Health Care Reform

Obamacare is another name for the Patient Protection and Affordable Care Act (or ACA) of 2010. The most well known provision, that everyone must purchase health insurance, took effect in 2013.

Here is a basic summary of what you need to know.

If you already have health insurance, you do not necessarily need to change your plan. If you have a private insurance plan (one you purchased yourself), an employer-provided plan including COBRA or retiree plans, Medicare, Medicaid, CHIP, TRICARE and other veterans health care programs, and Peace Corps Volunteer plans, you are covered. If you aren’t sure, ask your health-coverage provider or ask us at Roper Insurance.

Health plans that cover only vision or dental care, workers’ compensation, disease-specific coverage or plans that offer only a discount on services are not considered qualified plans and don’t count as being covered.

Obamacare changed the benefits you receive in a number of ways.

You may keep or add your children to your health plan until they reach age 26.

Wellness visits (also known as check-ups or physicals) and pregnancy visits do not have a co-pay and many time are now free.

Your insurance company cannot end your coverage if you become sick, even if you made a mistake on your application.

There are no more lifetime limits on insurance coverage for medical care.

If you or your child has a pre-existing condition, you will not lose coverage if you change your insurance. Insurance plans can no longer deny coverage to persons with pre-existing conditions.

Insurance must now provide justification to the states for any rate hikes and have their rates approved by the state.

Insurance companies must now spend at least 80% of premium payments on medical services (known as the MLR-Medicaid loss ratio), instead of such things as advertising or executive salaries. If they don’t, they must refund a portion of your premium.

If you don’t have health insurance you must purchase insurance or pay a penalty of as much as 1% of your income. The penalty will increase in future years. You can shop for insurance through the federal health care exchange or your state health care exchange. The exchanges help you find out if you qualify for tax credits or other government health benefits.  Exchanges allow you to compare health plans before you buy one. Some states have their own exchanges, funded in large part by government grants. There are also insurance plans available outside the exchanges which may vary from the exchange plans. You can shop on your own or you can have a have an insurance agent help you. An insurance agent can easily help you sort through the plans, both on and off the exchanges, help you understand the different options and help you find the best plan for you and your family for free.

If your income is 133% or less of the Federal poverty level, you will qualify for Medicaid. This will be completely funded by the Federal government for the first three years, and 90% funded after that. 

 If you don’t qualify for Medicaid, you are still eligible for a tax credit if your income is under 400% of the poverty level. You will receive the tax credit each month instead of waiting until annual tax time and can use that to help offset your insurance premiums. You may also qualify for reduced copayments and deductibles.

If you are a small business owner, there are also programs available to help you provide your employees with health insurance. If you have 25 employees or less you can get a tax credit of 50% of the cost of providing health insurance to your employees. If you have less than 50 employees you will not be fined if your employees get tax credits and purchase their insurance through an exchange. If you have 50 or more employees, you must provide health insurance or pay a fine of $2000 for each employee after the first 30 employees beginning in January 2015. 

Please Contact Us today for more information on Colorado Health Care Reform.