Affordable Health Care Act: What’s Changing
States may offer their own options. In the 36 states where the federal government has primary responsibility for the Marketplace, also known as exchanges, consumers will be able to choose from an average of 53 health plans. In most states, health plans will be offered by two or more insurance companies — a high of 13 companies in Wisconsin, but just one apiece in New Hampshire and West Virginia.
If you need coverage, you can use the Marketplace. If you have coverage, you gain new protections. If you don’t have coverage, you may have to pay a fee. Open enrollment for Marketplace plans begins October 1, 2013. Coverage begins as early as January 1, 2014.
Whether you’re uninsured, you’ve been denied coverage in the past, or you just want to explore new options, the Health Insurance Marketplace will give you more choice and control over your health coverage. The Marketplace will operate in all states, so no matter where you live, you’ll have access to coverage.
In the Marketplace, you can compare coverage options based on price, benefits, quality, and other features important to you. You can choose the combination of price and benefits that fits your budget and meets your needs.
- You can get lower costs on coverage: The Marketplace application will tell you if you’re eligible for a new way to get lower costs on your monthly premiums or out-of-pocket costs for private insurance. You’ll also learn if you can get free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
- Essential health benefits are covered in the Marketplace: All plans must offer a comprehensive set of essential health benefits including doctor visits, preventive care, hospitalization, prescriptions, and more.
- Pre-existing conditions will be covered: Plans won’t be able to deny you coverage or charge you more due to pre-existing health conditions, including a pregnancy or disability.
- You can get help in your area: If you need help finding a plan, several kinds of help will be available to give you personalized assistance with the process.
Beginning 2014, most people are required to have health coverage. If they don’t, they may have to pay a fee. People with very low incomes and others may be eligible for waivers.
Starting January 1, 2014, if someone who can afford health insurance doesn’t have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee from:
- 1% of income (or $95 per adult, whichever is higher) in 2014 to;
- 2.5% of income (or $695 per adult) in 2016.
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They also have to pay for all of their health care.
The fee for children is half the adult amount. The fee is paid on the 2014 federal income tax form, which is completed in 2015.
To avoid the fee in 2014 you need insurance that qualifies as minimum essential coverage. If you're covered by any of the following in 2014, you're considered covered and don't have to pay a penalty:
- Any Marketplace plan, or any individual insurance plan you already have
- Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
- The Children's Health Insurance Program (CHIP)
- TRICARE (for current service members and military retirees, their families, and survivors)
- Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
- Peace Corps Volunteer plans
Medicare isn’t part of the Health Insurance Marketplace, so you don’t need to do anything. If you have Medicare, you are considered covered.
The Marketplace won’t affect your Medicare choices, and your benefits won’t be changing. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now. You won’t have to make any changes.
Note: The Marketplace does not offer Medicare supplement (Medigap) insurance or Part D drug plans.
In certain states, the Marketplace doesn't provide the final decision on Medicaid eligibility. Instead, the Marketplace conducts an assessment and passes the application to the State Medicaid agency to conduct a final eligibility determination. Check with your state for information on health care coverage.
The Affordable Care Act is a set of health insurance reforms that started in 2010 and will continue to roll out in 2014 and beyond. There are important changes in the law from 2010 through 2015.
- March 23, 2010: President Obama signs the Affordable Care Act
- Coverage for children with pre-existing conditions
- Coverage for young adults under 26
- No more lifetime limits on coverage
- No more arbitrary cancelations or rescissions
- Right to appeal health plan decisions
- Consumer Assistance Program
- Small business tax credit
- Temporary coverage for people with pre-existing conditions
- Community Health Centers
- Prescription drug discounts for seniors
- Free Medicare preventive services for seniors
- The 80/20 Rule (Medical Loss Ratio)
- Rate Review
- New preventive services for women
- You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage.
- October 1: Open enrollment in the Health Insurance Marketplace begins
2014 is an important year. The Health Insurance Marketplace will offer a new way for people without insurance to get coverage and to find out if they can get lower costs for private insurance. They can also find out if they qualify for Medicaid or the Children’s Health Insurance Program (CHIP).
- People who do not have health coverage may have to pay a fee.
- January 1: Coverage begins in the Health Insurance Marketplace
- Coverage for pre-existing conditions
- Savings on monthly premiums and out-of-pocket costs
- Medicaid expansion
- No more yearly limits on coverage
- Expanded small business tax credit
- March 31: Open enrollment closes
Employer Shared Responsibility Payment