1-Individual mandate-U.S. citizens and legal residents are required to have qualifying health insurance. There is a phased-in tax (or penalty?) for those without coverage, with a few exemptions.
2-Pre-existing conditions eliminated-Individual and group health plans can no longer deny coverage or impose pre-existing exclusions for any person of any age. This does not include grandfathered individual plans. This provision is also known as guarantee issue.
3-Essential benefits-Individual and group plans must provide the essential benefits package, including coverage for hospitalization, emergency room, ambulatory patient services, maternity and newborn care, mental health and substance abuse, prescription drug, rehab, lab services, and preventive care. Deductible will be limited to $2000 for individuals and $4000 for families in the small group market, although some proposed rules allow for some wiggle room there.
4-Rating restrictions-Insurance companies can no longer base premiums on health status, claims history, or gender. The only factors allowing for rate increases are age, geography, family size, and tobacco use, which only allows a 50% increase.
5-Merged markets-the states are allowed to merge the individual and small groups if the state deems it appropriate.
6-Cost sharing limits-the out of pocket maximums are the same as those applicable to HSA plans under IRS code. For 2014, the max is $6,050 for self only plans and $12,100 for family coverage.
7-Wellness programs-employers can offer employees rewards of up to 30%, potentially increasing to 50%, of the cost of coverage for participating in the wellness program and meeting certain health standards.
Well I hope this clarifies things a little. If you are confused or concerned about what is to come, you are certainly not alone. I recommend that you consult with a trusted advisor that is professionally required to keep updated on this constantly changing world of healthcare reform. All of the above changes will begin implementation in 2014, but do not expect the storm to settle by then. Different changes will continue to be phased in through 2017 and the insurance companies will continue to scramble to understand and follow the laws as they roll out. The most important thing for us as individuals is to educate ourselves as much as possible in order to make the right decisions for ourselves, our families, and our businesses. Despite all the turmoil and uncertainty, I am confident in a prosperous future provided that we make well-informed decisions and strive to live healthier lifestyles.
About this Author: Marc Roethel has roughly seven years experience in helping the self-employed and small business owners to obtain affordable health, life, accident, and disability insurance. He also help retirees to obtain quality medicare benefits, supplements, and final expense insurance. He currently has contracts with over 60 insurance companies, allowing him to access the best possible solutions for his clients. He also helps individuals and business owners in planning for a secure, long, and prosperous retirement.