Answer : “It Depends”
The Affordable Care Act (ACA; aka “Obamacare”) is not understood and is feared by many. Since 2010 it has been gradually phased in and is on track for full implementation in 2014.{{more}} Many of the benefits that impact individuals, are already in effect, especially those who are over 65 or on Medicare and those under 65 who are on high deductible plans.
Individuals
Insurance coverage must include preventive services with no cost sharing i.e. annual physical, screenings such as colonoscopies, mammograms, pap smears, and psa test are covered .
Prohibits/Restricts Lifetime or Annual Benefit Limits
Allows dependent coverage to age 26
Prohibits discrimination based on employee compensation
Over age 65 or on Medicare, provides 50 percent discount on brand name drugs for people who are in the “donut hole” or coverage gap.
As of 2014
All individuals will be required to have health insurance or pay a $95 penalty.
Insurance companies cannot discriminate or exclude due to pre-existing conditions.
“Health Exchanges” will allow individuals and employers with fewer than 100 employees, to purchase “affordable” health insurance.
Small Business Owners
Employers with less than 50 employees will not be assessed a penalty if they do not offer insurance coverage to their employees.
Small employers with less than 25 employees and average wages of less than $50,000 who do offer health insurance will receive a tax credit .
Businesses with 50 to 100 employees will be required to offer “affordable “ coverage (defined as less than or equal to 9.5 percent of employees wage) or pay a penalty of $3,000 per employee.
Employers with 50 or more employees who do not offer insurance coverage will pay a per employee penalty if one fulltime employee receives a government subsidy in the exchange. Insurance plan must cover at least 60 percent of covered health care expenses for typical population.
Large Employers (200 + employees)
Required to auto enroll employees in health insurance plan.
Many of the mandates outlined above do not apply to those employers who choose to “self insure.” Self insuring allows companies to set aside a certain amount of money to cover employee medical expenses, up to a certain amount. Once claims exceed a predetermined threshold, “catastrophic” expenses are paid through an insurance plan.
Trish Pearson is a licensed insurance agent who specializes in individual and small group solutions.
Contact her at trishpearson281@gmail.com.