Since President Obama signed the Affordable Care Act into law on March 23, 2010, many changes in our healthcare system have already made a difference for working families. Millions more Americans are counting on the insurance protections and benefits of the law that will roll out over the next four years and beyond, with most changes taking place by 2014.
Already in Effect: 2010
More Affordable Healthcare; Lowering Costs
- No lifetime limits and restricted annual limits on coverage of essential health benefits.
- Parents can receive rebates for the cost of their prescriptions under Medicare.
- Small businesses with 25 or fewer employees are able to deduct up to 35% of their healthcare premium costs from their taxes, making the cost of coverage cheaper.
Greater Access to Care
- Young adults can stay covered under your policy until the age of 26.
- All new plans must cover preventive screenings and immunizations.
- States can receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available.
- New incentives to grow the primary care doctor workforce so you can find a physician when you need one.
- Consumer can access an easy-to-use website (healthcare.gov) to compare health insurance coverage options and pick the coverage that works for them.
- New funding to support the construction of and expansion of services at community health centers.
Holding Insurance Companies Accountable
- Children can’t be denied care because of a pre-existing condition.
- Insurers are not allowed to drop people from health plans because of illness.
- The ability to appeal coverage determinations or claims by your insurance company in all new plans.
Insurance transparency is making your insurance better. Beginning January 2011, all insurance plans have to report how much of your premiums they spend on care and provide you rebates if they spend too much on profits.
- At least 85% of all premium dollars collected by insurance companies for large employer plans must be spent on healthcare services and healthcare quality improvements.
- For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement.
States can receive federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available.
Expanded funding for scholarship and loan repayments for primary care practitioners working in underserved areas participating in the National Health Service Corps.
Cracks down on healthcare fraud to lower overall costs. Requires enhanced screening procedures for healthcare providers to eliminate fraud and waste.
Helps seniors save money by providing a free, annual wellness visit and personalized prevention plan services for Medicare beneficiaries and eliminates cost-sharing for preventive services.
- Seniors will get $250 if their prescription drug expenses reach “the donut hole,” a Medicare Part D coverage gap.
Increases access to home- and community-based services for people living with disabilities so they can choose to live independently at home.
The uninsured have more access to affordable care through community health centers.
- Money will be provided to expand current community health centers and create new ones, increasing the number of new places for free or low-cost care.
Newest Benefits for the ACA: 2012
These new benefits and protections started in 2012
More options for seniors who choose to live at home. January 1, 2012: The Affordable Care Act creates “Independence at Home” demonstration programs to test the effectiveness of physician and nurse practitioner directed home-based primary care for those Medicare beneficiaries with multiple chronic conditions.
Strengthening Medicare and preventing waste, fraud and abuse. January 1, 2012: The Affordable Care Act strengthens prevention tactics against fraud and abuse with screening, oversight, reporting and additional registration for providers and suppliers of services for these programs.
Tracking the facts about healthcare disparities. March 23, 2012: In order to gain a better understanding of how factors such as race, ethnicity, gender, sex, primary language and environment affect our health, the ACA enhances the requirements for reporting in these areas for Americans who receive their care through Medicare, Medicaid and the state Children’s Health Insurance Program.
No-Cost Preventive Services
The ACA makes preventive care affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without co-pays or premium costs. Before the law passed, too many Americans didn’t get the preventive healthcare they need to stay healthy, avoid or delay the onset of disease. The preventive services included in this part of the law include regular pediatrician visits for children; cancer screening such as pap smears, mammograms and colonoscopy for adults; recommended immunizations, flu shots, healthy diet counseling and obesity screening.
August 2012: Additional preventive services specific to women, such as screening for gestational diabetes and contraception, will be covered by new health plans with no co-pays.
Currently existing health insurance policies as of August 1, 2013 and in new health plans starting in August 2012. Religious-affiliated institutions will have one year to comply with the law. Americans who are not able to access reproductive health services through their employer will be able to get this coverage through their insurance company.
Easy-to-Read Coverage Summaries for Consumers
September 23, 2012: Insurance is complicated and often the language used by insurance companies is difficult to understand, incredibly detailed and very lengthy. It is nearly impossible to use this information to compare plans. The ACA requires private individuals and group plans to provide short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. Having access to this information in layman’s language is key to understanding coverage and choosing the plan that is personally best.
Improves preventive healthcare coverage by providing new funding to states that provide preventive services to Medicaid recipients at little or no cost.
Healthcare plans must start using electronic records to reduce administrative costs and streamline.
Strengthen America’s primary care doctor network by requiring states to pay primary care physicians the same rate Medicare pays.
Strong health insurance reforms take effect to protect Americans’ healthcare coverage.
- Health insurance companies can no longer refuse to sell or renew policies based upon an individual’s health status, or deny coverage for treatments based on pre-existing health conditions.
- New restrictions limit insurance companies’ ability to charge higher rates due to health status.
- No more annual limits on the coverage a person can receive for essential health benefits.
You may be eligible for healthcare premium subsidies to reduce the amount you pay for your health insurance through a new insurance exchange if you’re not offered affordable coverage through an employer.
Employers have new responsibilities to provide affordable coverage.
- For example, employers with 50 or more full-time equivalent employees who do not offer coverage to their employees will pay $2,000 annually for each full-time employee toward their healthcare costs if one or more employees receives a premium subsidy through a new insurance exchange.
Creates more affordable health insurance options for Americans by establishing Health Insurance Exchanges (Marketplaces).
- The Marketplace will help individuals and small group purchasers compare plans and provide more affordable coverage by grouping individuals and small businesses into a larger pool.
Promotes individual responsibility. If affordable healthcare options are available, but an individual chooses not to purchase a plan, the law requires most individuals to obtain acceptable health insurance coverage by paying a fee as little as $95 for 2014.
If affordable coverage is not available, this fee is waived.
The small business tax credit is expanded for qualified small employers.
You can generally buy health insurance only during the annual open enrollment period. Upcoming dates to know:
- March 31, 2014: 2014 open enrollment ends
- November 15, 2014: Proposed date for 2015 open enrollment to start
- January 15, 2015: Proposed date for 2015 open enrollment to end
2014 Open Enrollment
Open enrollment for 2014 coverage ends March 31, 2014. If you haven’t enrolled in coverage by then, you generally can’t enroll in 2014 coverage until the next open enrollment period, which begins November 15, 2014.
If you don’t have health coverage in 2014, you may have to pay a penalty. You don’t have to pay the penalty if you enroll in a plan by March 31, 2014.
Enrollment and Coverage Start Dates
During open enrollment, if you enroll:
- between the 1st and 15th days of the month, your coverage starts the first day of the next month.
- between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on February 16, your coverage starts on April 1.
2015 Open Enrollment
The proposed open enrollment period for 2015 coverage is November 15, 2014 to January 15, 2015.
If you haven’t enrolled in coverage by then, you generally can’t buy health coverage for 2015 until the next open enrollment period for coverage the following year.
If you don’t have health coverage during 2015, you may have to pay a penalty.
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time. There is no limited enrollment period for these programs.
Medicaid & CHIP Enrollment
You can apply for Medicaid or Children’s Health Insurance Program (CHIP) coverage directly to your state agency at any time. If you qualify for Medicaid or CHIP, your coverage can begin immediately.
You can also find out if you qualify for Medicaid or CHIP coverage in your state by applying through the Marketplace. If it looks like you’re eligible for either program, we’ll send your information to the state agency. They’ll contact you to finish enrollment.