10 Things You Need to Know about Health Reform

The Affordable Care Act (ACA) - also called Obamacare - is a new law helping more Americans get health insurance. Here are the 10 things you need to know:











Millions of individuals and businesses will be enrolling in benefits through an exchange starting in 2014.

An exchange is an online marketplace that shows you all your benefit options in one place, compares plans side-by-side, and allows you to enroll online. There are two types: public (government) and private (private sector) exchanges. Exchanges should also provide education on Health Reform, how the law affects you or your business, and help you determine if you qualify for any subsidies (like discounts on private health insurance) or tax credits.



You are required to have health insurance or pay a penalty, unless you qualify for an exception.

You must have health insurance or pay a penalty unless you qualify for an exception. Qualifed health coverage could include job-based coverage (your's, your spouse or partner's, or your parent's), private plans, Medicaid, Medicare, or another government-sponsored coverage. 



If your household income is less than 400% Federal Poverty Level (about $96,000 a year for a family of four), you could qualify for a tax subsidy to reduce your health insurance costs. 

A good way to think of a tax subsidy is a "discount" that reduces your monthly premium or out-of-pocket costs when you use for plan for things like deductibles and copays. A tax subsidy is money the government pays directly to your brand-name insurance company to make your plan more affordable. The amount of subsidy you receive is based on your family size, household income, and the cost of insurance plans in your area. You can only use your subsidy if you do not have access to an affordable job-based coverage - either through your job or your spouse/partner's job.  



You've still have the power of choice.

Obamacare is not government insurance. It's a law that helps more Americans gain access to affordable health insurance options. Even if you qualify for a tax subsidy - where the goverment pays part of your premium so it's affordable for you - your plan will be insured by a brand-name insurance company like BlueCross BlueShield, Humana, United Healthcare and more. Choose your favorite insurance company from the ones available in your area. You'll also have control over your benefits. Choose from a Platinum, Gold, Silver, Bronze, or Catastrophic plan. The benefits are exactly the same whether you accept tax subsidy or not; however, the doctor network could be smaller for subsidized plans. 



The law divides businesses into two categories: Small and Large.

Small businesses have less than 50 full-time equivalent employees. Large businesses have 50 or more full-time equivalent employees. A full-time equivalent employee is a true employee of your business (not 1099), generally getting a W2, who works 30 or more hours per week and at least 120 days per year. If you are Self-Employed (business of one), you are not considered "an employer" under the Health Reform law, and you will shop for Individual and Family policies instead of business policies. 



Large businesses are required to offer affordable health insurance to their employees or pay a penalty starting in 2015. 

The penalty for not offering health insurance is $2,000 per employee per year. There is a waiver on the first 30 employees. So for example, if you have 52 employees, you would pay zero penalty for the first 30, $2,000 penalty for the last 22 employees, or pay a penalty of $44,000 per year. Our expets will show you whether is less expensive to "pay or play". 


Your plan is unafforadable when what an employee pays toward single coverage exceeds 9.5% of his/ her Modified Adjusted Gross Income (MAGI). Affordability doesn't take into account any family members of the employee. If the plan doesn't pass the Affordability Test, and at least one employee qualifies for a subsidized individual plan, the business will be charged a penalty of $3,000 per employee. Our experts will make sure that your plan is affordable. 



Small Businesses are not required to offer health insurance but can choose to offer benefits if they want to.

Small Businesses are not subject to any penalties for not offering affordable health insurance, so you have more options. If you offer a group plan, you might qualify for a Small Business Healthcare Tax Credit. This credit is for businesses with less than 25 employees (the highest credit to businesses with less than 10) who pay at least half of the employee premium and have an average income of less than $50,000 per year. Many small businesses might benefit from not offering a group plan starting in 2014. Employees can shop for individual and families policies instead and qualify for tax subsidies to lower their costs. Our experts will show you down to the penny which option is best for your business. 



 Individual and Family Benefits are improving.

All new plans must include Essential Health Benefits - including things like ambulatory patient services, emergency services, hospitalization, prescriptions, and more - with no yearly or lifetime maxiums so you can't run out of insurance. Maternity is included in all new plans. You'll get free checkups and other preventive care like pap smears, mammograms, PSA tests, colonscopies, and more. Dental and vision care for children under 19 is included in every plan. 



You can't be turned down or charged higher premiums because of a pre-existing condition. No, really.

No health insurance company can turn down an individual or family because of a pre-existing condition. You cannot be charged a higher premium because of a pre-existing condition, and all pre-existing conditions must be covered. If you've been stuck paying high premiums for years, now is the time to move to a new plan. But remember: you must enroll during Open Enrollment. 



Individual, Family and Small Business policies are different now.

No health insurance company can charge you more because of health history, pre-existing conditions, how often you use your plan, gender, or profession. The only thing you could be charged extra for is tobacco usage. Before ACA, an older adult might pay six times more than a younger adult. But now, an insurance company can only charge an older adult three times more, making older adult premiums more resonable than before.