One of the key measures of the new health reform law is that it will ultimately extend coverage to millions of Americans without health insurance. Here's a rundown of the benefits that will become available to the uninsured and when each will be implemented.
Everyone
Starting Jan. 1, 2014
- Insurance becomes a must. Central to the Patient Protection and Affordable Care Act is extending health insurance to millions of Americans who currently aren't covered. As a result, most people will be required to buy insurance or pay an annual fee - a maximum of $695 for individuals and $2,250 for families. Low income and religious beliefs may exempt you from this mandate.
- Health insurance exchanges. Health insurance exchanges will provide a marketplace where small businesses and people who don’t get health insurance through their employer can shop for plans. The exchanges will offer health care consumers the full range of both private and public health insurance options available to them in their state.
- Help paying for coverage. If you’re an individual making $43,000 or less, or a family of four making less than $88,000, the government will subsidize premiums - the monthly payment you make to insurers for coverage - for health plans purchased through health insurance exchanges so that coverage is more affordable. You’ll be required to pay anywhere from 2% to 9.5% of your income for health insurance, and the government will pick up the rest. Reduced copayments, coinsurance, and deductibles may also apply to assist with the cost of coverage. In addition, the new law states that the cost of premiums can be no more than three times as expensive for older people than for younger people.
- Offering choice/options. If your employer offers insurance, but you’ve gone without benefits because your share of the coverage is too expensive, relief is in sight. The government will allow you to apply the dollar contribution your employer would have made toward insurance to help pay for a more affordable plan in the newly established health insurance exchanges.
People With Health Conditions
Already in effect:
- Coverage for the medically uninsurable. In July, new high-risk pools offering health insurance to people with pre-existing medical conditions unable to gain coverage on their own in the private market (this is for people who do not get insurance from their employer) kicked into gear. In order to qualify, you must be without insurance for six months. You’ll also have to demonstrate that you’ve applied for, and been denied, insurance in the private market. To apply for coverage in your state’s high-risk plan, check with your state's department of insurance for an application.
Starting Jan. 1, 2014:
- Insurers can’t deny coverage based on health status. The days of insurers denying consumers the opportunity to buy health care coverage because of a pre-existing medical condition are numbered. Once implemented, insurers will have to sell an insurance policy to everyone, and, they’ll be banned from charging more for that policy based on health status or sex.
Young Adults and Children
Starting Sept. 23, 2010:
- Kids with pre-existing conditions can’t be denied. Insurers can no longer deny care related to a pre-existing health condition for kids younger than 19. This applies to new and grandfathered plans in the group market (grandfathered plans are those that were already in place when health care reform was passed in March 2010). It doesn't apply to people who have existing plans they bought on their own in the individual market.
- You can stick with mom and dad. Adult children who don’t have insurance through a job of their own can now stay on their parents’ health plan until age 26.
Some insurers offered this benefit immediately upon health reform being passed, but others have left young adults in limbo, says Carrie McLean, consumer specialist with eHealthInsurance.com.
“We’re seeing a lot of people now [for whom] group insurance has lagged between when kids graduated college and group insurance allowing them to continue on their plans. Open enrollment is typically end of year for a Jan. 1 effective date. We’re seeing a lot of kids now who are in that window,” McLean says.
Retirees Not on Medicare
Already in effect:
- Early retiree coverage. People who retire and give up employer-sponsored health insurance before they are old enough to qualify for Medicare are often left without affordable health plan options. Until the health exchanges launch in 2014, businesses willing to extend coverage to workers (and their dependents) who retire between age 55-65 will be reimbursed by the government to offset the cost of doing so.
Businesses aren't required to offer this coverage. The government has made public a list of employers currently participating in the Early Retirement Reinsurance Program, which began in June. You can check healthcare.gov to see if your employer is among them.
Low Income
Already in effect:
- Expanded Medicaid coverage. As of April, states can receive additional federal matching funds by expanding eligibility for some low-income families who were not able to get coverage before.
Coming in October 2013:
- Expanded coverage for Children’s Health Insurance Program (CHIP). CHIP programs provide low-cost health insurance for children in families who earn too much income to qualify for Medicaid, but can’t afford to buy health insurance on their own. Due to health reform, states will receive additional funding in order to maintain and expand coverage for millions of children who are currently uninsured.
Each state runs its own CHIP program. You can find information about the program where you live at InsureKidsNow.gov.
Coming in January 2014:
- Increased access to Medicaid. States will receive additional funding from the federal government to cover the cost of extending Medicaid benefits to include a wider range of people. If you’re an individual making $14,000 per year or a family of four earning $29,000 or less (133% of the poverty level) starting in 2014, you’ll qualify.