There’s no question that health care reform and the Patient Protection and Affordable Care Act (ACA) are hot button issues and polarizing topics. You can hardly escape a conversation about health insurance without hearing statistics, mandates, delays, and costs thrown around like absolute truths—regardless if they are actually true or not.
If you are anything like the majority of businesses, you are likely burdened with the responsibility of helping your employees understand how the ACA affects them and their health insurance needs. The information surrounding health care reform seems to be endless and confusing, so we’ve compiled a list of three things your employees need to know about health care and how it directly affects them and their families.
1. There are penalties for not purchasing insurance.
If your employees have the notion that they can simply ignore this law without any consequence, they are mistaken. Health insurance is officially a mandate, and if they choose to forego purchasing health insurance—whether it is through your organization or through the Health Insurance Marketplace—there are monetary penalties that they will be required to pay. After March 31, 2014, individuals that do not have health insurance will be required to pay a fine of the greater of $95 or 1% of their income. The penalty will increase each year, and by 2016, the uninsured will experience a penalty of the greater of $695 or 2.5% of their income.
According to Consumer Reports, families without health insurance coverage by March 31, 2014, face even steeper penalties—$95 per person and $47.50 per child under 18, or up to $285. By 2016, this penalty will increase to $2,085 or 2.5% of their income.
2. Eligibility requirements for tax credit subsidies differ.
When it comes to subsidies and lower-cost premiums, there may be misinformation circling around the office water cooler. In general, a person must fall within one of the following categories in order to qualify for a tax credit subsidy on health insurance purchased through the Health Insurance Marketplace:
Their employer does not offer a compliant health insurance plan, and they fall within the following income ranges:
$11,490 to $45,960 for individuals
$15,510 to $62,040 for a family of 2
$19,530 to $78,120 for a family of 3
$23,550 to $94,200 for a family of 4
$27,570 to $110,280 for a family of 5
$31,590 to $126,360 for a family of 6
$35,610 to $142,440 for a family of 7
$39,630 to $158,520 for a family of 8
They do not qualify for Medicaid
They do not qualify for Medicare
To get an idea if they are eligible for subsidized coverage on their health insurance, your employees can enter their household information into this Subsidy Calculator.
3. All insurers will cover preventative care and annual checkups at 100%.
One of the central goals of health care reform is to reduce the cost of health care by giving individuals access to regular check-ups for primary and preventative care. When your employees invest in their health by regularly meeting with their primary care physician and taking preventative steps to avoid complex conditions that can be difficult and costly to treat, they save themselves, their insurer, and you money. In order to encourage annual check-ups and preventative care such as immunizations and cancer screenings, the health care reform law requires that all health plans cover 100% of the cost for preventative care and annual check-ups, without any cost sharing by the employee.
This feature of the ACA ensures that your employees have full access to preventative and wellness visits through whichever health care plan they have in place. Encourage your employees to take advantage of this aspect of the ACA; they benefit by remaining informed on the status of their health, and you will reap the benefit of a healthier workforce.
As the laws and regulations in the ACA evolve—and they will—it will be important that your organization keeps your employees informed about how the laws affect them, their families, and their wallets. Health care is no longer a discussion that can only take place once a year, and your employees will likely look to you as the “expert” in how the law affects them and their health care coverage.