These changes created by the Affordable Care Act become effective January 1.
• Opening of the Health Insurance Marketplace. Individuals and small businesses can buy qualified health plans and see what subsidies, if any, they qualify for.
• Requiring Individual Financial Responsibility. Most individuals must obtain basic health insurance coverage or pay a fee to offset the costs of caring for uninsured Americans.
• Expanding Medicaid. In many states, Americans who earn less than 133 percent of the poverty level (approximately $15,282 for an individual and $31,322 for a family of four in 2013) can enroll in Medicaid. Several states have elected to not expand Medicaid beyond the 100 percent of poverty level.
• Eliminating Pre-Existing Condition Limitations and Gender-Rating. Insurance companies cannot refuse to sell coverage or renew policies because of an individual’s pre-existing conditions. In the individual and small group markets insurers cannot charge higher rates due to gender or health status.
• Eliminating Annual Limits. New plans and existing group plans cannot impose annual dollar limits on coverage of essential health benefits.
• Protecting Individuals Participating in Clinical Trials. Insurers cannot drop or limit coverage on an individual who participates in a clinical trial that treats cancer or other life-threatening diseases. Doesn’t apply to grandfathered plans.
• Offering Tax Credits to Lower- and Middle-Class Consumers. People with income between 100 and 400 percent of the poverty line who are not eligible for other affordable coverage may obtain advanced premium tax credits to offset monthly premium payments.
• Increasing the Small Business Tax Credit. For-profit small employers (fewer than 25 full-time equivalent employees with wages averaging less than $50,000 per year) can receive a credit of up to 50 percent of their contribution toward employee health insurance; small non-profits can receive up to a 35 percent credit. In general, employers must pay at least half the cost of single coverage for employees, and they must buy coverage through the Small Business Health Options Program (SHOP) Marketplace to qualify. Required benefits make SHOP plans relatively expensive; your existing plan might cost less. We can help you compare your options.