1. The Patient Protection and Affordable Care Act
Increase the quality and affordability of health insurance
Lower the uninsured rate by expanding public and private insurance coverage
Reduce the costs of healthcare for individuals and the government
mandates
insurance exchanges
subsidies

2. Provisions of PPACA Guaranteed coverage Individual mandate
pre-existing conditions
same premiums
by age group and geographic area
regardless of gender
Individual mandate
insurance required for everyone
Employer mandate
> 50 full-time employees
≥ 30 hours

3. Provisions of PPACA
Individual “shared responsibility fee” or tax penalty
% annual modified adjusted gross income or $95/adult, $47.50/child, $285 max
2015 – 2% annual modified adjusted gross income or $325/adult
2016 – 2.5% annual modified adjusted gross income or $695/adult
2017 – increases based on rate of inflation, 2.5% minimum
small business fines $ /employee

4. Provisions of PPACA Health insurance exchanges/marketplaces
Minimum standards for insurance policies
four levels of coverage
based on premium : out-of-pocket expenses
no lifetime coverage caps
dependents covered until age 26
80 – 85% medical loss ratio
Subsidies
tax credits
100 – 400% poverty level
Expansion of Medicaid
raised income ceiling to 133% poverty level
25 states & District of Columbia

6. Essential Health Benefits
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use 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

8. Important Dates 10/1/13 – 3/31/14 – open enrollment
12/14/13 cut-off for coverage to begin 1/1/14
1/1/14 – penalties begin to accrue
2/15/14 – cut-off for coverage to begin by 3/31/14

9. Do It NOW!
You know more about personal finance after reading this chapter, so get started right now by:
Check out the health insurance exchange and compare $$$ and coverage.
Pay attention to spousal surcharges.
Don’t forget the kids!
Flexible spending arrangements—healthcare v. dependent care.
You do not have to wait to get started on managing health expenses. Get started today by doing these three things.
Learn exactly what group health care coverage you actually do have through your job, your school, and/or your parents.
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