Affordable Care Act

57Brave

57Brave

Well-known member
a helpful repost from tumblr:

During the past week, many of my fellow American following me here have asked me about Obamacare (the Affordable Care Act), so I decided to do an info post with some of the general information about the upcoming changes to health care. The official government website for this legislation is a bit of a mess to navigation and, while I appreciate trying to give uninsured Americans all the information about this new law, it’s a little bit of data overload. For COMPLETE and SPECIFIC information about how this law will effect you, I suggest going to Healthcare.gov. This post is meant as introduction with general information which, frankly, the Obama administration has done a poor job of conveying to the American public … unless, of course, Obama’s Tumblr reblogs this.. then…forget I mentioned it.

Who does this law effect?
Americans who are currently uninsured or those who are currently buying their coverage directly from insurance providers.

What if I have health insurance through my job? How does it effect me?
First of all, lucky you for having a job that provides health insurance. You can pretty much stop reading this post and go reblog more cat gifs because this law will not change a damn thing in your life.

Okay, so I need some basic info on what kind of coverage I can get…
Health insurance providers will break down coverage into five categories: Catastrophic, Bronze, Silver, Gold and Platinum. The difference between the categories is mainly how much you will pay out of pocket for insurance with, the Platinum category having the most expensive monthly rate and Catastrophic category being the least inexpensive monthly rate. Most of these categories have subsidies to help pay for these monthly premiums if you qualify.

Great. Catastrophic is the cheapest … SIGN ME UP!
Hold on. The catastrophic plan comes with more restrictions than the other plans. First, you will only qualify for this plan if you are under 30 or if you have a limited income (if you make too much to quailfy for medicare, but not enough to pay monthly premiums of other plans). Also, a catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. However, 3 primary care visits per year and some limited preventive care is covered by the plan with no out of pocket cost to you.

So, I’ve decided on a plan, what exactly does it cover?
By law, all categories must cover the following essential health care: 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; and pediatric services, including oral and vision care.

But…how do I pay for this? I need a little help. The premiums are still too high.
Well, if you are an individual making between $11,490 to $45,960 a year, then you will qualify for tax subsidies to help shoulder the monthly costs. Tax subsidies are also avaliable for families. Visit Healthcare.gov for specific income ranges. It depends on how large your family is.

I think I make less than $11,000… what now?
You may qualify for your State’s medicare program which offer no cost or low cost coverage. Medicare is also expanding in certain States, so I’d advise you to check with your State’s medicare website.

Blerg, I don’t want to enroll in any healthcare plan. I know it’s mandatory but… come at me, government…
There is a penalty to those who do not enroll in any healthcare plan. The fee in 2014 is 1% of your yearly income or $95 per person for the year, whichever is higher. The fee increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher. And, of course, if you get into some car accident or become sick, you’ll have to pay for all of your healthcare yourself. Good luck with that.

How do I get the ball rolling on this?
Starting on October 1, 2013, health care exchanges will be open so you can sign up and see EXACTLY how much healthcare plans will cost and if you qualify for subsidies. Once you sign up for coverage, your insurance will kick in starting January 1, 2014. Open enrollment ends on March 31, 2014. If you haven’t signed up for coverage by this deadline, you won’t be able to get health coverage through the Marketplace until the next annual enrollment period, unless they have a qualifying life event. Also, if you haven’t signed up for health coverage by deadline, you’ll be subjected to the penalty (see above).

Great, I need more information, where can I find it?.
Many states have their own websites with specific information for their residents. General information can be found at Healthcare.gov.
https://www.healthcare.gov/

Here are States that have their own websites for the Affordable Care Act.

California
Colorado
Connecticut
District of Columbia
Hawaii
Idaho
Kentucky
Maryland
Masschusetts
Minnesota
Nevada
New Mexico
New York
Oregon
Rhode Island
Vermont
Washington

If you do not see your State listed here, you can apply for coverage at the federal government’s official website over here.
https://www.healthcare.gov/how-do-i-apply-for-marketplace-coverage/

Wow, this post is useful. Why are your other posts so useless…
Hey, now. I love Canadian cop dramas, okay! I just hope this helps some of you. This is my attempt at being Bill Clinton, honorary secetary of explaining stuff.
 
57Brave said:
What if I have health insurance through my job? How does it effect me?
First of all, lucky you for having a job that provides health insurance. You can pretty much stop reading this post and go reblog more cat gifs because this law will not change a damn thing in your life.
Click to expand...

I did stop reading here.

Because it's BS and I knew the rest of the article would be as well.

My company is already making major changes based on the law, and I'm paying for it. For starters, my company was forced to offer a low quality, basic insurance plan for non-salaried and contractor workers. And to help pay for that, the rest of our premiums have increased. My premiums for this year were doubled, and there are rumors of doubling again next year.

