Reforms to Insurance Coverage and Insurance Marketplace
The Affordable Care Act includes many provisions that expand coverage and reform the private health insurance market.
Improving Coverage:
Pre–existing Conditions
The new law prevents insurers from denying coverage to children and adults with pre–existing conditions, as well as eliminates lifetime and annual limits on insurance coverage. The Pre–existing Conditions Insurance Plan will provide new coverage options for high–risk uninsured until 2014 when insurers will start offering coverage to any person regardless of pre–existing conditions.
Guaranteed Issue/Guaranteed Renewability
Beginning January 1, 2014, insurers must offer health care policy and renewal of coverage to any person wishing to purchase it, whenever they need it.
Modified Community Rating
Insurers may not set premiums based on the health status of an individual. Premiums can vary only due to tobacco use, wellness program participation, age and geographic location of the insured individual.
Health Insurance Market Reforms:
Employer Responsibilities
Starting in 2014, larger employers will face penalties for not offering affordable coverage to their employees. Smaller employers may qualify for tax credits to pay toward employees' premiums. Read more about penalties and tax credits you might qualify for as a practice owner.
Individual Mandate
Starting in 2014, each individual is required to buy health insurance or face a tax penalty. Read more about the individual mandate penalties.
State Insurance Exchange
Individuals and small business will be able to buy coverage through an organized marketplace, called a State Insurance Exchange. Read more about essential health benefits and subsidies offered via State Insurance Exchanges.
References
- P.L. 111 – 148, Sec. 1101, 2702, 2703, 2707, 2705. 1302, 1421, 1501–1502, 1511–1515.
- McDonough JE. Inside National Health Reform. University of California Press. 2011.
- AMA. Improving the Health Insurance Marketplace. Strategies to foster healthy markets. Overview. Published online: http://www.ama-assn.org/resources/doc/market-reforms/strategies-to-foster-healthy-markets.pdf
- The White House. The Affordable Care Act — Implementation Timeline. Available at: http://www.whitehouse.gov/healthreform/timeline
- Lo Sasso AT. Community rating and guaranteed issue in the individual health insurance market. National Institute for Health Care Management (NIHCM). January 2011. Available at: http://nihcm.org/pdf/EV-LoSassoFINAL.pdf