Pretty much everyone with health insurance has benefited in some way from the health reform law, whether they know it or not. For example, lifetime coverage limits are now a thing of the past and there?s more guaranteed access to preventive medical care now than there was a few years ago.
That said, not everyone is benefiting equally or in the most direct way right now. The most far-reaching consumer provisions of the law don?t actually come into effect until January 2014.
At Get Smart ? Get Covered, we don?t have a political position on Obamacare. The law is what it is, and our role is to explain it to consumers. In that vein, here?s a summary of the health reform law, what?s in effect now and what?s still on its way in 2014
Provisions of the ACA Currently in Effect:
Tax Breaks for Small Business ? Though not subject to the ?employer mandate? (see above), businesses with fewer than fifty full-time workers may qualify for special tax incentives when they choose to purchase group health insurance for workers. These tax incentives are in place now, and they?re scheduled to be expanded in 2014.
Medical Loss Ratio ? This provision of the ACA went into effect in 2011 and requires insurance companies to spend 80-85% of member premiums directly on member medical expenses. The insurance company?s costs and profits are limited to the remaining 15-20% of premium income. Insurance plans that do not meet these medical loss ratio (MLR) criteria are required to issue rebates to policyholders.
Children?s Coverage ? An early provision of the ACA prevents health insurance companies from declining coverage for children (age 18 and under) due solely to the presence of pre-existing medical conditions. This provision of the law has been in effect since September 2010. As an unintended consequence of the rule, insurance companies in some states stopped offering so-called ?child-only? plans ? that is, policies without a parent or guardian listed on the same application. Some states have tried to fill in the gap by requiring insurers to offer child-only coverage during special enrollment periods.
Young Adult Coverage ? A popular 2010 provision of the ACA allows young adults to retain coverage under a parent?s health insurance policy until age 26, even when the adult child is no longer in school or claimed as a dependent on the parent?s tax return.
Preventive Medical Care ? A September 2010 provision of the ACA mandated better coverage for specified preventive medical services and screenings. These benefits were made available on most new and existing individually-purchased or employer-sponsored health insurance plans with no out-of-pocket cost to the member seeking medical care.
Lifetime Coverage Caps ? The ACA did away with lifetime coverage limits for most medical services on most health insurance plans. This provision of the law went into effect in 2010. Prior to this, it was common for a person?s lifetime coverage under a health insurance policy to max out at between $1-6 million.
Pre-existing Condition Insurance Plans ? As a sort of stop-gap prior to 2014, the ACA provides additional funding for state high-risk pools and ?pre-existing condition insurance plans,? or PCIPs.? These are subsidized health insurance plans for people with complicated medical histories that prevent them from qualifying for individually-purchased health insurance on their own. Funding for these plans is scheduled to sunset in 2014 when the ?guaranteed issue? provision of the law will require all health insurance plans to accept applicants regardless of pre-existing medical conditions.
Provisions of the ACA Not in Effect Until 2014:
Individual Mandate ? The ?individual mandate? is the provision of the ACA requiring most consumers to purchase health insurance ? if they don?t get coverage through an employer ? or pay a tax penalty. It is scheduled to come into effect in 2014. In the language of the ACA, the individual mandate is considered necessary to make coverage for pre-existing conditions affordable, by bringing more healthy people into the insurance system and thereby balancing costs. The individual mandate is one of the most controversial provisions of the law and was one of the primary targets of the prosecution in the case before the Supreme Court.
Pre-existing Condition Coverage ? This, the so-called ?guaranteed issue? provision of the law, is scheduled to go into effect in 2014, and will require health insurance companies to extend coverage to all applicants regardless of their medical history or the presence of pre-existing medical conditions. While a handful of states have guaranteed issue laws already, it?s currently possible in most states to be declined for individually-purchased health insurance based on pre-existing medical conditions.
Employer Mandate ? This provision of the ACA requires employers with fifty or more full-time workers (or the equivalent in part-time workers) to provide employer-sponsored health insurance to employees. Like the individual mandate, this provision of the law is not scheduled to go into effect until 2014. Employers who fall under the employer mandate in 2014 but who choose not to provide health insurance to workers may face financial penalties.
Subsidies ? The ACA establishes subsidies to help individuals and families earning up to 400% of the federal poverty level purchase health insurance on their own, unless they qualify for government coverage programs like Medicaid, Medicare, CHIP, etc. The amount of subsidy assistance received by consumers will vary and is structured so that the insurance premium an individual or family will have to pay will not exceed a specific percentage of income, ranging from 2% for those with incomes up to 133% of the poverty level to 9.5% for those with incomes between 300 and 400% of the poverty level. The subsidies are scheduled to go into effect in 2014, at the same time as the individual mandate.
Online Health Insurance Exchanges ? The ACA calls for the establishment of online state health insurance exchanges by 2014, websites where individual consumers and small businesses can shop for and compare health insurance plans available in their state. State-sponsored health insurance exchanges would facilitate online enrollment in health insurance plans and enable eligible persons to have federal subsidies applied toward their premiums. Private, commercial versions of health insurance exchanges with online enrollment capabilities exist today and will continue to serve consumers in the post-2014 market too.
Source: http://blog.ehealthinsurance.com/2012/10/are-you-benefiting-from-health-reform-today/
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