So don't come in spouting that nonsense. Did you see what the Cleveland Clinic just did?
 
That seems to be a popular refrain " I did stop reading here."

www.theatlantic.com/politics/archiv...ng-away-jobs-cleveland-clinic-edition/279834/

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If you don't mind a suggestion -- learn how the program works since it will be affecting how you deal with your personal health. Perhaps you learn how it works you will see your boss needn't have to raise your rates -- just maybe -- learn how it works -- that is all the article above is saying.

Please don't cut off your nose to spite your face
 
Should have just done single payer instead if wasting a full generation on this bad idea of a bridge
 
I agree but they didnt and this is what we have to deal with.

Shoot --- look how hard it was to get any kind of reform run through the insurance companies -- the idea of a wholesale "socialist" plan being put into law is just laughable -- there wouldn't even be what good has come out of this.
A half a loaf is better than no loaf. I think Ben Franklin said that
 
goldfly said:
Should have just done single payer instead if wasting a full generation on this bad idea of a bridge
Click to expand...

Single payer or something like it. sturg33 is right in that the money to pay for the coverage to the uncovered has to come from somewhere and it's coming in fees to businesses and individuals instead of a straightforward tax. Payday for the consultants.

I thought the Republican plan of the early-1990s suggested in reaction to the Clinton proposal has always been the way to go. Require individuals to have coverage with premiums based on the plan chosen and an income-based sliding scale. My addition to that would be if the insurance industry doesn't go along, put in a public option.
 
57Brave said:
Who does this law effect?
Americans who are currently uninsured or those who are currently buying their coverage directly from insurance providers.

What if I have health insurance through my job? How does it effect me?
First of all, lucky you for having a job that provides health insurance. You can pretty much stop reading this post and go reblog more cat gifs because this law will not change a damn thing in your life.
Click to expand...

This law effects everyone. To say it only effects those that are uninsured is misleading at best and a lie at worst. It will effect every single person in this country.

Secondly, it also effects those that have a job with health insurance. My insurance is going up and probably going to double when it's all said and done. This law sucks. If this law were so good, congress and their staffs would be participating in the law instead of having exemptions. I have no way to exempt myself from this debacle, it's so kind of those in congress to take care of themselves and their staffs but screw the rest of the country.
 
the portion of the law you speak of doesn't even go into affect for 5 days.
So how do you or anyone know what is going to happen or the effects a year from now? I go back 10 years to the bi-partisan drug bill -- the general consensus you and others are feeding from thought it a rousing success -- well -- not quite

If your insurance doubles you don't understand the process. If your boss is raising your premiums your boss is cheating you
the law is very clear on who pays what and under what circumstances. Of course things will not be like they are today. Change is funny like that
Funny thing is if you google the effects of ACA you get two pages of links to people that have been wrong at every turn the past 25 years - on every subject and every event. From the war to cash for clunkers, the bail out of the auto industry to the above drug bill to strategies to overthrow this law. Of even more recently their criticisms of Obama over Syria. If this law is such a catastrophe why does draw such political ire? There are many indications learned opponents to this law fear it will be a success and will leave people satisfied
How is Massachusetts fairing under virtually the same program?

Tell me about the donut hole? Is that portion of the bill that went into affect a year or two ago working?
What about preexisting conditions-- ?
What about those with health care that have lost their jobs and would have lost their insurance until new employment was found?
Or even the move to paperless documentation?
How is ACA working for those people?
Why if those portions are getting the ball moving why would you so strongly doubt the success of the latest increment instead of take a wait and see approach?

I too would prefer single payer -- but we didnt get that - we got this. !/2 loaf vs whole loaf.
 
57Brave said:
the portion of the law you speak of doesn't even go into affect for 5 days.
So how do you or anyone know what is going to happen or the effects a year from now? I go back 10 years to the bi-partisan drug bill -- the general consensus you and others are feeding from thought it a rousing success -- well -- not quite

If your insurance doubles you don't understand the process. If your boss is raising your premiums your boss is cheating you
the law is very clear on who pays what and under what circumstances. Of course things will not be like they are today. Change is funny like that
Funny thing is if you google the effects of ACA you get two pages of links to people that have been wrong at every turn the past 25 years - on every subject and every event. From the war to cash for clunkers, the bail out of the auto industry to the above drug bill to strategies to overthrow this law. Of even more recently their criticisms of Obama over Syria. If this law is such a catastrophe why does draw such political ire? There are many indications learned opponents to this law fear it will be a success and will leave people satisfied
How is Massachusetts fairing under virtually the same program?

