Individual and Employer Coverage Mandates (2014)
Individual Requirements:The Affordable Care Act requires most individuals to obtain acceptable health insurance coverage or they will be subject to a penalty beginning in 2014. In 2014, the penalty is $95 per adult and $47.50 per child, with a maximum penalty of $285 per family, OR one percent of family income, whichever is greater. In 2015, the penalty is $325 per adult and $162.50 per child, with a maximum penalty of $975 per family, OR two percent of family income, whichever is greater. In 2016 and beyond, the penalty is $695 per adult and $347.50 per child, with a maximum penalty of $2,085 per family, OR 2.5 percent of family income, whichever is greater. If your income is below 150 percent of the Federal Poverty Level, you are considered unable to afford health insurance, so you will not pay a penalty if you do not obtain coverage. If you are able to purchase coverage using less than 8 percent of your annual income, you are deemed able to afford insurance coverage. In some cases, hardship waivers are available if you can afford coverage but have other pressing financial needs.
Employer Requirements for those who DO NOT offer coverage: The Affordable Care Act requires that employers with 50 or more employees who do not offer health insurance coverage to their employees pay a penalty if one employee receives a government subsidy for coverage. The penalty amount could be up to $2,000 annually for each full-time employee.
Employer Requirements for those who DO offer coverage: The Affordable Care Act requires that employers who do offer health insurance coverage but whose employees receive tax credits pay a fine of $3,000 for each worker receiving this tax credit. Employers will be required to report to the federal government employees who opt out of coverage.
Health Insurance Marketplaces (2014)
The Affordable Care Act requires that Health Insurance Marketplaces be established in each state. Individuals and small employers will be able to enroll in health insurance plans through the Marketplace. Small employers are defined as those with no more than 50 employees. Larger employers will be able to enroll through the Marketplace in 2017.
Expansion of Medicaid (January 1, 2014)
For those states that choose to expand Medicaid within their state, Medicaid eligibility will expand to 133% of the Federal Poverty Level offering those unable to afford health care coverage an option through Medicaid. Currently, state Medicaid programs range greatly and many do not offer coverage for childless adults. States will receive 100% federal funding for the first three years to support this expanded coverage, transitioning to 90% percent federal funding in subsequent years.
Increasing the Small Business Tax Credit (January 2014)
Second phase of the small business tax credit will be implemented for small business and small non-profit organizations. In this phase, the credit is up to 50% of the employer's contribution to provide health insurance for employees. There is a 35% credit for small non-profits.
Premium Insurance Tax Credits (January 2014)
Individuals with income between 100%-400% of the Federal Poverty Level will be eligible for tax credits to make it easier to afford insurance. The tax credit is advanceable, so it can lower your premium payment each month, rather than making you wait until tax time. It is also refundable, so even moderate-income families can receive the full benefit of the credit. They may also qualify for reduced cost-sharing such as co-payments, co-insurance and deductibles.
Premium Subsidies (2014)
Premium and cost-sharing subsidies will make health insurance more affordable for those with an annual income between 133% and 250% of the Federal Poverty Level and who purchase insurance coverage through their state's marketplace.
Clinical Trial Coverage (January 1, 2014)
Insurers must provide coverage to an individual who chooses to participate in a clinical trial. The insurer is prohibited from dropping or limiting coverage if an individual chooses to enroll.
Eliminating Annual Limits (January 1, 2014)
Prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive for care.
Elimination of Pre-Existing Condition Exclusions (January 1, 2014)
Prohibits insurance companies from refusing to sell or renew health insurance policies because of an individual’s pre-existing health condition. It also eliminates the ability for an insurer to charge higher premium rates due to gender or health condition.