Access to quality health care for you and your family is influenced by a number of factors that include your insurance status, income, race, gender, age, and where you live. One of the goals of the Obama Administration in passing the Affordable Care Act (the Act) is to address inequities or special considerations in these areas to increase the number of people who are insured and make comprehensive and affordable coverage available to more people.
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Dr. Peter L. Duffy explains the nature of the employer’s responsibility to provide coverage under the Affordable Care Act.
According to the 2009 census, 50.7 million Americans do not have health insurance. More than half of those who do have insurance are covered by group plans offered and paid in whole or part by their employers. But having a job does not guarantee health insurance coverage. About 39 million of those who are uninsured have at least one employed person in the family. But employers are not required to offer health insurance, and even if they do, that doesn't mean all their employees are eligible or can afford their portion of the premiums. Deductibles can also be very high and out of reach for many people.
It can also be difficult for small businesses, the self-employed, and people who have recently lost their jobs to afford coverage, especially if they have pre-existing conditions that prevent them from qualifying for individual insurance policies.
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Losing your job doesn’t necessarily mean losing your health insurance coverage, too. Dr. Peter L. Duffy explains your options under the Affordable Care Act.
For many Americans, federal, state, and local governments provide health care services and coverage through the Medicare and Medicaid programs, but again, not everyone is eligible.
One goal of healthcare reform is help those who want health insurance coverage to find ways to get it, pay for it, and benefit from comprehensive care that includes preventive services. To accomplish this goal, provisions of the Affordable Care Act were written to expand coverage to 32 million more American by:
- increasing the number of people covered by Medicaid,
- creating a competitive marketplace for comparing and buying coverage, and
- raising the age limit to 26 for adult children covered by their parents' insurance plans.
Medicaid is a state administered assistance program that uses federal and state funds to pay medical bills for
- low-income pregnant women,
- children under the age of 19,
- people over 65, and
- those who are blind, disabled, or who need nursing home care.
Combined with the benefits of The Children's Health Insurance Program (CHIP), which provides coverage for more than 7 million children up to age 19, low-income children are often covered even though their parents and individuals without children are not covered at all.
The Act will increase the number of people covered by Medicaid by including adults without children and raising the maximum income you can earn before being eligible for Medicaid. Current income requirements for Medicaid vary from state to state but that will change when the new healthcare provisions go into effect. Beginning January 1, 2014, no matter where you live, your state will be required to provide benefits to eligible beneficiaries who make less than 133 percent (approximately $14,000 for an individual and $29,000 for a family of four) of the Federal Poverty Level (FPL).
State Insurance Exchanges
Another way the Affordable Care Act expands coverage in 2014 is to offer a marketplace where private insurance companies will compete for your business. These state marketplaces will make it easier for you to review and compare plans, creating an incentive for insurance companies to keep premiums low and more competitive with other plans, including group plans.
So, if you aren't already covered by insurance through your employer, Medicare, or Medicaid-say, for example, you are self-employed or between jobs-the marketplace will help you find affordable, comprehensive coverage that includes preventive care.
The Act also provides for subsidies and tax credits to help individuals and small businesses afford health insurance coverage. If your family income is between 100 percent and 400 percent of the federal poverty level (approximately $10,830 to $43,000 for individuals and $22,050 to $88,000 for a family of four, according to 2010 guidelines) you may qualify. These tax credits will lower your total tax bill, but they can also be used before tax time to reduce your premium payments, copayments, co-insurance, and deductibles.
Small businesses, or employers with fewer than 50 employees, can also benefit from tax credits up to 35 percent (25 percent for small nonprofits) of their contribution to their employees' health insurance coverage. In time these percentages will increase to 50 percent (35 percent for nonprofits). It is estimated that up to 4 million small businesses qualify for these credits, so it's definitely worth investigating to see if you qualify.
Individuals and small business owners still unable to afford coverage may be eligible for sliding scale subsidies. The Henry J. Kaiser Family Foundation offers a handy tool for calculating your eligibility for subsidies based on income level, age, family size, and regional costs.
Under the new law, you still have the option to go without health insurance. However, beginning in 2014, if you as an individual or employer with more than 50 employees can afford coverage but choose not to get it, you may be charged penalties or fines.
Coverage for Adult Children
Prior to passage of the Act, most health insurance policies covered children on their family's health insurance policies until they turned 18 or 19, or 22 or 23 if the child went on to attend full-time college after high school.
As of September 23, 2011, or January 1, 2011, depending on when your plan year begins, your adult children, which may include stepchildren, adopted children and foster children, can join or remain on your family policy or group plan up to age 26. Your child does not have to be in school, live at home, be single, or qualify as a dependent. With some exceptions prior to 2014, your adult children can stay on your policy even if they can get health insurance through their employer.
Some carriers have already agreed to extend the coverage for these young adults without waiting for the new provisions to take effect. But if they don't, you may face an expensive gap in coverage. You might want to check with your insurance company to find out for sure.
The following resources offer more information about healthcare reform and your options for finding affordable care with or without federal and state assistance.