Medical Professionals

 What Ahead in 2014 for the Affordable Care Act in Utah?

Even though Affordable Care Act (ACA) implementation has been bumpy, it will continue — and 2014 will prove to be a pivotal year. Much of the law’s major provisions take effect next year, and yes, there are likely to be more delays or problems.

Here’s a look at what’s ahead in 2014 for Affordable Care Act (ACA)

The Individual Mandate
Beginning Jan. 1, 2014, Americans must buy health insurance from a private insurance provider or through a public program. While the glitch-marred exchange website debuted in October 2013, individuals must have insurance by Jan. 1 in order to comply with the new regulation. The penalty for failing to do so is either $95 or 1 percent of a person’s income — whichever is higher.

Most Utahn’s Are Unaware of ACA Enrollment Deadline
More than half of Americans (55 percent) still don’t know that the deadline to sign up for health insurance under ACA is March 31, according to a Bankrate.com report released Monday. Confusion over the deadline was highest among the 18-to-29 age group, those who make less than $30,000 annually, and those without college degrees.

About one in four Americans (24 percent) incorrectly think the deadline already passed on Jan. 1. And 11 percent think they have until Dec. 31 to sign up, a full nine months after the deadline. Though it’s no secret Americans have been confused by the law’s details, it’s surprising so many aren’t sure of the deadline when those who miss it will pay a tax penalty under the law and be forced to wait until next year’s open enrollment to get insurance -- unless they experience a qualifying event such as marriage in the interim.

In 2014, the penalty is $95, or 1 percent of a person’s income, whichever is higher. The penalty escalates in subsequent years. Further potentially hindering the law’s success is the fact that many Americans aren’t taking the deadline to sign up for the ACA seriously. Most Americans don’t realize they’ll be “Locked-Out” of the Marketplace if they don’t enroll before March 31st.  Most American think they can get sick, and then sign-up for coverage, which I not true!  If you miss this initial “Open-Enrollment” period the next opportunity for you to purchase cover won’t be until November 2014, and the policy won’t become effective until January 1st, 2015.

Brokers and Agents Play a Bigger Role than Ever Before
Did you know you don’t pay any more when you use a Broker or Agent?  You pay the same rate as if you had gone straight through the carrier.  So why not get free unbiased advice to ensure you purchase the right Utah health insurance plan that meets your unique needs. This is an unprecedented time; things are more complicated than ever when it comes to purchasing health insurance for your family. In numerous cases I’ve seen monthly health insurance premium costs as much as a mortgage payment, so don’t go it alone.  A decision of this financial importance demands experience that you can only get when you use a Broker, or Agent.

Market Reforms
Affordable Care Act (ACA) includes a bevy of market reforms — the most notable being that carriers will have to cover people with pre-existing conditions. Others include prohibiting lifetime limits, defining small employer groups as between 1–100 employees (some states can define as 50 employees until 2016), and limiting annual deductibles to $2,000. Brokers and agents point to ACA’s edict on modified community ratings as a major factor in potential increases in the cost of plans. The ACA mandates a 3:1 community rating, while some states are as high as 8:1. Carriers also will not be able to charge more for women.

Tax Credits Begin
Because of the individual mandate, the ACA also includes tax subsidies for individuals to help them afford the cost of health insurance. However, the tax credits are dependent on annual income and access to private plans. Determining if you qualify for a tax-credit or premium subsidy can be confusing.  Oftentimes the effort and time put forth to get the tax-credit is greater than the credit itself.  So before you put a lot of time and effort into completing a Marketplace application to determine your tax-credit let us help you determine if it’s even worth your time.

Medicaid Expands
Medicaid — the state-federal program that provides health coverage for the poor — will expand to cover individuals whose incomes are 133 percent of the federal poverty level. Some states have opted not to take part in the Medicaid expansion.  Utah is one of the states the opted out, and decided not to take the Medicaid expansion.

Healthcare Co-ops
Co-ops will be allowed to compete for consumers on the exchanges. An Oct. 22 story in the Washington Post, however, reported some co-ops are in trouble and might not have enough funding to adequately begin operations. In some states, though, co-ops have launched. Here in Utah “Arches Health” is one of the new created co-ops.

Minimum Essential Health Benefits
All health insurance policies must adhere to standards set forth under ACA.  People who’ve lost policies in 2013 and those who will continue to lose coverage in 2014 will do so because their existing plans don’t meet 10 minimum standards mandated under ACA.  The Minimum Essential Health Benefits requirement is another huge cost driver attributed to increased costs for ACA plans.  No everyone has to pay for “maternity coverage” whether you need it or not.  To see more of the Minimum Essential Health Benefits you’re going to be paying for in 2014 please see below:

The Minimum Essential Health Benefits Include:

·         ambulatory patient services

·         emergency services

·         hospitalization

·         maternity and newborn care

·         mental health and substance use disorder services, including behavioral health treatment

·         prescription drugs

·         rehabilitative and habilitative services and devices

·         laboratory services

·         preventive and wellness services and chronic disease management

·         pediatric services, including oral and vision care

Waiting Periods Defined
Also starting Jan. 1, the waiting period for people to sign up for health insurance will be set by the ACA. Waiting periods of more than 90 days will be prohibited for all health plans. However, this provision mainly affects businesses and industries that experience high turnover.

For navigating the Utah Health Insurance Marketplace please contact Bret Harding, or Utah Insurance Solutions.   Visit: www.UtahInsuranceSolutions.com