Transcript Document
What You Need To Know
About Health Care Reform
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Health Care Reform Key Facts
• March 23, 2010 - President Obama signed the Affordable Care
Act.
A central goal of the ACA is to significantly reduce the
number of uninsured by providing affordable coverage
options through Medicaid and new Health Insurance
Marketplaces. The law requires most people to maintain a
minimum level of health insurance coverage beginning in
2014.
• Oct. 1, 2013 – Health Insurance Marketplaces open.
• Jan. 1, 2014 – Coverage begins.
What is a Health Insurance Marketplace?
• An online marketplace where individuals may:
• Shop for health insurance.
• Compare benefits and prices.
• Enroll in a plan.
• There will be two types marketplaces in the US:
1. Public– The Health Insurance Marketplace facilitated
by state and/or federal government. (Tax Credits and
Subsidies available for qualified individuals.)
2. Private–marketplaces facilitated by private companies.
(Tax Credits and Subsidies are not available.)
• Federal and State marketplaces will be accessible at:
https://www.healthcare.gov/
Who can use the Federal or State Health Insurance Marketplace?
• With a few exceptions, all United States citizens and lawful residents may purchase
their health insurance through a Federal or State Health Insurance Marketplace.
• Tax credits to help offset the cost the purchasing coverage in a Federal or State
Health Insurance Marketplace are available to eligible individuals.
• Household income must be between 100% and 400% of the federal poverty
level.
• Individuals who have access to employer-provided health care are not eligible
for tax credits unless the employer plan is unaffordable or does not provide
minimum value.
• An employer plan is not considered affordable if the employee’s share of the
premium (for employee only coverage) exceeds 9.5% of household income.
• An employer plan provides minimum value if the plan pays at least 60% of
covered expenses.
• Subsidies to help offset out-of-pocket expenses may also be available for coverage
purchased through a Federal or State Health Insurance Marketplace.
• Small employers can access Small Business Health Options Program (SHOP)
exchanges to provide employer-sponsored coverage.
• States may allow large employers to become eligible for SHOP in 2017.
The Health Insurance Marketplace will offer 4
coverage levels
Bronze: plan pays 60% of “essential health benefits”
Silver: plan pays 70% of “essential health benefits”
Gold: plan pays 80% of “essential health benefits”
Platinum: plan pays 90% of “essential health benefits”
Low income consumers may be eligible for subsidies to assist
with premium expenses and out-of-pocket expenses.
Benchmark
Plans in the individual and small group markets must include “Essential Health Benefits”
The specific terms of coverage will vary based on the particular plan that is
purchased. However, all coverage purchased through a State or Federal
Health Insurance Marketplace is required at a minimum to cover the
following types of services:
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Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance abuse disorder services, including
behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Plans must provide “Preventive Care” at no cost
Specific details may vary by plan, but in general, you will not have to pay a
copayment, co-insurance, or deductible to receive certain preventive
health care, such as:
• Blood pressure, diabetes (Type 2), and cholesterol tests
• Many cancer screenings, including mammograms and
colonoscopies
• Counseling on such topics as quitting smoking, losing weight,
eating healthfully, treating depression and reducing alcohol use
• Regular well-baby and well-child visits, from birth to age 21
• Routine vaccinations for children against diseases such as measles,
polio or meningitis
• Counseling and screenings to ensure healthy pregnancies
• Women’s wellness and pre-natal visits
• Flu and pneumonia shots
Additional changes to health care plans …
• Guaranteed Issue and Renewal
• Plans cannot deny coverage based on “pre-existing”
conditions.
• Plans cannot exclude “pre-existing” conditions.
• Plans cannot charge a higher premium for “preexisting” conditions.
For us at <insert company name>, this means…
Slide Option 1: Employer Offering Major Medical Benefits
• Our company will offer the following major medical
benefits:
• <Insert benefit and vendor details>
• Open Enrollment begins: <Insert date>
• Costs: <Insert cost details>
• Our company will offer the following voluntary benefits:
• <Insert benefit and vendor details>
• Open Enrollment begins: <Insert date>
• Costs: <Insert cost details>
For us at <insert company name>, this means…
Slide Option 2: Employer NOT Offering Major Medical Benefits
• While our company will not offer major medical benefits,
you will have access to the Health Insurance Marketplace.
• Open Enrollment begins: October 1, 2013
• Visit: https://www.healthcare.gov/
• Our company will offer the following supplemental
benefits:
• <Insert benefit and vendor details>
• Open Enrollment begins: <Insert date>
• Costs: <Insert cost details>
For more information…
Healthcare.gov http://www.healthcare.gov/
Kaiser on Health Care Reform http://kff.org/health-reform/
U.S. Small Business Administration/Health Care
http://www.sba.gov/healthcare/
Aflac Healthcare Reform Resources
http://www.aflac.com/healthcare_reform/default.aspx
Questions
This material is intended to provide general information about
an evolving topic and does not constitute legal, tax or accounting
advice regarding any specific situation. Aflac cannot anticipate all
the facts that a particular employer or individual will have to
consider in their benefits decision-making process. We strongly
encourage readers to discuss their HCR situations with their
advisors to determine the actions they need to take or to visit
healthcare.gov (which may also be contacted at 1-800-318-2596)
for additional information.
HCR13004A
8/16/13