Wednesday, January 1, 2014

Now in Effect: ACA Pre-existing Conditions, Small Business Health Insurance Tax Credit

Establishing the Health Insurance Marketplace

Effective January 1, 2014
Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too.

Promoting Individual Responsibility

Effective January 1, 2014
Under the new law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption.

Increasing Access to Medicaid

Effective January 1, 2014
Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.

Makes Care More Affordable

Effective January 1, 2014
Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate income families can receive the full benefit of the credit.  These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).

Ensuring Coverage for Individuals Participating in Clinical Trials

Effective January 1, 2014
Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. This applies to all clinical trials that treat cancer or other life-threatening diseases. 

Eliminating Annual Limits on Insurance Coverage

Effective January 1, 2014
The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.

No Discrimination Due to Pre-Existing Conditions or Gender

Effective January 1, 2014
The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status.

Increasing Small Business Health Insurance Tax Credit

Effective January 1, 2014   
The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.
 

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