Affordable Care Act Information
In 2010, the United States Congress passed, and the President signed, the new health care law. While the proper title of the legislation is the Patient Protection and Affordable Care Act or PPACA, it is now more commonly referred to as the Affordable Care Act or ACA.
AFFORDABLE CARE ACT - WHAT YOU CAN EXPECT NOW
Many provisions of the Affordable Care Act (ACA) do not take effect until 2014. However, the following is a list of changes that apply to most health coverage starting on or after September 23, 2010.
No-Cost Preventive Care:
New health plans must eliminate any cost-sharing for certain preventive services. Health carriers cannot charge a deductible, copay, or coinsurance for preventive care measures such as flu shots and other immunizations, mammograms and other cancer screenings, diabetes screenings and more.
Ban on Health Policy Rescissions:
Health carriers are prohibited from rescinding or retroactively canceling your health coverage unless you committed fraud or made an intentional misrepresentation of an important fact on your application.
No Lifetime Limits on Your Health Care Costs:
For new plans, health carriers will be prohibited from setting lifetime limits on significant benefits, such as hospitalization and emergency services. The ACA also restricts and phases out the annual dollar limits a health plan can place on most of your benefits - and does away with these limits entirely in 2014.
Extended Coverage for Young Adults:
Most health carriers and employers providing dependent coverage to children are required to make coverage available to adult children up to age 26. This applies to adult children who do not have access to coverage from their own job and regardless of whether or not they are students, financially dependent on their parents, live with their parents or are married.
No Denial for Children with an Illness or Chronic Condition:
Health carriers are prohibited from denying coverage for children under the age of 19 because of a medical condition. Health carriers will also be prohibited from excluding coverage for the pre-existing conditions of children.
Medicare Prescription Drug Discounts:
Seniors who are in the Medicare prescription drug coverage gap known as the “donut hole” will receive discounts on covered prescription drugs.
Help for Small Business:
Some small businesses with fewer than 25 full time-equivalent employees with certain average wages or lower, may qualify for a small business tax credit for a limited number of years to help offset the costs of providing health insurance for employees. Small business owners can learn more from the Internal Revenue Service.
AFFORDABLE CARE ACT - WHAT YOU CAN EXPECT IN 2014
New Health Coverage Exchange called the Health Insurance Marketplace:
In 2014 if your employer doesn’t offer health coverage, you will be able to shop for coverage directly in the Health Insurance Marketplace -- a new transparent and competitive marketplace where individuals and small businesses can shop for and compare affordable and qualified health benefit plans. The Health Insurance Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. For more information, visit: http://marketplace.cms.gov/.
Starting in 2014, Michigan residents who earn less than 133 percent of the poverty level (currently, approximately $14,856 for an individual and $30,657 for a family of four) may be eligible to enroll in Medicaid. Income may be the only determining factor for eligibility.
Financial Help to Purchase Health Care Coverage:
In 2014, tax credits to help the middle class afford health coverage will become available for those with income between 100 percent and 400 percent of the poverty line who are not eligible for other affordable coverage. (In 2012, 400 percent of the poverty line was about $44,000 for an individual or $92,000 for a family of four.)
Health Coverage Requirement:
Beginning in 2014, most individuals who can afford it will be required to obtain basic health coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption.
OTHER HELPFUL RESOURCES
For more information on the Affordable Care Act, visit: www.healthcare.gov.
To view the Health Insurance Consumer Assistance Program (HICAP) brochure on the new health care law, choose your preferred language: English - Spanish - Arabic - Chinese - Hindi
Disclaimer - The information provided is only intended to be general summary information to the public. It is not intended to take the place of either the written law or regulations. If you have questions about whether a provision applies to your plan, contact your health carrier, plan administrator, employer or the Department of Insurance and Financial Services ? HICAP (OFIR-HICAP@michigan.gov).