Voter Guide: Health Reform Overview
Help Paying for Insurance
The law provides:
- Tax credits for people with incomes that are between 138% and 400% of the poverty level (up to $92,200 annually for a family of four in 2012).
- Coverage for more people under Medicaid, the state and federal health insurance program for people with low incomes. An individual that makes less than $15,415 or a family of four that earns less than $31,809 will be eligible.
States have the option to expand their Medicaid program and cover more people. People living in states that don’t expand Medicaid may not be eligible for Medicaid coverage.
New Health Insurance Markets
Each state is required to have an American Health Benefits Exchange, an online market where people without access to affordable employer coverage can shop for a health plan. Each state will also have a separate exchange for small employers to buy insurance.
Requires Most Businesses to Cover Employees or Pay a Penalty
Businesses with more than 50 full-time employees must offer health insurance to their employees or pay a penalty. The penalty fee will be $2,000 per full-time employee.
New Requirements for Private Insurance
The law requires insurers to comply with new regulations. Starting in 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 have already been put in place:
- 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.
- There is guaranteed insurance coverage for children under the age of 19 with pre-existing health conditions. This guarantee will expand to all people with pre-existing conditions in 2014.
- Drug discounts are available for people on Medicare.
- 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.