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The Affordable Care Act or "Obamacare"


Did you know that under the Affordable Care Act health plans cannot deny coverage to children under the age of 19 simply because those children have a pre-existing condition? (a pre-existing condition is an illness that the child developed before the child applied to join the plan.

Until now, plans could refuse to accept anyone because of pre-existing health conditions, or they could limit benefits for that condition.  Now, under the health care law, plans that cover children can no longer exclude, limit or deny coverage to your child under age 19.  This rule applies to all job-related health plans as well as individual health insurance policies issued after March 23, 2010.  The rule affected your plan as soon as it began on or after September 23, 2010.

The pre-existing condition rule does not apply to “grandfathered” individual health insurance policies.  A grandfathered individual health insurance policy is a policy that you bought for yourself or your family and is not a job-related health plan.

Starting in 2014, these protections will be extended to Americans of all ages.  Coverage for adults may be available under the Pre-Existing Condition Insurance Plan.

Below are some key features of the Affordable Care Act


Open enrollment in the Health Insurance Marketplace is supposed to begin October 1, 2013.

In 2014, All Americans will have access to affordable health insurance options.  The Marketplace will allow individuals and small businesses to compare health plans on a level playing field.  Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage.  And the Medicaid program will be expaned to cover more low-income Americans.  

Also in 2014, new consumer protections will be implemented.




·Prohibiting Discrimination Due to Pre-Existing Conditions or Gender.The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status.Effective January 1, 2014.

·Eliminating Annual Limits on Insurance Coverage.The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.Effective January 1, 2014.

·Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial. Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.




·Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014.


·Establishing the Health Insurance Marketplace. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too.


·Increasing the Small Business health insurance Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees. There is also up to a 35% credit for small non-profit organizations. Effective January 1, 2014.



·Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014.

·Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans. If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014.


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