Health Care Reform: What It Means for You

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The Affordable Care Act (ACA) is a law that helps patients in many ways. This article will help you understand what the law means for you and your family.

How does the health care law benefit me and my family?

Below are some of the benefits of the law:

Children.  Health insurance companies can no longer deny coverage to children who have pre-existing medical conditions. A pre-existing medical condition is a condition that a person has or has received treatment for before applying for health insurance coverage. New health plans (those that do not have “grandfather” status under the law) are also required to cover the full costs of immunizations for children. This means that you don’t have to pay a co-payment or deductible to have your child vaccinated under these plans.

Adults. 
New health plans are required to cover all costs associated with preventive services for men and women. This means you don’t need to pay a co-payment or deductible for preventive services under these plans. Preventive services help you stay healthy. The types of preventive services you need depend on your gender, age, medical history and family history. Examples of preventive services include diabetes screening, some vaccines (such as the flu shot), Pap smears for women and prostate cancer screenings for men.

Also, if you are 26 years of age or younger, you can remain a dependent on your parents’ private health insurance plan even if you do not live with them and are not a student.

People who are sick.  Your health insurance company can no longer drop you from coverage if you get sick, even if you are seriously ill. Also, health insurance companies cannot set lifetime financial limits on benefits. This means that your health insurance plan is required to offer you the same benefits even if you have a long or expensive illness.

How does the law benefit seniors?

The law benefits Medicare patients who hit the coverage gap (“donut hole”) under the prescription drug benefit. The coverage gap is a period of time in which you have to pay for all your prescription drug costs yourself.

  • Enrollees receive a 50% discount on brand-name prescription drugs covered by Medicare Part D. The discount began to increase starting in 2013 until enrollees pay just 25% of the cost of brand-name drugs in 2020.
  • Enrollees also receive a discount on generic drugs covered by Medicare Part D. The discount started at 7% in 2011 and will grow by 7% each year until enrollees pay just 25% of the cost of generic drugs in 2020.

If you are a Medicare patient, you no longer have to pay any costs associated with preventive services that Medicare currently offers. The oldest people in a health insurance plan will pay no more than 3 times the rate paid by the youngest people in the plan.

I don’t have health insurance. Will I have to get it?

Probably. Under the law, most Americans will have to have health insurance by March 31, 2014. If you don’t have health insurance and don’t meet one of the exceptions listed in the law, you will need to pay a penalty. The penalty can be as little as $95 per adult and $47.50 per child (with a maximum penalty of $285 per family per year) or 1% of family income, whichever is higher. The penalty will increase to $695 per adult and $347.50 per child (with a maximum penalty of $2,085 per family per year) or 2.5% of family income by 2016.

American Indians, individuals who have religious objections, and those with a financial hardship can avoid the penalty.

What if I can’t afford health insurance?

Under the law, if you are younger than age 65 and have an income level that is 133% of the federal poverty level, you may qualify for Medicaid. In 2014, 133% of the federal poverty level for an individual is $15,521 and $31,720 for a family of 4. For larger families, incomes can be higher. If you live in Alaska or Hawaii, the amounts will differ slightly. View 2014 federal poverty guidelines to see if you qualify.

States have the option of expanding Medicaid above the federal minimums. Find out if your state is expanding Medicaid.

If you don’t qualify for Medicaid but cannot afford the full cost of health insurance, you may qualify for financial assistance from the government. This financial assistance will help you purchase private health insurance through a state-based health insurance exchange. This exchange will allow you to compare benefits and prices among several insurance plans to decide which one meets your needs. All insurances in the exchange will offer at least a minimum benefit package. They will also offer other coverage options beyond the basic plan. Depending on your income, you will pay from 2% to 9.5% of your income for insurance. The government will cover the rest of the costs.

If your employer does not offer health insurance options, or if you have a small business, you will be able to buy coverage from the health insurance exchange.

I am an adult who has a medical condition. Am I able to get health insurance?

Yes. If you cannot currently get private health insurance because of your medical condition and you have been uninsured for at least 6 months, you have access to a temporary national “high-risk pool.” This pool provides insurance coverage with financial assistance from the government. This will lower your insurance premiums.

The law does not allow health insurance companies to deny coverage to any American citizens or legal residents for any reasons.

I already have health insurance from my employer. Can I keep it?

Yes, many Americans continue to get health insurance from their employers. The law offers options for people who:

  • do not get health insurance at work.
  • cannot afford to buy private health insurance.
  • have lost their jobs.
  • have pre-existing conditions.
  • are small business owners and want to insure themselves and their workers.

Will my insurance premiums ultimately go up?

Maybe. No one knows for sure. The Congressional Budget Office (CBO) estimates that people who are insured by their employers will pay essentially the same rates under the health care reform law that they paid prior to the health care reform law. The cost of insurance may be lower for people who are sick because insurance companies can no longer charge them more than they do anyone else. Insurance premiums may be higher for people who are healthy. Insurance companies may want to even out costs since they cannot deny coverage to people who are sick.

Will my taxes go up?

It depends. People who have a very high income (over $200,000 for an individual and over $250,000 for couples) may pay higher income taxes. The higher taxes help pay for health care coverage for all Americans. People who have lower incomes may receive a tax credit to help them buy insurance.

Other Organizations

Written by familydoctor.org editorial staff

Reviewed/Updated: 02/14
Created: 05/10

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