The Affordable Care Act (ACA), or Obamacare, will see lots of action in 2014, since deadlines for at least nine major health reform compliance categories will be initiated on January 1, 2014, with an unknown number of regulations to clarify them. This column will provide you with an overview of the nine, but to get more information, you can see the sources at the end of this column. Understanding health reform and Obamacare takes time, so refer to previous columns for a review if needed. Most of the following information was taken from the government website, www.healthcare.gov/law/timeline/full.html.
The compliance categories for 2014, primarily involve insurance coverage, so the insurance industry is hard at work to bring policies into line with the implementation guidelines. Consumers will continue to see changes in their premiums and insurance coverage as 2014 approaches. Here are the basic compliance categories with brief explanations.
1. Pre-existing conditions and gender: Insurance companies will be prohibited from refusing to sell coverage or renew policies to people with pre-existing conditions. Higher rates for health status or gender are also prohibited. (example: women of childbearing age will no longer have higher premiums)
2. Annual coverage limits will be eliminated.
3. Coverage will no longer be limited or dropped for participation in clinical trials, regardless of cancer or other life-threatening disease.
4. Middle class tax credits (Phase 2): Tax credits will be available for those ineligible for affordable insurance coverage within specific income guidelines. (For specifics see www.healthcare.gov/law/timeline/full.html.)
5. Insurance exchanges: Insurance policies are available directly from Affordable Insurance Exchanges, if employers do not offer coverage. Exchanges are designed to be competitive marketplaces for policies where individuals and small businesses can buy coverage plans. These exchanges are run by each state unless deadlines were missed in 2012. In that case, the exchanges are run by the federal government.
6. Small business tax credit (Phase 2): Qualified small businesses and small non-profits will be able to get tax credits of up to 50% of the employer’s contribution to provide for employee health insurance coverage. Small non-profits can get up to a 35% credit.
7. Increased access to Medicaid: Americans earning less than 133% of the poverty level will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years of this expanded coverage, and 90% in succeeding years.
8. Individual Mandate: The controversial individual mandate challenge now being considered by the Supreme Court requires individuals who can afford basic health insurance coverage, to buy it or pay a fee to help offset the cost of covering uninsured Americans. Exemptions are offered if affordable coverage is not available.
9. Ensuring Free Choice: Employees meeting certain requirements who cannot afford employer provided coverage, may take whatever funds employers might have contributed to their insurance and use those funds to help buy more affordable coverage in the state health exchange.
These new initiatives are coming soon and consumers will be flooded with information as compliance deadlines approach in 2014. New regulations will be a factor as well. This website will keep you up to date on the latest, so check in often.
Helpful sources for the ACA compliance deadlines: