Did you know the new healthcare law, called the Affordable Care Act, contains more than ninety provisions that will be enacted through 2018? While you may think that many of these new mandates do not directly impact you, there are several provisions that likely will because they focus on: 1) promoting low cost medical insurance, 2) expanding access to health insurance, especially for those with pre existing conditions, and 3) increasing consumer protections.
The following is a quick summary of the key rules that are not specifically directed at Medicare and Medicaid:
2010 Key New Healthcare Law Provisions - currently in effect
- Pre Existing Conditions Insurance Plan- requires each state to establish a pre existing condition medical insurance plan for individuals that cannot qualify for individual medical health insurance. Since health insurance companies can medically underwrite individuals until 2014, this important program provides access to pre existing conditions insurance to many uninsured persons that would otherwise not qualify for individual medical health insurance.
- Review of health plan premium increases- requires health insurance companies file with the government and post medical plan premium increases in excess of 10%. Designed to promote transparency and accountability among health insurers, this provision is aimed at putting a lid on rising medical insurance premiums.
- No cost preventive care services- all health plans must cover preventive care services, such as immunizations and cancer screening free of charge. This provision is designed to promote the early prevention and treatment of illness and disease.
- Adult dependent medical insurance coverage to age 26- allows dependents to remain covered under their parent’s medical insurance plan, regardless of their financial, student, employment or marital status, to age 26. This rule is aimed at expanding access to medical insurance.
- Guaranteed health insurance for children less than age 19- requires health insurance companies to accept children less than age 19 for medical insurance, regardless of their health status. Health insurers must also cover the child’s pre existing conditions. This rule is geared toward ensuring that children can secure medical insurance and have full coverage for pre existing conditions.
- No annual health insurance policy limits- requires that lifetime policy limits be removed from individual medical health insurance and group health plans.
- Health insurance claims appeal and recsission process- restricts a health insurer’s ability to rescind or reform (modify) a medical insurance policy except in cases of fraud.
- Tax on indoor tanning services- imposes an excise tax of 10% on the amount paid for indoor tanning services. Along with an extensive list of other taxes to pay for the new healthcare law, this provision is designed to raise revenue to cover the expenses associated with healthcare reform.
2011 Key New Healthcare Law Provisions - currently in effect
- Minimum medical insurance loss ratios for health insurers- requires health plans to report the amount of health plan premium dollars spent on clinical services, quality, and other healthcare costs and provide rebates to consumers if the share of the health plan premium spent on clinical services and quality is less than 85% for plans in the large group market and 80% for plans in the individual medical health insurance and small group markets.
- Funding for health insurance exchanges- gives grants to states to begin planning for the creation of American Health Benefit Exchanges and Small Business Health Options Program Exchanges, which facilitate the purchase of medical insurance by individuals, families and the self employed and small employers.
- Changes to tax free Health Saving Accounts- excludes the costs for over-the-counter drugs not prescribed by a doctor from being reimbursed through a Health Savings Account. Also, increases the tax on distributions to 20% from a Health Savings Account when monies are not used to pay for qualified medical out-of-pocket healthcare expenses.
2012 Key New Healthcare Law Provisions
- Annual fees on the pharmaceutical industry- imposes new annual fees on the pharmaceutical industry
2013 Key New Healthcare Law Provisions
- Tax on medical devices- imposes an excise tax of 2.3% on the sale of any taxable medical device.
- State notification to federal government regarding health insurance exchanges- states are required to communicate to the Secretary of the Department of Health and Human Services if they intend to operate a health insurance exchange that meets the federal government’s requirements.
2014 Key New Healthcare Law Provisions
- Implementation of health insurance exchanges- creates state based exchanges through which individuals, families and the self employed, and small business with up to 100 employees can purchase qualified coverage. Enrollment in the health insurance exchanges begins on January 1, 2014.
- No annual health insurance policy limits- requires that medical insurance plans remove any annual policy limit or benefit cap, thereby providing unlimited benefits to covered individuals.
- Essential health benefits- creates a core set of benefits considered “essential” by the federal government, including coverage for maternity, that health plans must provide.
- Individual mandate- requires that individuals purchase a medical plan or pay an IRS fine. This is designed to work in conjunction with the guaranteed medical insurance rule which forces health insurance companies to accept all applicants for medical insurance, regardless of their health status. By requiring Americans to buy medical insurance, more individuals will have health insurance and the cost of providing healthcare to unhealthy individuals will be spread across a greater number of individuals.
- Guaranteed medical insurance- prohibits health insurance companies from denying individuals with pre existing conditions access to medical insurance, and also requires health insurers to cover pre existing conditions and limits the amount maximum health plan premium that can be charged.
- Basic Health Plan- gives states the option to create a Basic Health Plan for uninsured individuals with incomes of 133% to 200% of the federal poverty level who would otherwise be eligible to receive a health plan premium subsidy through the health insurance exchange.
- Health insurance premium and cost sharing subsidies- provides government assistance in the form of a subsidy to eligible persons based on their income. It is designed to promote low cost medical insurance, as individuals apply the subsidy toward the cost of purchasing medical insurance on the health insurance exchange.
- Employer medical insurance plan requirements- assesses financial penalties on employers with 50 or more employees that either do not provide health insurance or existing health plan does not meet the federal government’s definition of affordable or low cost medical insurance.
2018 Key New Healthcare Law Provisions
- Tax on high cost medical insurance- mandates an excise tax on health insurers of employer-sponsored medical plans with health plan premiums or expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.
For more information on the new healthcare law news, how to secure low cost medical insurance regardless of your health status and your health insurance choices, such as HIPAA Portability and COBRA Continuation, visit healthinsuranceadvisory.org or call us today at 800-403-8511.