What is the health care law?

Let’s be clear: The health care law is confusing. We know you have questions. We’re here with the answers. The law may change the way you buy a health plan, which benefits you receive, and how much you pay. But one fact isn’t changing: health insurance is one of the most important things you can do to keep you and your family healthy.

The Basics

Health insurance, primarily through its coverage of preventive care services, helps you protect your health and well-being. It also limits your risk of paying for very expensive health care services.

Explore our Health Care Reform Timeline.

Here’s how health insurance works for most people: You choose a plan based on the cost of the plan and services it covers. For most plans, you will pay a premium to your health insurance company. This is a fixed amount you pay each month. You also may pay each time you get care from a doctor or hospital, have a prescription filled, or get some type of medical care. These payments are frequently referred to as cost-sharing. How much you pay, and when you pay these fees, varies depending on your health plan.

With health care reform, this model will still exist. However, many things about health insurance are changing. Here are some of the changes that are taking place as part of the new health care law:

  • People will be required to have health insurance.
  • Health plans offered to people who purchase health insurance on their own and those that get benefits from an employer with 50 or fewer employees must include 10 core benefits, known as essential health benefits.
  • Many single people and working families may receive assistance from the government to help pay their health care coverage costs. This includes many people who the government does not help now.
  • Many state Medical Assistance programs, also known as Medicaid, are expanding by offering health plans to more people who are uninsured.*
  • There will also be a new way to buy health insurance: the Health Insurance Marketplace.
  • Rates for individual and small group plans (50 or fewer employees) will be based on who will be covered under the health plan, their age, where they live, whether they smoke, and the health plan selected.

* At this time, the Commonwealth of Pennsylvania has decided not to expand Medicaid coverage. If this changes, it will affect eligibility for Medicaid and tax credits/subsidies.

For a quick and easy-to-follow breakdown of the health care law, check out our infographic:

Health Care Law infographic

The health care law requires that you have health insurance beginning January 1, 2014. You can shop for health plans from Independence Blue Cross on www.ibx4you.com or through the government-run Health Insurance Marketplace. In order to have coverage for January 1, 2014, you must purchase your plan by December 15, 2013. Employers with 51 or more employees will be required to offer health care coverage to all full-time employees or the employer may have to pay a shared responsibility payment to the federal government. People that are not offered or do not qualify for an employer-sponsored benefit program will be required to purchase insurance on their own. Most people will pay a penalty to the government if they do not have a health plan; in 2014, that penalty will either be $95 or 1% of your taxable income (whichever is greater).

Remember, while the new law impacts all of us, your coverage may not be affected if you have health insurance through your employer. To get more information, visit www.healthcare.gov.

The Protections

The health care law has several protections built in to help you and your family:

  • You can’t be denied coverage — so you don’t have to worry about being able to get health insurance if you have an expensive medical condition.
  • Your health plan can only be cancelled if you commit fraud or don’t pay your bill.
  • All plans must cover 10 core benefits, or essential health benefits, and many preventive care services will be covered 100 percent.
  • There are no annual or lifetime limits on the amount your health insurer will pay for essential health benefits.

The Coverage Levels

The health care law creates four benefit levels of coverage or metallic tiers based on how much of the cost is covered. The tiers — bronze, silver, gold, and platinum — are designed to make it easy to compare different health insurance plans. All plans contain the same core health benefits like doctor visits, prescription drugs, X-rays, and hospital stays, but will differ in what you pay when you need these services, as well as the monthly premium.

How the metal tiers compare on costs:

How the metal tiers compare on costs

Independence Blue Cross, along with the government-run Marketplace, will have tools to help you determine which plan provides the ideal coverage level and premium cost based on your needs.

The Essential Health Benefits

As a key part of the law, all small group and individual health plans must offer a core set of essential health benefits starting in 2014:

  • Preventive, wellness, and disease management services
  • Emergency care
  • Ambulatory services
  • Hospitalization
  • Maternity and newborn services
  • Pediatric services, including dental and vision
  • Prescription drugs
  • Laboratory services
  • Mental health, behavioral health, and substance abuse services
  • Rehabilitation and habilitation services

There are no lifetime limits on the amount your health plan spends on these essential health benefits services for you and your family. In addition, insurers will cover 100 percent of the cost of many preventive services, such as wellness visits, immunizations, and screenings for cancer and other diseases when you use an in-network provider. That means you will not pay any deductible, copayments, or co-insurance for many preventive services that can help you stay healthy.

For more details on the essential health benefits, see Page 10 of our Health Care Law & You guide.