Health Care reform


Image 4Enacted March 23, 2010 the Affordable Care Act reform law has thousands of pages and hundreds of provisions.   Some provisions are already in place.   Others will not take effect until a future date and before they do, additional laws and regulations will be developed.     Some of the major reform provisions and changes that may affect you as an individual or your family are highlighted below.     Please note this is not a complete list of Affordable Care Act reform provisions.

Whether you buy your Individual and/or Family health insurance yourself or get it through your employer, there are impacts to your health insurance coverage as a result of the new Affordable Care Act reforms.   Some provisions have already been implemented such as dependent coverage (important to understand if you have children), preventive care, and pre-existing condition plans.   But the provisions with the greatest impact to individuals came on January 1, 2014 including guaranteed coverage, health insurance Exchanges, rating restrictions, and a personal responsibility requirement for everyone to obtain health insurance or pay a cash penalty.

Please note some of the provisions and changes below may not affect existing plans until they renew for the next plan year.

  • Individual requirements to have health insurance (Individual Mandate)   One of the most significant impact to the individual and/or families of the Affordable Care Act reform is the individual mandate.    Starting on January 1, 2014 everyone must have healthcare coverage or pay a Shared Responsibility Payment (penalty), which will be enforced by the Internal Revenue Service.
  • Pre-existing Condition   Provides  healthcare coverage for individual with pre-existing conditions without the premium being rated up.  This does not apply to Individual and/or Family grandfathered plans.
  • Dependent Coverage to age 26   Children may stay on their parents health insurance policies until age 26, regardless of their martial status.
  • Lifetime and Annual Limits     Individual and/or Family Health Plans may not impose lifetime limits on the dollar value of essential benefits and will be eliminated altogether starting January 1, 2014
  • Preventive Services with No Cost Sharing   New policies must cover the full cost of preventative care including, immunizations, preventive care for infants, children and adolescents and additional preventive care for women.    This does not apply to Individual and/or Family grandfathered plans.
  • Government Health Insurance Exchanges    Creates Insurance Exchanges administered by a government agency or non-profit organize and managed a market place where individuals may purchase health insurance and/or apply for Advance Premium (subsidy) Tax Credits.
  • Guaranteed Availability of Insurance (Guaranteed Issue)   Effective January 1, 2014 insurance companies must accept every individual who applies for coverage.
  • Essential Benefits   All new policies issued after January 1, 2014 will be required to include the following 10 Essential Benefits:   Ambulatory Patient Services; Emergency Services; Maternity and Newborn Care; Pediatric Services, including Dental ad Vision care; Rehabilitative Services and Devices; Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment; Preventive and Wellness Services and Chronic Disease Management; Hospitalization; Prescription Drugs and Laboratory Services.
  • Advance Premium (subsidy) Tax Credit    Tax credits are available to Individuals and/or Families who meet certain income requirements to help them pay their health insurance premium.  If your income changes over the year, your tax credits may be adjusted accordingly.   If your income increases, you will have to pay the difference at tax filing time.   It will be important that you stay on top of any income changes so you have an idea of how much you will owe the IRS at tax time.