Health Care Reform, Premiums, and Costs: FAQ
Q: In 2014, what assurance does health care reform provide that premiums will be affordable?
A: Here's a look at what will happen. For the middle class, tax credits will be made available to help pay for health plans purchased through the health insurance.
If you're an individual making $43,000 or less, or a family of four making less than $88,000 annually, the government will subsidize your insurance premiums. You may also be eligible for reduced co-payments, coinsurance, and deductibles to assist with the cost of coverage. And there will be exemptions for financial hardship.
To find out how much of a subsidy you’ll be eligible for in 2014, input your financial information into the Kaiser Family Foundation’s health reform subsidy calculator.
Q: What is the fine if you don't get insurance?
Right now, there is no fine for going uninsured.
The Affordable Care Act does require all U.S. citizens to get health insurance or face a penalty beginning in 2014. That could change, of course, if the individual mandate, which requires everyone to have health insurance (the most hotly debated aspect of the law) is overturned.
As of now, here's how it breaks down: Starting in 2014, the tax penalty will be $95 and that amount will gradually increase to $695 per year for individuals, $2085 per family, or 2.5% of a household's income, whichever is greater.
Q: Is anyone watching how much of our premiums the insurance companies spend on actual medical care?
A: Yes. Effective Jan., 1, 2011, insurers are required under the law to spend the bulk of the premiums you pay for medical care, rather than for profit, overhead, or administrative costs. Insurance carriers who sell policies to large groups of 50 or more people must spend 85% of premium dollars on medical care and those who sell to individuals and small groups must spend 80%.
The idea, says Anthony Wright, executive director of Health Access California, is to “make sure you get value for your dollar.” Health Access California is a statewide health care consumer advocacy coalition.
Health plans will be required to report to HHS annually about how much of the premium dollars they collected were spent on medical care. If they fall short of the required percentage, beginning in 2012, the companies must refund money to individuals or to employers who purchase insurance on behalf of employees.