As you probably know, some provisions of the Affordable Care Act are already in force, such as the requirement to cover children up to age 26 on a parent’s plan, that plans are not allowed to set lifetime limits on coverage, etc. More regulations have taken, or will take, effect during 2013, with even more taking effect on January 1, 2014 and thereafter. A lot has been written about these changes. We want to highlight some issues you should be aware of now and tell you a little about the Colorado Health Exchange, due to start on January 1, 2014.
In addition to plans offered through health insurance companies in the state, individuals and families will have options under the Colorado Health Insurance Exchange. Small businesses (with fewer than 100 employees) will also have options now, with larger employers (over 100) able to participate in 2017.
The Colorado Exchange should be operational by October 1 of this year, allowing you to compare quotes with plans offered through health insurance companies.
For those who already have coverage through an individual plan or through an employer, you will be able to stay covered with those plans or shop for coverage in the Exchange.
Those who don’t have coverage now will be eligible for coverage three ways: a) through Medicaid (low-income qualifications apply), b) buy coverage through the Exchange with (or without) help paying your premiums through a government subsidy, or c) buy private coverage.
The Exchange will offer four plans (Bronze, Silver, Gold and Platinum) that cover from 60% to 90% of your medical expenses. The specifics of coverage and cost will vary depending on the plan chosen.
Individuals who decide not to buy health insurance will pay a penalty, as required under the individual mandate provision of the law. Beginning in 2014, the penalty will be $95 or 1% of their taxable income, whichever is greater. In 2015 that will increase to $325 or 2%; to $695 or 3% in 2016; with annual adjustments in 2017 and thereafter.
Business owners should be aware of the following more recent regulations impacting health insurance coverage in 2013 and 2014:
- Summary of Benefits and Coverage (SBC): Health plans (whether insured or self-insured) must provide a Summary of Benefits and Coverage. The SBC provides information about plan benefits and coverage in an easy-to-read format. This rule is already in effect for plans with open enrollments on or after September 23, 2012.
- Employers must provide employees with a written notice about the mandated health insurance exchanges by October 1, 2013, or before if they choose. When approved, the notice must inform employees: a) that the exchanges exist and what services they provide, b) how to qualify for a tax credit on the premiums they pay, c) explain why they may pay less for coverage if their health plan doesn’t meet certain requirements, and d) explain the risk of losing any employer contributions toward the cost of coverage.
- In 2014, the employer mandate provision of the law will require businesses with at least 50 workers to pay a penalty of $2,000 per employee if they don’t offer “affordable” coverage to employees. There is no penalty for the first 30 employees, however the penalty does apply to the rest of the full-time workforce.
- For plan years beginning on or after January 1, 2014, heath plans (both insured and self-insured) will not be allowed to impose pre-existing condition exclusions on any covered individual, regardless of age (this is already in effect for those under age 19). This also applies to individual or family plans.
In addition to the original 906 pages (as enacted) of the Affordable Care Act, the amount of regulations coming out of Washington has been described as an “avalanche” by those who have to sort through all that are now being finalized.
At HealthQuotes.com, we will do our best to help you find answers to questions you may have regarding the many facets of this new law. For more information on the Colorado Health Insurance Exchange, see: coloradohealthinsuranceexchange.us and this guide.
HealthQuotes.com remains committed to providing affordable health insurance to our fellow Coloradans, whether individuals, families or businesses.