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The Affordable Care Act: FAQs, 2014

Posted on Jun 16, 2014 by Ailee Slater ()  | Tags: Obamacare, Affordable Care Act, ACA, insurance changes 2014, workplace wellness programs, online insurance exchanges,, annual and lifetime limits, insurance subsidies, insurance mandate

Since its approval by congress in 2010, the Affordable Care Act (ACA) has brought changes each year to the American health care and insurance system. During the law’s first few months some Americans became eligible for preventative health services free of charge; in 2011, Medicare recipients received discounts of 50 percent on prescription drugs; 2012 brought a focus on coordinated health services through Accountable Care Organizations; and in 2013 consumers were able to purchase health insurance on a state or federal online insurance exchange. 

This year, U.S. citizens and businesses will again see advancements in the ACA, and possible changes in health coverage and cost. Following are a few questions that Americans might ask about health legislation in 2014. 

By what date must I hold health insurance?

Federal law states that every American must have obtained coverage by March 31, 2014. Any person who did not purchase a policy by this date will have been taxed a fine: of up to 1 percent household income or US$95, whichever is greater. Citizens who are uninsured for only part of the year will only have to pay part of that no-insurance penalty, and as long as coverage was applied for by March 31, no fine will be charged for those first few months of the year. 

When the ACA was first approved, it was thought that by March 21, 2014, businesses with more than 50 employees would be required to provide coverage to all employees. However, that mandate was delayed last year, meaning that businesses do not need to cover their workers until March 2015. In the meantime, employees who do not have insurance must find an individual plan in order to comply with the ACA and not face a fine. 

What if I can’t afford insurance? 

Individuals living on a low income may be eligible to sign up for the federal insurance program Medicaid. Offering health and dental care, Medicaid offers free or reduced-cost health services to adults and children, with eligibility for enrollment in the program varying from state to state. In states that have chosen to expand their Medicaid programs through the ACA – including California, West Virginia and New Mexico – individuals with incomes of up to 133 percent of the federal poverty level are now eligible for Medicaid starting in 2014. 

People who do not qualify for Medicaid may still be able to access federal subsidies to help pay for health insurance. Subsidies are available to individuals making from 100 to 400 percent of the national poverty level, and differs depending on the average cost of insurance in the enrollee’s area of residence. Americans interested in using a subsidy can check their eligibility on their state’s online exchange, or at the federal insurance marketplace 

How will changes to lifetime and annual limits in 2014 affect me? 

An annual limit is the maximum dollar amount that an insurance company will pay for care in any given year. Once a patient reaches this annual limit, all costs must be covered by the patient. Lifetime limits are similar – dictating that an insurance holder is only entitled to a certain amount of coverage during his lifetime. 

When the Affordable Care Act was first approved, many insurance providers were prevented from implementing annual and lifetime limits, and starting in 2014 no coverage plan may enforce any of these limits. Patients with costly chronic health conditions such as diabetes or renal disease may find a lower cost of care thanks to these changes. 

At the same time, consumer should be aware that any American holding a grandfathered insurance plan may still be subject to annual and lifetime limits. A grandfathered plan is one which has been individually purchased before 2010, and is exempt from many of the changes brought on by Obamacare. Holders of grandfathered policies do have the opportunity to shop for coverage through an online exchange if they are unhappy with their current insurance policy. 

What’s a wellness discount? 

Starting in 2014, employers can receive insurance discounts – and pass those savings on to their employees – by offering coverage price cuts to workers who participate in wellness activities. For example, an employee who smokes may be charged 50 percent more than his non-smoking colleague – but if that smoker undergoes smoking cessation classes, she may be eligible for an insurance discount of up to 30 percent from this year onward. Many employers already offer their staff financial rewards and penalties for taking part in fitness or diet programs, and large companies such as Walgreens and the Ford Motor Company have already said that they will be using wellness programs to offer employees financial incentives to stay healthy. 

Is Obamacare here to stay? 

In his recent State of the Union address, President Obama spoke of the positive effects that the ACA has already had in the United States. The President noted that 3 million Americans under the age of 26 have gained insurance through being allowed to stay on their parents’ policies, and more than 9 million new customers have bought coverage through online insurance exchanges. 

At the same time, the online exchange technical problems of 2013 continue to garner criticism. Opponents of the ACA say that some users are still experiencing difficulties signing up for coverage or understanding their subsidy opportunities and insurance options. Some Americans have also been dropped from their current coverage policies; a situation that the President had previously promised would not occur. In order for the ACA to function well this year, Americans who have lost coverage because of the law must be able to find equally good, and equally priced, new health insurance. 

Despite promises from the White House that Obamacare will overcome glitches this year, many Republican politicians are still calling for the repeal of the Affordable Care Act. At the end of January, three GOP senators proposed a policy that would overhaul Obamacare and replace it with new legislation – giving states more control over Medicaid, downsizing federal subsidies, and completely getting rid of online insurance marketplaces. 


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