- Extending health care coverage to those who do not have it;
- Protecting and maintaining the rights of those with insurance;
- Ensuring a basic set of benefits is available through different coverage options;
- Addressing high health care costs and making health insurance more affordable.
Since the Supreme Court decision on the Affordable Care Act in June 2012, the ACA has received even more attention than before. Michiganders and many across the country are trying to decipher what exactly has changed in their health insurance policy. Most of the changes won’t take place until 2014, but some have already been put into effect.
Currently, there is some uncertainty around national health reform, and more guidance from the state and federal governments is expected in the future. In the meantime, we have put together this overview, highlighting some key upcoming reform milestones, to help you understand the law and how it may affect you.
- There will be an expansion of preventive care benefits to include services for women, such as contraceptive methods and counseling.
- All health insurance companies and group health plans will be required to provide current and prospective members with a Summary of Benefits and Coverage, outlining comparable health benefits and coverage.
- If applicable, an individual member or group member may receive a Medical Loss Ratio (MLR) rebate if their insurance company does not meet an annual threshold.
- Employers must provide new and existing employees with written information about the existence of a health insurance exchange, including a description of services and the potential availability of premium tax credits and cost-sharing reductions if the employer does not offer coverage with at least 60 percent actuarial value.
- Medicare hospital insurance tax on wages will increase 0.9 percent (from 1.45 percent to 2.35 percent) on earnings over $200,000 for individuals and $250,000 for married couples filing jointly.
- Cafeteria plans’ flexible spending arrangement contributions will be capped at $2,500 per year.
- Employers with at least 50 full-time equivalent employees in 2014 will be required to offer minimum essential health coverage to full-time employees or risk paying a penalty.
- Employers with 50 or fewer employees in 2013 may be able to purchase insurance from state-run exchanges for small group employers.
- Income-adjusted premium tax credits may be available for purchase of individual market policies on an exchange by U.S. citizens or legal immigrants with an income between 100 and 400 percent of the federal poverty level, if no other coverage is available.
- Most people will be required to obtain “minimum essential coverage” for themselves and their family. If you do not get health coverage you may face a penalty, but this penalty will not apply to many low-income individuals.
- States will have the option to expand Medicaid coverage, including to parents and single adults, up to138 percent of the Federal Poverty Level.
- Health insurance companies will be required to accept all individual and group applicants regardless of pre-existing conditions and health status.
- Health insurance companies will be limited in what rating factors they can use to determine premiums. Only age, tobacco use, family size and geography can be used.
- Employers may offer incentives to employees of up to 30 percent of the cost of coverage for participating in wellness programs where the reward is conditioned on satisfying a standard related to health status.
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