5 Things To Know About Health Care Reform for 2014

July 31, 2012

So you know last month the Supreme Court decided to uphold almost all of President Obama’s Patient Protection and Affordable Care Act (PPACA). However a lot of people are still unaware of what the new law covers and when it will take effect. While some of the regulations have already been in place for sometime now, we won’t get to the main event until January 1, 2014. Here are five key points to know about the PPACA before 2014 rolls around.

1. No More Pre-Existing Conditions

Starting on January 1, 2014 health insurance companies will no longer be able to deny coverage to individual and families who have pre-existing medical conditions. The law will also eliminate their ability to charge higher rates for gender or medical history.

The Spin: While on the surface these are much needed changes, there are two key reaction to be aware of. First when you start insuring more expensive conditions the overall cost of the insurance will naturally cost more. Two, not properly rating individuals can lead to “healthy” people paying much more for their coverage to offset the cost of the unhealthy.

2. Individual Mandate Responsibility

Everyone who is able to afford coverage will be required to purchase “basic health insurance coverage” or “pay a fee to help offset the costs of caring for uninsured Americans.” As stated by HealthCare.gov. If coverage is not available to an individual, they will be eligible for an exemption. You can also apply for a waiver asking not to pay an assessment if you don't qualify automatically.

The Spin: In order to insure everyone for everything it is necessary to have a safeguard in place to prevent people from buying insurance only when they need it. The “Individual Responsibility” or “Mandate” or “Tax” is designed as a deterrent to prevent people from purchasing health insurance on their way to the hospital just before they incur thousands of dollars of medical bills.

3. Insurance Exchanges

If you do not have benefits available to you through your employer, you will be able to purchase coverage directly from the “Affordable Insurance Exchange.” These state by state exchanges goal will be to create a transparent and competitive insurance marketplace where individuals and small businesses can buy coverage. Starting in 2014, Members of Congress will also be getting their health care insurance through Exchanges.

The Spin: There is so much uncertainty surrounding the exchanges it is almost impossible for me to say what they will look like come 2014. We don’t know what kind of plans will be sold there, what insurance companies will be selling them and most importantly who will be able to assist you in making such a purchase.

4. Ensuring Free Choice

Workers who meet certain requirements and cannot afford the coverage available to them through their employer will be allowed to use whatever funds their company would have contributed to their insurance and use it to purchase more affordable coverage through the new Affordable Insurance Exchanges.

The Spin: Not to sound like a broken record, but like the exchanges, the specifics surrounding the “requirements” for employees to take advantage of this benefit are very murky right now. It is too early to tell if or how big of a crack there might be in this provision.

5. Eliminating Annual Limits on Insurance Coverage

The new law prevents new plans and existing group plans from setting annual dollar limits on insurance policies.

The Spin: If your health insurance policy was worth the paper it was printed on, you already had at least a $3 million lifetime maximum. Most policies sold in Ohio before 2010 had a $7.5 million lifetime maximum.

Do you think this will improve or make your coverage more affordable? If so what part of the law do think will benefit you most?