Presentation on theme: "What You Need To Know About Health Care Reform. Health Care Reform Key Facts March 23, 2010 - President Obama signed the Affordable Care Act. A central."— Presentation transcript:
What You Need To Know About Health Care Reform
Health Care Reform Key Facts March 23, President Obama signed the Affordable Care Act. A central goal of the ACA is to significantly reduce the number of uninsured by providing affordable coverage options through Medicaid and new Health Insurance Marketplaces. The law requires most people to maintain a minimum level of health insurance coverage beginning in Oct. 1, 2013 – Health Insurance Marketplaces open. Jan. 1, 2014 – Coverage begins.
What is a Health Insurance Marketplace? An online marketplace where individuals may: Shop for health insurance. Compare benefits and prices. Enroll in a plan. There will be two types marketplaces in the US: 1.Public– The Health Insurance Marketplace facilitated by state and/or federal government. (Tax Credits and Subsidies available for qualified individuals.) 2.Private–marketplaces facilitated by private companies. (Tax Credits and Subsidies are not available.) Federal and State marketplaces will be accessible at: https://www.healthcare.gov/ https://www.healthcare.gov/
With a few exceptions, all United States citizens and lawful residents may purchase their health insurance through a Federal or State Health Insurance Marketplace. Tax credits to help offset the cost the purchasing coverage in a Federal or State Health Insurance Marketplace are available to eligible individuals. Household income must be between 100% and 400% of the federal poverty level. Individuals who have access to employer-provided health care are not eligible for tax credits unless the employer plan is unaffordable or does not provide minimum value. An employer plan is not considered affordable if the employees share of the premium (for employee only coverage) exceeds 9.5% of household income. An employer plan provides minimum value if the plan pays at least 60% of covered expenses. Subsidies to help offset out-of-pocket expenses may also be available for coverage purchased through a Federal or State Health Insurance Marketplace. Small employers can access Small Business Health Options Program (SHOP) exchanges to provide employer-sponsored coverage. States may allow large employers to become eligible for SHOP in Who can use the Federal or State Health Insurance Marketplace?
Bronze: plan pays 60% of essential health benefits Silver: plan pays 70% of essential health benefits Gold: plan pays 80% of essential health benefits Platinum: plan pays 90% of essential health benefits The Health Insurance Marketplace will offer 4 coverage levels Benchmark Low income consumers may be eligible for subsidies to assist with premium expenses and out-of-pocket expenses.
Plans in the individual and small group markets must include Essential Health Benefits The specific terms of coverage will vary based on the particular plan that is purchased. However, all coverage purchased through a State or Federal Health Insurance Marketplace is required at a minimum to cover the following types of services: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care
Plans must provide Preventive Care at no cost Specific details may vary by plan, but in general, you will not have to pay a copayment, co-insurance, or deductible to receive certain preventive health care, such as: copaymentco-insurancedeductible Blood pressure, diabetes (Type 2), and cholesterol tests Many cancer screenings, including mammograms and colonoscopies Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use Regular well-baby and well-child visits, from birth to age 21 Routine vaccinations for children against diseases such as measles, polio or meningitis Counseling and screenings to ensure healthy pregnancies Womens wellness and pre-natal visits Flu and pneumonia shots
Additional changes to health care plans … Guaranteed Issue and Renewal Plans cannot deny coverage based on pre-existing conditions. Plans cannot exclude pre-existing conditions. Plans cannot charge a higher premium for pre- existing conditions.
For us at, this means… Our company will offer the following major medical benefits: Open Enrollment begins: Costs: Our company will offer the following voluntary benefits: Open Enrollment begins: Costs: Slide Option 1: Employer Offering Major Medical Benefits
For us at, this means… While our company will not offer major medical benefits, you will have access to the Health Insurance Marketplace. Open Enrollment begins: October 1, 2013 Visit: https://www.healthcare.gov/https://www.healthcare.gov/ Our company will offer the following supplemental benefits: Open Enrollment begins: Costs: Slide Option 2: Employer NOT Offering Major Medical Benefits
Healthcare.gov Healthcare.gov Kaiser on Health Care Reform Kaiser on Health Care Reform U.S. Small Business Administration/Health Care U.S. Small Business Administration/Health Care Aflac Healthcare Reform Resources Aflac Healthcare Reform Resources For more information…
This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at ) for additional information. healthcare.gov HCR13004A8/16/13