Voter Guide: Health Reform Overview
Help Paying for Insurance
The law provides:
- Tax credits for people with incomes that are between 100% and 400% of the poverty level (up to $47,000 for individuals and $97,000 annually for a family of four in 2016).
- Coverage for more people under Medicaid, the state and federal health insurance program for people with low incomes. An individual that makes less than $16,242 or a family of four that earns less than $33,465 will be eligible Medicaid in the states that expanded their Medicaid program.
State Health Insurance Marketplaces
The health insurance Marketplace is a new way to find health coverage. It lets you compare the costs and benefits of different plans.
Each state has a Marketplace. The federal government oversees the Marketplaces in some states, while other states run their own. All plans sold on the Marketplace must include 10 essential health benefits:
- Outpatient care
- Emergency care
- Prenancy, maternity, and newborn care
- Mental health and substance use treatment
- Prescription drugs
- Rehabilitative and habilitative care
- Laboratory services
- Preventive and wellness services
- Pediatric care, including vision and dental
In addition to offering standardized benefits, Marketplace plans must fit into one of four “tiers” based on how much of your medical expenses are covered:
- Platinum - on average covers 90% of your medical expenses
- Gold - on average covers 80%
- Silver - on average covers 70%
- Bronze - on average covers 60%
Requires Most Businesses to Cover Employees or Pay a Penalty
Businesses with more than 50 full-time employees must offer affordable health insurance to their full-time employees or pay a penalty. The penalty ranges from $2,160 to $3,240 per full-time employee.
New Requirements for Private Insurance
The law requires insurers to comply with new regulations. Since 2014, insurers cannot charge people who are older more than three times what a younger person pays. They can only charge one and a half times more for people in various geographic areas or who use tobacco.
Other consumer protections include:
- Consumers have the right to appeal an insurer’s decision.
- Preventive care is available to people with private insurance and Medicare with no out-of-pocket costs, including copayments, coinsurance, or deductibles.
- People with pre-existing conditions can no longer be denied health insurance or charged more for their premiums based on their medical history.
- Insurers can no longer impose lifetime limits on health insurance spending.
- Insurers are subject to a review of suspected unreasonable insurance rate increases.
- Insurance companies must spend at least 80% of the money they collect on medical expenses, rather than on marketing or executive salaries.
- Young adults can stay on their parent’s health insurance plan up to the age of 26.