Tell me about the donut hole? Is that portion of the bill that went into affect a year or two ago working?
What about preexisting conditions-- ?
What about those with health care that have lost their jobs and would have lost their insurance until new employment was found?
Or even the move to paperless documentation?
How is ACA working for those people?
Why if those portions are getting the ball moving why would you so strongly doubt the success of the latest increment instead of take a wait and see approach?

I too would prefer single payer -- but we didnt get that - we got this. !/2 loaf vs whole loaf.
Click to expand...

Bookmarked.
 
Small businesses

Starting in 2014, employers with up to the equivalent of 50 full time employees — those working 30 hours or more — are not required to offer health insurance to full-time employees and are exempt from any penalties, according to the Small Business Administration website.

To encourage those employers to provide insurance, the Affordable Care Act created the Small Business Health Options Program. Businesses with fewer than 25 employees that choose to provide insurance anyway, are eligible for a tax credit to offset the cost.

SHOP allows small employers to pool their risk and get a better rate. In 2016, SHOP will be opened up to businesses with up to 100 employees.

The small business Health Care Tax Credit is targeted to those employers with low- and moderate-income workers. Businesses that have fewer than 25 full-time equivalent employees, pay average annual wages below $50,000, and that pay at least 50 percent or employees’ insurance premiums may qualify for the tax credit.

The tax credit will cover up to 35 percent of the costs of insurance. In 2014, it will go up to 50 percent and will be available to qualified small employers that participate in SHOP.

Large businesses

Businesses with more than 50 full-time employees will face a penalty for not providing affordable health care to employees starting in 2015.

Most large employers already offer health insurance but there are still two provisions that insurance must meet.

Under the act, if any employee has to pay more than 9.5 percent of their income to get the coverage offered by their employer, it is deemed unaffordable and the business would be fined.

The plan also must pay for at least 60 percent of covered health care expenses.

Those companies will be fined $2,000 per year for each full-time employee. The business will receive a credit and not be fined for

30 of those employees it does not cover. Every employee over that 30- person threshold not provided coverage will result in a fine.

For example, a company with 60 uninsured employees will pay a penalty of $60,000 per year for not providing coverage. The fine could increase each year if premiums increase.

http://bismarcktribune.com/news/loc...cle_fec309b8-2495-11e3-bb35-001a4bcf887a.html
 
Employers with Up to 50 Employees
Key Provisions Under the Affordable Care Act for Employers with Up to 50 Employees

Implementation of the Affordable Care Act occurs in stages, with many of the reforms and requirements taking effect in 2013 and 2014. Some of the provisions that may impact employers with up to 50 employees include:

Small Business Health Options Program (SHOP)

Starting in 2014, small employers with generally up to 50 employees will have access to the new health care insurance marketplaces through the Small Business Health Options Program (SHOP). Currently, small businesses may pay on average 18% more than big businesses for health insurance because of administrative costs. SHOP will offer small employers increased purchasing power to obtain a better choice of high-quality coverage at a lower cost. Costs are lowered because small employers can pool their risk. To enroll, eligible employers must have an office within the service area of the SHOP and offer SHOP coverage to all full-time employees. In 2016, employers with up to 100 employees will be able to participate in SHOP. HHS recently launched a new Call Center specifically to serve small businesses with 50 or fewer employees interested in the SHOP Marketplace. For more information, call 1-800-706-7893 (TTY users: 1-800-706-7915) from Monday through Friday, 9 a.m. to 5 p.m. EST.

Employer Notice to Employees of the New Health Insurance Marketplace

Under the Affordable Care Act, employers covered by the Fair Labor Standards Act (generally, those firms that have at least one employee and at least $500,000 in annual dollar volume of business), must provide notification to their employees about the new Health Insurance Marketplace; inform employees that they may be eligible for a premium tax credit if they purchase coverage through the Marketplace; and advise employees that if they employee purchase a plan through the Marketplace, they may lose the employer contribution (if any) to any health benefits plan offered by the employer. Employers are required to provide this notice to all current employees by October 1, 2013, and to each new employee at the time of hire beginning October 1, 2013, regardless of plan enrollment status (if applicable) or of part-time or full-time status. The Department of Labor has provided employers with two sample notices they may use to comply with this rule, one for employers who do not offer Download Adobe Reader to read this link content a health plan and another for employers who offer a health plan Download Adobe Reader to read this link content for some or all employees. For more information refer to DOL’s Technical Guidance.

Summary of Benefits and Coverage (SBCs) Disclosure Rules

Employers are required to provide employees with a standard “Summary of Benefits and Coverage” form explaining what their plan covers and what it costs. The purpose of the SBC form is to help employees better understand and evaluate their health insurance options. Penalties may be imposed for non-compliance. For more information, refer to this completed sample of the SBC form Download Adobe Reader to read this link content from the U.S. Department of Labor.

