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Health reform: What you should know

The Patient Protection and Affordable Care Act became law on March 23, 2010, beginning a process that will ensure for the first time in our nation’s history that every American will have access to health insurance.

  • The requirement to have health insurance takes effect in 2014.
  • While almost every U.S. citizen and legal resident will be required to have health insurance, there will be exceptions for people with low incomes, Native Americans and people who cannot participate for religious reasons.
  • After 2014, most people will still be insured the way they are today – through a private plan at work.
  • For six years, small businesses (those with 25 or fewer employees and average annual wages of under $50,000) will get a tax credit of up to 35 percent of the cost of insurance to help provide health insurance to employees. Small nonprofits are also eligible for limited tax credits.
  • After 2014, insurance companies will not be able to turn away anyone who wants to buy health insurance.
  • People who are uninsured in 2014 will be able to buy insurance through a health insurance exchange. Many businesses also will be eligible to buy health insurance through exchanges.
  • Exchanges are health insurance marketplaces set up in each state to help people shop for insurance. Exchanges also will help people enroll in Medicaid and figure out eligibility for insurance premium credits.
  • Premium credits to help with the cost of insurance will be available for people with incomes of less than 400 percent of the Federal Poverty Level ($88,200 a year for a family of four). For help figuring out what your premium rate and premium credit might be, see the Health Reform Subsidy Calculator created by the Kaiser Family Foundation, http://healthreform.kff.org/subsidycalculator.aspx.
  • Tax penalties for people who do not have insurance will be phased in beginning in 2014. After 2016, the penalty will be $695 per person, with a maximum penalty of $2,085 for a family, or 2.5 percent of income, whichever is greater. No one will go to jail for not having health insurance.

Immediate benefits for Coloradans
High-risk pool
Colorado established a high-risk pool, GettingUSCovered, for people who have been uninsured for six months and have a pre-existing condition. There will be limits on how much people can be charged. Check www.GettingUSCovered.org for details.

Coverage for young adults
As of Sept. 23, young adults up to age 26 will be eligible for coverage under their parents’ insurance. That includes young adults who are married andyoung adults not living at home or financially dependents of their parents. The only exception is for young adults who have insurance through their jobsor the offer of insurance. Check with your company for eligibility rules. Eligibility begins at renewal, so not everyone will be able to enroll right away.

Coverage for pre-existing conditions
Pre-existing condition exclusions for children applying for new plans will be eliminated Sept. 23. Adults have to wait until 2014.

Rescission, lifetime and annual caps

  • Rescission is prohibited (except in cases of fraud) as of Sept. 23. Rescission is when a health plan cancels your policy after you get sick.
  • No lifetime coverage limits as of Sept. 23.
  • Annual limits begin to be phased out as of Sept. 23.

Donut hole closing for seniors
Seniors who hit the Medicare “donut hole,” a gap in coverage where beneficiaries must pay the full cost of prescription drugs, will get a $250 rebate in 2010. The donut hole closes entirely by 2020.

Preventive care access increased

  • Starting Sept. 23, new plans cannot require co-payments for preventive services.
  • By January 2011, there will be no copayments for most preventive care in Medicare, and preventive services will be exempt from deductible requirements.

Voluntary long-term care program – the CLASS Act
Beginning January 2011, people can sign up to buy long-term care insurance, paid for through payroll deductions. The insurance will help people stay at home as they get older or if they become disabled.

Health care access in Colorado
Medicaid, Child Health Plan Plus expansions
A new Colorado law made more parents, children and pregnant women eligible for Medicaid and the Child Health Plan Plus as of May 1, 2010. The eligibility groups are: parents of Medicaid-eligible children in families with incomes of less than 100 percent of the Federal Poverty Level, and children and pregnant women in families with incomes up to 250 percent of poverty. The Federal Poverty Level is annual income of $22,050 for a family of four; 250 percent of poverty is an annual income of $55,125 for a family of four.

Contact: Elisabeth Arenales
Health care director
303-573-5669, ext. 302

Originally released April 29, 2010
Updated Sept. 22, 2010

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