ACA's Common Categories
Are you still wondering how health care reform will affect you and your family? The Affordable Care Act's (ACA) many pieces appear to be in near constant transition and it's difficult to know what's happening and when it's effective.
Below is a snapshot of some of the more common categories of the ACA and where they stand today.
Elderly and Medicare The elderly now receive free preventive services under Medicare, annual wellness visits and personalized prevention plan services. Once those with Medicare prescription drug coverage enter the “donut hole” coverage gap, they will be entitled to 50 percent off certain brand-name medications. Medicare beneficiaries earning $85,000 or more will pay higher Part B premiums until 2019. Those with Medicare Advantage plans may lose some benefits or experience an increase in copayments.
Employees of a Large Company Employers with 50 or more full-time equivalent employees will be required to provide coverage or pay a penalty starting in 2015. Existing coverage packages will be grandfathered in, but new plans have to meet minimum requirements. Caps on out-of-pocket spending are intended to keep costs down.
Low-income Employees Even without children or a disability, those among the lowest-income workers will be eligible for Medicaid as of 2014. Those who earn less than 400 percent of the federal poverty level (about $88,000 for a family of four) will be eligible for subsidies to help buy coverage. The expansion of funding for community health centers, designed to offer free and reduced-cost care, will also provide relief.
Children with a Pre-existing Condition Group health plans and health insurance issuers may not impose exclusions on coverage for children with a pre-existing condition. Provision applies to all employer plans and new plans in the individual market.
Adults with a Pre-existing Condition Starting in 2014, adults with pre-existing conditions will be able to obtain individual coverage through an insurance exchange and pay the same rate as other participants in same age group. Insurers cannot place annual or lifetime limits on coverage, nor can they deny coverage or charge higher premiums due to a pre-existing condition.
Unemployed and Uninsured Most individuals who are unemployed and uninsured likely qualify for Medicaid under the coverage expansion that began in 2010. The expansion of funding for community health centers, designed to offer free and reduced-cost care, will also provide relief. Certain uninsured individuals with pre-existing conditions can obtain coverage through the temporary high-risk pool as well.
Small Business Owners Organizations with 25 or fewer workers may be eligible for a tax credit to help provide coverage for employees. Those with 50 or more employees must provide benefits or incur a penalty starting in 2015. Small business owners will be able to buy insurance for employees through insurance marketplaces by 2017.
Young Adults Children may stay on their parents’ policies until age 26. Those who buy coverage on their own or through the exchanges can obtain cheaper catastrophic coverage. Individuals who obtain traditional benefits packages will pay less than those who are older than age 26. Starting 2014, individuals age 26 or younger must obtain coverage unless qualified for an exemption.