will be able to purchase coverage through a website at www.healthcare.gov.
Individuals can apply for a tax credit on the exchange to help them reduce the cost of their monthly premium. Small businesses purchasing on their exchange will may be eligible for tax credits to help them offer coverage to their employees. The website for individuals will be called the Marketplace (sometimes referred to as the exchange). For small employers, they will be able to purchase through the Small-employer Health Options Program (or the S.H.O.P. exchange).
The first open enrollment period is from October 1, 2013 to March 31, 2014. These new plans will be available with effective dates beginning January 1,2014.
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 who do not have health insurance will be required to have a health plan in place by March 31, 2014 to avoid penalties.
The penalty for not having insurance in 2014 is $95 per adult, $47.50 for a child, and up to $185 per family, or one percent (1%) of family income, whichever is greater.
When you file your income tax return for 2014 with the IRS, probably by April 2015.
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 with Avera Health Plans. All individual plans will be transferred to a qualified health plan(a plan that is compliant with the Affordable Care Act) in January, 2014.
You can get individual health insurance today with Avera Health Plans. All individual plans will be transferred to a qualified health plan – a plan that is compliant with the Affordable Care Act – on January 1, 2014.
How to get ready now
- Sign up for email or text updates about the Marketplace. Receive important new information about the Marketplace, and timely reminders about important dates.
- Learn about different types of health coverage. Through the Marketplace, you’ll be able to choose a health plan that gives you the right balance of costs and coverage. You can be better prepared if you understand the types of coverage you’ll choose from. Here are our plans for individuals and small businesses.
- Make a list of questions you have before it’s time to choose your health plan. Call us toll-free at 1-888-322-2115 and we can help you or set-up a time to meet.
- Make sure you understand how coverage works, including things like premiums, deductibles, out-of-pocket maximums, copayments, and coinsurance. Our uniform glossary can help you understand these terms. You’ll want to consider these details while you’re looking for health insurance.
- Gather basic information about your household income. Most people using the Marketplace will qualify for lower costs on monthly premiums or out-of-pocket costs. To find out how much savings you’re eligible for, you’ll need income information, like the kind you get on your W-2, current pay stubs, or your tax return. Use this checklist to get started.
- Set your budget. There will be different types of health plans to meet a variety of needs and budgets. You’ll need to figure out how much you want to spend on premiums each month.
- Ask your employer if they plan to offer health insurance in 2014. If not, you may need to get insurance through the Marketplace or from other sources in 2014. If you don’t have coverage, you may have to pay a fee.
- South Dakota is participating with the federal Marketplace. Visit healthcare.gov to compare your options and enroll in coverage. You may be eligible for federal financial assistance and it is only available applying through the Marketplace.
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 in 2014.
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.
You can also call toll-free 1-855-692-8372 and we will be happy to assist you with your questions. Representatives are available Monday through Friday, 8 a.m. to 8 p.m. CT and 8 a.m. to Noon on Saturdays.
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.