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Q: How Does The New Federal Healthcare Law Affect Me?

2013 April 1

There are many elements to the new federal healthcare law, known as the Patient Protection and Affordable Care Act (PPACA) and, in some cases, the final regulations have not been released yet by the Dept. of Health & Human Services.  Many changes have already occurred, such as Health plans no longer having maximum lifetime benefit limits, mandatory preventative care services and the inclusion of dependent children in plans up to age 26.  However, the most significant changes go into effect 1/1/14 and includes what has been called the “individual mandate”.  This requires most consumers to purchase health insurance which meets a benefit standard set by the Federal Government or be subject to a penalty.

If your Employer provides Group Health Insurance benefits, it is likely that your plan will meet the mandate requirement since there are guidelines that Employers must follow that are based on benefit design and affordability or they would be subject to penalties.  If your Employer does not provide Health Insurance, then you will be required to purchase a plan and provide proof of coverage to avoid penalties.  Your Employer is also required, if offering a Health plan, to have the Employee contribution for single coverage not to exceed 9.5% of their wages or they could be subject to penalties.

Plan options for individuals and small businesses are still being developed but PPACA requires the establishment of Health Insurance Exchanges in each state that will provide an outlet for individuals and families who do not receive benefits from their employer.  Currently there are four plans expected to be offered and these will meet the requirements of the individual mandate.

As of 1/1/2014 Insurance Companies can no longer limit, exclude or deny coverage or charge higher premiums on pre-existing health conditions so, access to a plan is not limited any longer by your health. In addition ACA establishes subsidies to help individuals and families afford this expense.  The subsidies vary by income level and are intended to help those between 133%-400% of the poverty
level limit their costs to 3-9% of their adjusted gross income.  The 400% level presidents a family of four earning approximately $92,000 per year.

There are several other elements of PPACA going into effect 1/1/2014 with many provisions effecting Employer plans. You can visit for more details.  We will update this posting as more information is made available.