The Affordable Care

Act

What It Means For You and Your Family

What We’ll Cover:

What Is the Affordable Care Act

How Will the Affordable Care Act Impact Health Coverage Choices and Options

Your Call To Action

What is it?

Affordable Care Act:

The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010.

The name “Affordable Care Act” is used to refer to the final, amended version of the law.

On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.

http://www.healthcare.gov/glossary/a/affordable-care.html

Who is Affected?

• American citizens• American nationals• Aliens legally

present

What’s Coming?

Coming in 2014 Individuals must have basic coverage also known as Minimum Essential Coverage;

Or be eligible for a qualifying exemption;

Or pay a shared responsibility cost on annual income tax.

What is Minimal Essential Coverage?

Minimum Essential Coverage:

The type of coverage an individual needs to have, to meet the individual shared responsibility requirement under the Affordable Care Act.

Individual Shared Responsibility

• Everyone shares responsibility under the Affordable Care Act

• Each individual must ensure they have minimum essential coverage

• All individuals are included regardless of age – everyone must have coverage or an exemption, or must make a payment on individual income tax

What Qualifies as Minimal Essential Coverage?

• Employer sponsored coverage including COBRA, and retiree coverage plans

• Coverage purchased in the individual insurance marketplace

• Medicare Part A• Medicaid• Peach Care for Kids• Children’s Health Insurance Program (CHIP)• Some veterans’ health coverage plans• TRICARE

What’s Not Required for Minimum Essential Coverage?

• Vision Only Plans

• Dental Only Plans

• Workers Compensation Plans

• Special Coverage for Specific Conditions

What Is a Qualifying Exemption?

• Religious Conscience• Health Care Sharing

Ministry• Indian Tribes• No Filing Requirements• Short Coverage Gap• Hardship• Unaffordable Coverage

Options• Incarceration• Not Lawfully Present

How to Qualify For An Exemption

• Certificate through Health Insurance Marketplace if seeking exemption based on religion or hardship.

• Elect status on income tax return if seeking exemption due to legal status, low income, affordability or coverage gaps.

• Choose either method (certificate or tax return) if seeking exemption based on health care sharing ministry, incarceration or member of an Indian tribe.

• If you are not required to file income taxes you are automatically exempt and do not need to be certified by the exchange.

Health Insurance Marketplace

What Do You Need To Do?

If you have coverage and are happy with your coverage you don’t need to take any action.

What Do You Need To Do?

• If you do not have coverage

• If you want to explore your options

• If you plan on terminating your current coverage

Health

Insurance

Marketplace

What Do You Need To Do?

Open enrollment begins October 1, 2013

Coverage begin on Jan 1, 2014

How Much Will This Cost?

• Many people/families will be able to qualify for free or low cost insurance

• Others may be eligible for a tax credit to reduce the cost of premiums

Free and Low Cost Options

• Private Insurance Options• Medicaid• Children’s

Health Insurance Program (CHIP)• Community

Health Centers

Free and Low Cost Options

• Private insurance options• Insurance finder tool to help you identify

options that are affordable www.healthcare.gov• Low premiums• Low out-of-pocket costs• Coverage for pre-existing health conditions

• Network of community health centers that provide preventive and primary care for free or on a sliding scale.

• American Indians and Alaska Natives may be eligible through the Indian Health Services program www.ihs.gov

Tax Credits

• Tax credit for eligible individuals can be applied right away to lower monthly premiums

• Application for tax credit can be completed during open enrollment

• Eligibility based on income and family size

Medicaid Expansion

Beginning in 2014 most adults under age 65 with income less than $15,000/year will qualify for Medicaid in every state

Medical Loss Ratio Rebates

Insurance companies must spend at least 80% of premium dollars on medical care, or they must provide a rebate to policy holders at the end of the year.

Other Changes

• Flexible Spending Accounts (FSA) contributions limited by the government to a $2,500 max

• High income earners ($200,000 single or $250,000 married) saw a 0.9% increase in Medicare withholding in 2013

• Beginning in 2013 there is a 38% Medicare tax being assessed on certain types of investment income

More About WLS

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Recommended Resources

http://www.healthcare.gov/index.html

http://www.medicaid.gov/