Healthcare reform: Patient protection and affordable care act

Published 10:12 pm Monday, June 10, 2013

Editor’s note: Robin Dixon, a benefits specialist with Main Street Financial Group Inc., will offer a column each month explaining the ins and outs of changes related to healthcare reform that citizens need to know.

To this point, many Americans have given little thought to the legislation passed  March 23, 2010 known as PPACA.

Written in part to make health insurance more accessible and more affordable to Americans, PPACA is a vast piece of legislation that affects everyone, from individuals and families to businesses of all sizes.
Despite the efforts of some and the hopes of others, PPACA has not been repealed in entirety or in part, and is moving forward with full implementation.

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It matters little if you agree or disagree with PPACA, it is best to understand how the law might affect you or your business, and then plan to meet any mandates fully prepared.

Known by many names, including the Affordable Care Act, Obamacare, and Health Care Reform, PPACA has already been busily at work.

Some may have already noticed increased preventive health benefits or the elimination of pre-existing conditions for children.  Some may have reenrolled adult “children” on their group plans, when they suddenly became eligible to be covered to age 26 under their parents.

Others on “grandfathered,” plans may be ineligible for richer reform benefits, but will also avoid some of the pitfalls.

January 1, 2014 brings more visible impacts of the law into focus. Each American will have to show that they have qualified health insurance or pay a tax penalty on their 2014 taxes.

This penalty grows over the next three years until a single person making $40,000 a year will pay $1000 in tax penalty.

Plans must meet minimum standards of coverage to be compliant.  Each plan will have maternity benefits, and there will be no pre-existing conditions.  Plans must stay below a maximum deductible and out of pocket.

Some individuals already insured may be on a non-compliant plan, and forced to buy richer coverage to avoid the tax penalty.

Employers will need to count their employees, full and part time, to determine if they are mandated to offer, and assist in paying for group health insurance.

Those employers who fall under the mandate requirements will have to pay penalties if they refuse to offer coverage, or offer coverage that is too expensive or too poor a benefit to meet minimum requirements.

The Federal Marketplace will be set up by October, so that individuals and small employers can review their options, and apply for coverage. Marketplace “Navigators,” will provide information about the available options. Insurance agents will also be great sources of information, and assist in the application process.

In the Marketplace, applicants can also enter income data to be considered for a federal health insurance subsidy.

For those who qualify, subsidies are hoped to offset a portion of the premium costs. Some early figures indicate that a family of 4 can make up to $94,200 a year and still qualify for a small subsidy.

Many of these topics will be explored in detail in coming months, and will include information on the individual mandate, subsidies, penalties/tax, employer mandates,  and the “Marketplace,” to name a few.