For plans that cover dependents, young adults can stay on their parents' insurance until their 26th birthday.
Insurance can no longer exclude individuals under 19 with pre-existing conditions.
Insurers cannot cancel policies to avoid paying medical bills when an individual becomes ill.
Lifetime limits for essential health benefits ended.
For plan years beginning on or after September 23, 2010, health insurers and group health plans (employers) must provide coverage for certain preventive services without cost-sharing for non-grandfathered plans. All plans must comply by 2018.
For plan years beginning on or after September 23, 2010, health insurers and group health plans must establish an appeal process for denial of payment for services or claims for non-grandfathered plans.
Medicare beneficiaries receive a $250 rebate check if their Medicare prescription drug coverage was in the “donut hole gap” between the $2,700 initial limit and catastrophic coverage at $6,154.
Businesses with fewer than 50 employees may receive tax credits to cover 35% of their health care premium contributions. The credit will increase to 50% in 2014.
The Health Insurance Marketplace begins with open enrollment in October! Health insurers like Independence Blue Cross will participate in the Federally Facilitated Marketplace, or consumers can go to ibx4you.com starting October 1, 2013, to:
Use interactive tools to compare plans.
Transfer to the Marketplace to register for subsidies, then return to Independence Blue Cross to select a plan.
Coverage under the new plans begins January 1, 2014.
Each Marketplace certifies that the qualified health plan (QHP) meets certain standards.
As part of the QHP certification process, a health plan must meet the following standards:
Provide essential health benefits.
Guarantee issue of insurance to all individuals.
Limit price variations based on four but no more than 10 criteria.
Offer four comparable plan tiers—bronze, silver, gold, and platinum—with limited out of pocket expenses.
Eliminate lifetime and annual coverage limits.
Contributions to flexible savings accounts are limited to $2,500 per year, increased annually by the cost of living adjustment.
The Medicare payroll tax increases from 1.45% to 2.35% for individuals earning more than $200,000 and for married couples filing jointly who earn above $250,000.
The income threshold increases from 7.5% to 10% of adjusted gross income for itemized deductions on unreimbursed health expenses. Individuals older than 65 can claim the 7.5% deduction through 2016.
Similar to the individual marketplace, small businesses can get health coverage in the Small Business Health Options Program (SHOP) Marketplace.
Businesses with 50 or fewer full-time equivalent (FTE) employees can use SHOP to offer coverage to their employees. This applies to non-profit organizations as well.
The business determines the type of coverage offered and how much the business pays toward premium costs.
The business may qualify for a small business health care tax credit worth up to 50% of premium costs. The rest of the premium costs not covered by the tax credit are eligible for deduction.
The Employer Medicare Part D subsidy deduction is eliminated. Employers lose the tax deduction for subsidizing prescription drug plans for Medicare Part D-eligible retirees.
Refuse to sell or renew policies because of an individual's health status.
Exclude coverage for pre-existing conditions.
Charge higher rates because of health status, gender or other factors.
Health plans are prohibited from imposing annual limits on coverage.
Tax credits and subsidies are available through exchanges for those whose income is above Medicaid eligibility yet below 400% of poverty level who are not eligible for or offered other acceptable coverage.
Individuals are required to obtain basic health insurance coverage or pay a penalty fee. In 2014, the individual penalty is $95.
Companies with 50 or more full time or full time equivalent employees must offer health coverage. If the company doesn’t, they face a penalty of $2,000 per employee after the first 30 days if at least one of the employees receives a tax credit.
The waiting period before insurance takes effect is limited to 90 days.
Employers who offer coverage but whose employees receive tax credits will pay $3,000 for each worker receiving a tax credit.
The Medicare coverage “donut hole gap” is completely phased out and closed. When the Medicare Part D prescription drug plan was created in 2003, the coverage included a large gap been the initial limit and the “catastrophic limit”. Beneficiaries had no prescription drug coverage while in the gap and had to pay out-of-pocket for prescription drugs.
Since 2010, the donut hole has been gradually filled in. In 2012, people who entered the gap received a 50% discount on name-brand drugs and a 14% discount on generics. In 2013, those discounts increased to 52.5% on name-brand drugs and 21% on generics. The discounts will increase each year until 2020, when the gap will be completely filled.