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Affordable Care Act2

What Is The Affordable Healthcare Act: Obamacare 101

Obamacare aka the Affordable Healthcare Act rolls out October 1, 2013.  Here’s your crash course on what you need to know:

What Is the Affordable Healthcare Act?

The Patient Protection and Affordable Care Act (PPACA) affectionately known as “Obamacare” and more appropriately as The Affordable Care act is upon us as of October 1, 2013.  Some of the provisions within the new law have been slowly coming into play, however, the most important is the new mandate that everyone purchase individual health insurance.  This doesn’t mean that you drop your current insurance plan, however, if you’re in need of health insurance or cannot afford current insurance premiums, then checking out how the Affordable Health Care exchanges might save you money while fulfilling the individual mandate may be beneficial.

Bottom line: you must purchase a health insurance policy and it doesn’t matter where you do so. 

Key Changes to Health Insurance As We Know It

  • If you have a pre-existing condition, then it is illegal for you to be denied coverage.  This provision started for children in 2010 and will begin for adults in 2014.
  • Insurance companies can no longer drop your coverage if you become sick.
  • Parents may keep their children on their insurance plans through age 26.
  • All preventative care services are free – no co-payments
  • Insurance companies aren’t allowed to raise your premium before getting permission from the government
  • Some families may receive a check from their insurance company.  This is because the new law requires that insurance companies spend at least 80% of premiums on medical services.  Spent on anything else, a rebate check must be sent back to the insured.

Important Preventative Services For Women

Type of Preventive Service HHS Guideline for Health Insurance Coverage Frequency
Well-woman visits. Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception care and many services necessary for prenatal care. This well-woman visit should, where appropriate, include other preventive services listed in this set of guidelines, as well as others referenced in section 2713. Annual, although HHS recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.* (see note)
Screening for gestational diabetes. Screening for gestational diabetes. In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.
Human papillomavirus testing. High-risk human papillomavirus DNA testing in women with normal cytology results. Screening should begin at 30 years of age and should occur no more frequently than every 3 years.
Counseling for sexually transmitted infections. Counseling on sexually transmitted infections for all sexually active women. Annual.
Counseling and screening for human immune-deficiency virus. Counseling and screening for human immune-deficiency virus infection for all sexually active women. Annual.
Contraceptive methods and counseling. ** (see note) All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity. As prescribed.
Breastfeeding support, supplies, and counseling. Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment. In conjunction with each birth.
Screening and counseling for interpersonal and domestic violence. Screening and counseling for interpersonal and domestic violence.

* Refer to guidance issued by the Center for Consumer Information and Insurance Oversight entitled Affordable Care Act Implementation FAQs, Set 12, Q10. In addition, refer to recommendations in the July 2011 IOM report entitled Clinical Preventive Services for Women: Closing the Gaps concerning distinct preventive services that may be obtained during a well-woman preventive services visit.

** The guidelines concerning contraceptive methods and counseling described above do not apply to women who are participants or beneficiaries in group health plans sponsored by religious employers. Effective August 1, 2013, a religious employer is defined as an employer that is organized and operates as a non-profit entity and is referred to in section 6033(a)(3)(A)(i) or (iii) of the Internal Revenue Code. HRSA notes that, as of August 1, 2013, group health plans established or maintained by religious employers (and group health insurance coverage provided in connection with such plans) are exempt from the requirement to cover contraceptive services under section 2713 of the Public Health Service Act, as incorporated into the Employee Retirement Income Security Act and the Internal Revenue Code. HRSA also notes that, as of January 1, 2014, accommodations are available to group health plans established or maintained by certain eligible organizations (and group health insurance coverage provided in connection with such plans), as well as student health insurance coverage arranged by eligible organizations, with respect to the contraceptive coverage requirement. See Federal Register Notice: Coverage of Certain Preventive Services Under the Affordable Care Act (PDF – 327 KB)

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Am I eligible?

It’s important to note that everyone won’t be eligible for health insurance through the new market place.  However, if your income is less than 400% of the federal poverty level then you are eligible.  This means that you can make up to $45,960 as an individual and $94, 200 for a family of 4.  Single women with no children making above $45, 960 will find that they are not eligible for savings through the new health insurance marketplace.

How Do I Sign Up?

Check with your state to see whether or not they opted to set up their own health insurance marketplace.  For example, here in the DC Metro area, MD and DC set up their own exchanges where as Virginia did not and therefore their exchange will be run by the federal government.   Plans will fall into four categories:  bronze, silver, gold and platinum.  Start here.

Important Dates You Must Know

  • October 1 2014: The “Health Insurance Marketplace” opens up and there you can shop for plans offered in your state.
  • December 15 2014:  Payment must be made by December 15, 2013 in order for coverage to begin on January 1, 2014.
  • January 1, 2015: If work for or own a business with 50 or more employees then there will be a tax of $2000 per employee if health insurance isn’t offered.   If they do offer health insurance then that business will get a tax credit equal to 50% of the premium
  • March 15, 2014 -If you submit your payment by this date to avoid the income tax penalty.
  • March 31, 2014: Open enrollment closes.
  • 2015:  If you haven’t signed up for health insurance by this time then the penalty rises to 2% of your adjusted gross income (AGI).  The open enrollment window also shrinks to October 7 2014 – December 31 2014.
    • 1% of AGI in 2014
    • 2% of AGI in 2015
    • 2.5% of AGI in 2016

Penalties:  How Will The Individual Mandate Affect You?

obamacare-penalties

Since there is an individual mandate tied to the Affordable Healthcare Act, everyone must carry health insurance or be subject to the prescribed penalties.  By March 31, 2014, you must purchase a plan (secure health insurance through the marketplace or other means) or pay a tax which starts off at 1% of your adjusted gross income.  As you can see, the penalty per adult is $95 and $47.50 per child or 1% of the family’s income if that happens to be greater.  If you think that’s steep then note that by 2016, the penalties are slated to grow to $695 per adult and $347.50 per child or 2.5% of the family’s income if greater.

Apply here.

 

How do you feel about the new healthcare mandate?  How will the new healthcare law affect your household? 

 

 

 

 

 

 

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