Individual Medical Health Insurance Changes Effective 2014 « Health Insurance Advisory

Welcome to the New Healthcare Law Center and State News

new healthcare reform lawThe new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), represents comprehensive healthcare reform legislation signed into law on March 23, 2010. It contains numerous provisions designed to protect consumers and promote low cost medical insurance, including many new taxes to pay for the cost.

In this section of the site, you can also obtain the following information specific to your state: available medical insurance options, efforts to regulate medical insurance premiums, healthcare, the individual medical insurance marketplace and the new healthcare law.

Our objective is to help Americans make sense of the new healthcare law by explaining key provisions in plain English and assisting individuals, families and the self-employed in using this information to find and secure affordable medical insurance.

Individual Medical Health Insurance Changes Effective 2014

The core pieces of the new healthcare law are scheduled to take effect in 2014 which will significantly impact individual medical health insurance.

“American Health Benefit Exchanges” will be operational. These will enable individuals, families, the self employed and small businesses with up to 100 employees to shop, compare and enroll in qualified medical insurance. Additionally, medical insurance premium tax credits and cost-sharing subsidies for eligible individuals will also be available exclusively through the health insurance exchanges.

The Congressional Budget Office (CBO) estimates in 2019 that 35 million individuals will be enrolled in non-employer sponsored health insurance, of which 24 million will be through a health insurance exchange, with roughly 20 million receiving medical insurance premium credits.

The highly controversial “individual mandate” also becomes effective in 2014. This provision of the new healthcare law, called the Affordable Care Act, requires persons purchase approved medical insurance coverage or pay a penalty, unless: 1) not covered by Medicare, Medicaid, or other public insurance program, 2)  member of an organized religious sect, 3) exempt by the IRS, or 4) waived due to financial hardship.

Other individual medical health insurance and small employer group market reforms in 2014

  • Restricting annual medical insurance policy limits for covered expenses considered “essential”
  • Modified community rating rules apply (this requires health insurers to charge the same insurance premium within a given territory to all persons without regard to health status.  Limited rate adjustments are permissible based on demographic characteristics, such as age and gender)
  • Medical insurance coverage must be offered on a guaranteed issue and guaranteed renewal basis (persons with pre existing conditions cannot be denied coverage)
  • Employer sponsored (group) coverage cannot have waiting periods greater than 90 days
  • Qualified individuals may not be denied participation in clinical trials
  • Medical insurance plans must cover benefits considered “essential,” such as maternity
  • Medicaid eligibility to include all individuals and families with incomes up to 133% of the poverty level. Low income persons and families above the Medicaid level and up to 400% of the poverty level will receive federal subsidies on a sliding scale if they choose to purchase individual medical health insurance through an exchange

Rules already implemented for individual medical health insurance and employer group plans

  • Creation of the Pre Existing Conditions Insurance Plan for uninsured individuals that cannot qualify for individual medical health insurance until the guarantee issue market reform becomes effective in 2014
  • Prohibiting lifetime medical insurance policy limits for covered expenses considered “essential”
  • Prohibiting recission or reformation of medical insurance coverage except in cases of fraud or intentional misrepresentation of material fact
  • Requiring medical insurance plans to cover preventive care screening services and immunizations without cost sharing
  • Providing medical insurance coverage to children under age 19, regardless of health status
  • Allowing dependents to remain covered under their parent’s medical insurance plan up to age 26
  • Capping health insurance company non-medical, administrative expenditures and profit to no more than 20% of premium revenue (Medical Loss Ratio)
  • Ensuring that consumers have access to an effective claims appeals process
  • Requiring health plans to make it easier for healthcare providers to have insurance claims filed, processed and paid
  • Filing and posting of unreasonable (defined as 10% or more) health plan premium increases

Since twenty states and numerous organizations have challenged the constitutionality of the “individual mandate” and the Affordable Care Act, the fate of all or part of the new healthcare law will likely be decided by the Supreme Court. The Supreme Court has accepted the case and oral arguments will begin on March 26, 2012 with a ruling expected by the end of June 2012.

Our goal at is to help consumers find and secure low cost medical insurance, regardless of  health status. We will work with you to identify your health insurance choices, including the new government Pre Existing Conditions Insurance Plan.

We can also help you save money on an individual dental insurance plan too. Call us today at 800-403-8511.

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