Medical Loss Ratio Rebates

Under ACA, insurance companies must spend at least 80% of premium dollars on medical care rather than administrative costs. Insurers who do not meet this ratio are required to provide rebates to their policyholders, which is typically an employer who provides a group health plan. Employers who receive these premium rebates must determine whether the rebates constitute plan assets. If treated as a plan asset, employers have discretion to determine a reasonable and fair allocation of the rebate. For more information on the federal tax treatment of Medical Loss Ratio rebates, refer to IRS's FAQs.

Limits on Flexible Spending Account Contributions

For plan years beginning on or after January 2013, the maximum amount an employee may elect to contribute to health care flexible spending arrangements (FSAs) for any year will be capped at $2500, subject to cost-of-living adjustments. Note that the limit only applies to elective employee contributions and does not extend to employer contributions. To learn more about FSA Contributions, as well as what is excluded from the cap, refer to this document Download Adobe Reader to read this link content provided by the IRS.

Additional Medicare Withholding on Wages

Beginning January 1, 2013, ACA increases the employee portion of the Medicare Part A Hospital Insurance (HI) withholdings by .9% (from 1.45% to 2.35%) on employees with incomes of over $200,000 for single filers and $250,000 for married joint filers. It is the employer’s obligation to withhold this additional tax, which applies only to wages in excess of these thresholds. The employer portion of the tax will remain unchanged at 1.45%.

New Medicare Assessment on Net Investment Income

Beginning January 1, 2013, a 3.8% tax will be assessed on net investment income such as taxable capital gains, dividends, rents, royalties, and interest for taxpayers with Modified Adjusted Gross Income (MAGI) over $200,000 for single filers and $250,000 for married joint filers. Common types of income that are not investment income are wages, unemployment compensation, operating income from a non-passive business, Social Security Benefits, alimony, tax-exempt interest, and self-employment income.

90-Day Maximum Waiting Period

Beginning January 1, 2014, individuals who are eligible for employer-provided health coverage will not have to wait more than 90 days to begin coverage. The IRS has provided temporary guidance Download Adobe Reader to read this link content on how employers should apply the 90-day rule and is expected to provide more information in the near future clarifying these rules.

Transitional Reinsurance Program Fees

The Transitional Reinsurance Program is a three-year program, beginning in 2014 and continuing until 2016, that reimburses insurers in the individual insurance Marketplaces for high claims costs. The program is funded through fees to be paid by employers (for self-insured plans) and insurers (for insured plans). The U.S. Department of Health and Human Services estimates that the fees for 2014 will be $5.25 a month (or $63 for the year) for each individual covered under a health care plan, with the required fee for the following two years to be somewhat lower. The fee applies to all employer-sponsored plans providing major medical coverage, including retiree programs. The U.S. Department of Labor has advised that for self-insured plans, these fees can be paid from plan assets. The IRS has stated that the fees are tax deductible for employers. HHS is expected to provide more information in the near future clarifying the details of this program.

Workplace Wellness Programs

The Affordable Care Act creates new incentives to promote employer wellness programs and encourage employers to take more opportunities to support healthier workplaces. Health-contingent wellness programs generally require individuals to meet a specific standard related to their health to obtain a reward, such as programs that provide a reward to employees who don’t use, or decrease their use of, tobacco, and programs that reward employees who achieve a specified level or lower cholesterol. Under final rules that take effect on January 1, 2014, the maximum reward to employers using a health-contingent wellness program will increase from 20 percent to 30 percent of the cost of health coverage. Additionally, the maximum reward for programs designed to prevent or reduce tobacco use will be as much as 50 percent. The final rules also allow for flexibility in the types of wellness programs employers can offer. For more information and to view the final rules, visit www.dol.gov/ebsa.

Health Insurance Coverage Reporting Requirements

Beginning with health coverage provided on or after January 1, 2014, employers that sponsor self-insured plans must submit reports Download Adobe Reader to read this link content to the IRS detailing information for each covered individual. The first of these reports must be filed in 2015. The IRS is expected to provide more information in the near future clarifying these requirements.

Find Insurance Options

Find and compare health plans for your employees.

Timeline of Provisions

The Affordable Care Act timeline provided by the U.S. Department of Health and Human Services includes the next steps you can take to implement the provisions.
 
This program seems well organized except for the whole delaying of everything for a year except of course the individual mandate. I also enjoy seeing the IRS not able to account for $67 million. Nice to see they're on top of things and there won't be any government waste.
 
Saw something this morning that made me laugh for a few minutes then get quiet and sad.

When asked, more Americans opposed Obamacare versus The Affordable Care Act.

46% of Americans say they oppose Obamacare.
37% of Americans say they oppose the Affordable Care Act.

Quite comical, and quite sad.

At least we know what "news" channel that 9% is watching. No wonder Fox News brags about their ratings so much.
 
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