Published August 01, 2013
With just two months until the Oct. 1 deadline for states and the federal government to have their health-care exchanges up and running, now’s the time for consumers to learn how their insurance plans will operate under the Affordable Care Act.
The individual mandate, which requires every U.S. citizen to either have health care or pay a penalty--which begins at $95 per year, kicks in Jan. 1, so it behooves people to understand their options. Experts the exchange landscapes will begin to solidify more over the next several weeks, providing consumers a better sense of what they are in for come the New Year.
The new law means very different things for different groups of people, says Devon Herrick, senior fellow at the National Center for Policy Analysis. For example, certain low-income individuals and undocumented workers will not be penalized for not having coverage.
“You also cannot be turned away from insurers due to your health status, which is a big issue for people [today] as they approach middle age,” he says.
And while not all states are expanding their Medicaid programs, eligibility requirements will loosen, Herrick says. “If you are a low-to-moderate income individual, you will probably qualify for free--or nearly-free--coverage through Medicaid.” Subsidies will be available for people that are at or below 400% of the poverty level.
Here’s a breakdown of how the upcoming rollouts of health-care reform impacts different groups of people:
Those With Coverage at Large Companies or Individual Plans
Already-insured consumers will face minimal changes, according to Herrick, as long as their carrier continues to participate in either the state or federal exchange. Prices may fluctuate though as premiums shift under the new law.
For those with current coverage, Nate Purpura, director of consumer information for eHealth Insurance, suggests finding out if it will be grandfathered in under the new law, meaning it had an effective date of March 23, 210.
“If so, it will have all of the old benefit structures and you can hold onto that plan,” he says. “But you will have more choice come open enrollment.”
It is less clear what happens to those without grandfathered plans, he says.
“This is a state-by-state issue. If the Department of Insurance in your state is letting insurers stay on the existing plan, that is the insurance company’s decision if they are going to do that, or move the pre-ACA plan to a new post-ACA plan model. This is a carrier-by-carrier level.”
To find out more information, contact a state’s department of insurance and the individual insurance company.
For consumers currently insured with a carrier that is leaving the state or not listing on an exchange, it’s possible another carrier may pick up its participants. If not, it may be time to look for a new provider.
Those Without Coverage and Working at Small Companies
Workers that don’t get insurance may be in for a pleasant surprise if their company has at least 50 full-time employees, as some businesses will choose to offer their workers coverage under the new law.
The employer mandate portion of the ACA was recently delayed until Jan. 1, 2015, but Herrick suggests uninsured workers inquire with employers about their plans.
Businesses with more than 50 workers will have to offer coverage to full-time workers or pay a penalty of $2,000 per worker, per year. Some businesses plan to pay the fine saying it’s cheaper than offering coverage.
“It may be in their best interest to offer workers these plans directly,” Herrick says.
Part-time workers could face a reduction in hours as employers look to avoid the requirement to provide coverage for those that work 50 hours a week.
“They need to be on their guard,” Herrick says.
Those Without Any Coverage at All and no Employer Options for Coverage
Those who are currently uninsured because they do not work, don’t have coverage from their employer or do not qualify are in the best position come the 2014, says Purpura. Once state and federal exchanges are open for business, it will be easier to shop for qualified health plans and compare pricing to find what works best for each consumer.
“There are new marketplaces opening up, and once the exchanges open you can look around like you do when buying airline tickets on Travelocity,” he said.