What Everyone NEEDS to Know About Healthcare Reform Reposted from LegalShield
No matter where you stand politically on the Affordable Care Act
(ACA), you need to be prepared. How the law will affect you
depends greatly on whether or not you are currently insured and the
type of insurance you have. Some aspects of the law, including
Medicaid expansion and roll out dates for the Health Insurance
Market Places, will vary from state to state.
• Employer Provided Insurance – If you already receive insurance at work you will notice
several changes to your current plan.
o Insurance companies will be required to cover prescription drugs, maternity and
newborn care, mental health care, preventative care, laboratory services,
hospitalization, emergency care and rehabilitation services.
o Dependent children may now remain on their parent’s policy until age 26.
o Out-of-pocket fees will be limited under the ACA.
o Insurance companies will no longer be allowed to set lifetime or yearly dollar limits
on the benefits you receive.
o Your policy cannot be terminated because you are sick.
o You cannot be denied coverage or charged more for pre-existing conditions.
o Your paycheck will now show how much your employer contributes to your
• Medicare – If you already have Medicare you will retain your coverage. There are some
changes and new benefits to the program designed to cut waste and enhance benefits. In
addition, the new law extends the Medicare Trust fund until 2029.
o Doctor, hospital and rehabilitation coverage will be protected from cuts.
o The prescription drug doughnut hole will close gradually until 2020, when it will be
fully eliminated. Medicare Part D recipients will still be responsible for out-of-pocket
co-payments and premiums.
o Some preventative screening tests and wellness checkups will be added at no
o The ACA includes provisions to fight fraud and waste in Medicare to help offset
some of the additional costs of the program.
• Medicaid – Medicaid is a state and federal partnership designed to provide health coverage
to those who are unable to bear the cost.
o The greatest change to Medicaid will involve new eligibility standards designed to
help those who cannot afford insurance receive Medicaid coverage. Previously, adults
without dependent children were not eligible for Medicaid; under the ACA that will
o The ACA expands Medicaid to offer coverage to Americans under age 65 with
income at or lower than 133 percent of the federal poverty level. This is $15,282 for
an individual and $29,726 for a family of four in 2013.
o A recent Supreme Court decision allowed states to opt out of the expansion. So far
only 24 states and the District of Columbia have agreed to the expansion.
Uninsured or Self Insured – If you do not meet the requirements for Medicaid or Medicare
and you do not receive insurance from your employer you will be required to purchase
insurance or pay a penalty.
o Many states have set up exchanges where you can purchase insurance. In states where
no exchange has been set up, the federal government will do so.
o Visit www.healthcare.gov to find the insurance health exchange available in your
state. Because the website is new and demand is high, expect some delays and
glitches to go along with the roll out. There are open phone lines available for
o Open enrollment through health care exchanges began on October 1st in some states.
The open enrollment period ends on March 31, 2014. Under the ACA, individuals are
supposed to have insurance coverage by January 1, 2014. This means people using
the exchanges will need to select and enroll in a plan by mid-December to have
coverage in place before the deadline.
o Depending on your income you may be eligible for tax subsidies to help cover the
cost of insurance.
o Insurance plans are rated bronze, silver, gold and platinum. Bronze plans have the
lowest monthly premiums, but potentially higher out-of-pocket expenses should you
become ill and incur major medical expenses. Platinum plans have much higher
monthly premiums, and, in turn, far lower co-pay and deductible amounts.
o Review plans carefully to determine what best suits the needs of you and your family.
Beware: some plans may have extremely limited lists of physicians and hospitals that
you may utilize. Review the network available for your policy before you sign up.
o If you refuse to purchase insurance you may incur a tax penalty. For 2014 the penalty
will be $95 per person or 1% of your income whichever is greater. The amount is
set to increase each year. By 2016, the penalty will be $695 per person or 2.5% of