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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Insurance Costs: FAQ

I smoke. Can a company charge me more for health insurance?

Yes. Starting in 2014, insurance companies can charge you up to 50% more for premiums than someone who doesn't use tobacco.

On the other hand, smoking-cessation programs are one of the benefits that all health plans sold on a state's Marketplace must offer.

I've heard that I might get a rebate from my health plan if it doesn't spend enough on health care. Is that true?

Yes. Health plans must now spend at least 80% of the premiums they charge customers on:    

  • Medical care
  • Steps to improve the quality of care

If they spend less than this percentage, health insurance companies have to send out rebates to customers.

However, employers who are self-insured don't have to follow this rule. A self-insured employer is a company that collects premiums from its workers and then pays the workers' medical claims itself.

I take good care of my health. Can I start getting preventive services free of charge?

Yes. You may now be able to get a number of preventive treatments and services without an out-of-pocket payment.

Out-of-pocket payments are medical costs that you have to pay on your own, often through a copay or coinsurance payment. A copay is a set amount you have to pay for a health service that's covered by your insurance plan. For instance, each time you see a doctor you may pay $15, and your health plan pays the rest of the charges. Coinsurance is the amount you pay for a covered health service that's usually a percentage of the full cost. For instance, you might pay 20% of the cost when you see a doctor and your health plan pays the rest.

Preventive services that your insurance will pay for include:

You may need to see an in-network provider in order to get these services at no cost. You can get preventive services before you've paid your complete deductible, but in some cases you may have to pay for an office visit, such as a copay or coinsurance.

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