Everyone is talking about the new health care reform laws. When do they go into effect?
The Affordable Care Act (ACA) was signed into law in March 2010. The ACA changes will roll out over a period of years. Some laws, such as prohibiting exclusions for pre-existing conditions regardless of age, have already gone into effect. Many other reforms are on the way.
Can I keep the health coverage I have?
Although this has become somewhat of a hot-button issue, the short answer is yes. However, because of the ACA reforms going into effect, the coverage you currently have under your health plan may face some changes. If your employer’s health plan existed prior to March 23, 2010 and has not been changed, there is a possibility that the plan may have grandfathered status.
On November 14, 2013, a transition relief policy for 2014 will go into effect for non-grandfathered coverage for individual and small group heath insurance. If your state participates, this policy will enable health insurance issuers the option to renew policies that are currently carried without having to adopt all of the reforms required by the ACA.
On March 5, 2014, the Department of Health and Human Services (HHS) extended this transition relief for two years to policies that begin on or before Oct 1, 2016. This means that individuals and small businesses may have the ability to keep their ACA non-compliant coverage into 2017.
Are individuals required to have health coverage?
Starting in 2014, most individuals will be required to have acceptable health coverage for themselves and their dependents. If they do not have coverage, they face a penalty. This is called the “individual mandate”.
There are some exemptions, which you can read about here.
How long can my grown child keep coverage under my health plan?
Your child can stay covered until they turn 26 years old. This applies to all individual and non-grandfathered employer plans, and as of 2014, all grandfathered plans.
What about my pre-existing condition?
Beginning on January 1, 2014, health plans cannot exclude pre-existing conditions for any enrollees. This applies to all non-grandfathered and grandfathered plans.
Are my health benefits subject to lifetime limits or annual limits?
The ACA prohibits lifetime limits for most benefits. Lifetime limits refer to the total dollar amount the plan would spend on your covered benefits during your entire time on the plan.
The law also restricts the annual limits that a health plan can impose on most covered benefits. In prior years, the annual limit was $2 million. As of January 1, 2014, no annual limits are permitted.
Will I lose my coverage if I get sick?
Unless an individual has intentionally misrepresented themselves or committed fraud, a health plan or insurance company is prohibited from dropping your coverage. This applies to all grandfathered and non-grandfathered plans.
Do I really get free preventive care?
All non-grandfathered individual plans must provide free coverage for recommended preventative health services, such as vaccinations, screenings, and counseling. If the requirement applies to your plan you wont have to pay deductibles or co-payments to receive these services.
Some examples of preventative services include:
- Cancer screenings
- Well-baby and well-child visits up to age 21
- Routine vaccinations
- Diabetes, blood pressure, and cholesterol tests
There are exclusions. If you have a grandfathered plan, this many not apply. Additionally, if your health plan is through a network of providers, you may only be able to use these benefits through your network providers.
Did the Affordable Care Act get rid of COBRA?
No. COBRA coverage is still available and the rules have not changed.
I keep hearing about the Health Care Exchange or Marketplace. What is that?
The exchange is essentially an online marketplace where individuals and small businesses can go to research and buy health insurance coverage. There you can compare plans and get answers to questions regarding health insurance. You can also find out if you are eligible for tax credits or other cost-reducing benefits. Although enrollment for 2014 is now closed, you may still be eligible.
You can learn more at www.healthcare.gov
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Call (949) 222-0444 to learn more!