The Patient Protection and Affordable Care Act (PPACA), aka: ObamaCare, was passed into law on March 23, 2010. The Act has been in the process of implementation
since then and will continue to be implemented through 2022. The law was enacted to help millions of Americans obtain health insurance coverage, improve
access for others, remove the burden that healthcare cost have become, and make the healthcare system more patient-oriented instead of industry-oriented.
Major plan benefits that have been improved or added by ObamaCare
1. Children may now remain on their parents’ health plans until they attain 26 years of age
2. After 2014 no one may be denied coverage or penalized because of pre-existing conditions.
3. Life-time limits have been eliminated
4. There will no longer be any out of pocket costs for preventive care
5. Insurance companies must justify large increases in insurance premiums and must control the amount of premium dollars that is spent on administrative
6. The waiting period for entry into a plan can no longer be more than ninety (90) days.
To improve access to services ObamaCare will, through the federal or state government, establish a Marketplace (Exchanges and SHOPs) where individuals,
families and businesses who need insurance coverage may shop for, and compare plans and benefits offered by various carriers then select the plan that
best suits his/her/its needs and pocketbook. Plans should be in place on January 1, 2014. Open Enrollment begins October 1, 2013 and ends March 2014.
In subsequent years open enrollment will be October 15 thru December 7.
Large employers (50 or more full time equivalent employees) must offer health benefits to all full time employees or face a “pay or play” penalty, aka:
employer shared responsibility payment. The enforcement of this penalty has been deferred to 2015. Individuals and families that neglect to obtain
health coverage will be subject to penalties. These penalties go into effect in 2014.
All employers (whether you offer health insurance coverage or not) must provide employees with the ‘New Health Insurance Marketplace Coverage’ notice by
October 1st, 2013. This notice informs employees of their health insurance options – through the employer or the Marketplace.
Certain employers must report the cost of group health insurance cost on their employees’ W-2’s beginning in 2012 per IRS regulations.
An Advanced Premium Tax Credit will be available in 2014 to individuals and families to assist with the cost of health insurance premiums. To utilize the credit individuals/families must meet the following criteria:
1. File a tax return
2. Enrolled in a plan offered through an exchange - No employer subsidy
3. Lawful resident
4. Not be eligible for any other acceptable coverage, eg. Medicare, Medicaid etc.
5. Household income less than 400% of the Federal Poverty Level (FPL)
6. Not enrolled in an available employer sponsored plan because it is unaffordable
7. Other eligibility rules may apply
Businesses (for profit and not for profit) with twenty-five (25) or fewer full time equivalent (FTE) employees may be eligible for a federal tax credit
of up to 35% of premiums paid. See instructions to Internal Revenue Service Form 8941 for directions on how to obtain the credit.
The Exchange/Health Insurance Marketplace
The exchange is a pool of insurance carriers that will work cooperatively to offer health insurance plans to individuals, families and businesses. Offerings
will range from very economical to Cadillac plans. Purchasers will be able to compare and contrast available plan options both inside and outside the
Marketplace and choose the plan that fits the budget and need. Carriers in the Marketplace will accept qualifying tax credits in payment of premiums.
The Marketplace will begin accepting online applications in October 2013.