Affordable Care Act – What to Expect in 2014

Jan. 30, 2014 – Now that 2014 is here, we’d like to summarize what to expect from the Accountable Care Act this year.

Insurance Exchanges: Health care purchasing exchanges must be operational in every state.

New Health Coverage Options Begin: Millions of Americans have been signing up for health insurance plans since the exchanges opened on October 1, 2013. People who have been successful in signing up can now take advantage of new health plan options and federal subsides.

Individual Health Insurance Mandates: If you are not enrolled in a Qualified Health Plan in either the individual market, or through an employer or other group plan by March 1, 2014, you can expect to pay a penalty of $95 or 1% of your income, whichever is higher, unless you qualify for an exception.

Insurance Subsidies: Premium tax credits and cost sharing reductions kick in for those individuals who are eligible.

Medicaid Expansion Begins: As a result of the Supreme Court ruling, the Medicaid program will be expanded in 2014. As many as 3.9 million additional low income people will now have access to the program.

Annual or Lifetime Limits: Health plans can no longer include annual or lifetime limits on benefits.

Small Business Tax Credits: Small businesses are eligible to apply for a small business tax credit which would help them purchase health insurance for their employees. It is projected that a very small number of small businesses will qualify since the credits can only be used if they buy SHOP exchange coverage which is limited in 2014.

Individual and Businesses will see additional taxes and fees: The new ACA National Premium Tax will cost consumers, fully insured individuals, and group health insurance an estimated $8 billion in 2014 and is expected to reach $14.3 billion by 2018.

Group Health Care Waiting Periods: Employer health plans can only have waiting periods of up to a maximum of 90 days and is effective on the plan year effective date.

Cost Sharing Limits: All group health plans may not have out of pocket costs that exceed the annual Health Savings Account contribution maximum.

Wellness Program Discounts: Employers may now offer a discount of up to 30% for employee participation in an employer sponsored wellness program.

More information regarding these ACA provisions can be found on MBPA’s Health Care Reform Connect website.