Health Insurance and the Affordable Care Act (ACA)

Major medical health insurance policies changed when the Patient Protection and Affordable Care Act (PPACA) (often referred to as ACA or Obamacare) was enacted March 23, 2010. The bill itself is 2,700 pages. It is estimated that Congress will generate over 1 million pages of laws to enforce the Affordable Care Act. Needless to say, there is much confusion associated with the Affordable Care Act.

Individual Mandate

A key provision of the ACA is the Individual Mandate. The Individual Mandate "requires" individuals to purchase health insurance whether they want it or not. If they do not purchase health insurance for each member of their family beginning in 2014, they will be subject to a fine each year by the Internal Revenue Service (IRS). The fine increases each year through 2016 when it will be $2,085 or 2.5% of you income which ever is greater. After 2016 the fine increases by the cost-of-living increase.

The IRS is hiring 16.000 new agents to enforce the individual mandate.

There are a limited number of exceptions to the requirement to purchase health insurance. 95% of Americans will be required to purchase either at work or an individual policy if group insurance at work is not "offered". Notice it says "offered". It does not say "offered at a price you like."

For the first time in our country's history, the government is requiring you to buy something whether you want it or not!

Now that we know you "have to have it", let's learn what an ACA compliant major medical policy does for you.

Key components of the ACA policies are:

  • Essential Health Benefits (EHB)
  • Qualified Health Plan (QHP)
  • Guaranteed Issue—Medical history is not considered
  • No annual or lifetime limits on how much the insurance company pays in benefits
  • Medical Loss Ration (MLR)
  • Metallic level plans—Bronze, Silver, Gold, and Platinum
  • Maximum Out-of-Pocket expense (2017) for an individual is $7,150 and $14,300 for a family
  • Young Adult Coverage—Children can stay on parents' plan until 26th birthday
  • Premiums will be the same for males and females (Unisex premiums).
  • Premiums will be the same regardless of you health status (pre-existing conditions do not matter)

See the menu on the left for more information.