Are you wondering what the different parts of the ACA really mean? Straight from Blue Shield, here are the top 10 key issues you should know about.
1. Guaranteed Issue – No one will be denied healthcare due to health, age, gender, or other issues including pre-existing conditions.
2. The Individual Mandate – All individuals will be required to have coverage that qualifies as the minimum essential by January 2014, or risk paying a tax penalty.
3. Grandfathered Plans – People who have healthcare plans that were in effect prior to March 23, 2010, can keep their plans if they want. The only caveat is they are not subject to the ACA’s requirements.
4. New Marketplaces – Marketplaces (Exchanges) have been created as a place for people to explore and compare different health plans. You can access this marketplace directly through brokers and individual carriers just as before.
5. Open Enrollment – This Open Enrollment period began on October 1, 2013 and ends March 31, 2014.
6. Essential Health Benefits – All non-grandfathered plans for individuals and small businesses will include the following 10 categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioural health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including or and vision care
7. Metal Level Plans – All non-grandfathered health plans offered to individuals and small businesses will be required to provide coverage at a “metal level”—Platinum (90%), Gold (80%), Silver (70%), and Bronze (60%)—based on the actuarial value (E.g. With a gold plan, the Insured pays 20% of health care costs, while the plan covers 80%).
8. Federal Subsidies – Subsidies will be available starting 2014 for those whose annual income is between 134% and 400% of the Federal Poverty Level (FPL) and who meet the guidelines. Subsidies will help lower the costs of both premiums and out-of-pocket costs. Those who fall less than 134% below the poverty level may be eligible for Medi-Cal. Tax credits will also continue to be available to small businesses with 25 or less full-time equivalent employees to help cover the costs of providing coverage.
9. ACA Taxes – Taxes covering the ACA will start January 1, 2014. Click here for a downloadable copy of the ACA tax fact sheet
10. Play-or-Pay – As of January 1, 2014, the ACA requires companies over a certain size to offer affordable health coverage to full-time employees and their dependents or face paying a penalty if an employee receives federally-subsidized coverage through the Exchange.