Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) has arrived with fanfare, challenges and no small degree of uncertainty. As we get closer to the March 31 mandatory enrollment deadline and implementation of the ACA continues, individual and business clients will naturally have questions going forward. Most of us are concerned or unsure about what to do mainly because of the difficulties that have marked the rollout of the new health care law.

Following, are some basics of what the ACA is all about, including coverage requirements and individual and employer mandates.

What Is the ACA?
The ACA opened the door for all Americans to have access to health insurance. The exchange created by the ACA is the platform for the sale and purchase of health insurance from private insurance companies, such as Blue Cross Blue Shield, United Health, AETNA and others.

The online portal to this new marketplace can be found at The six-month window from October 1, 2013 to March 31, 2014 is the first open enrollment period for coverage under the ACA.

The ACA establishes a number of important changes to health insurance in the United States…

  • no annual lifetime limits to benefits
  • insurance companies can no longer deny coverage based on pre-existing conditions
  • changes for employers: a 90-day maximum waiting period for employees to qualify for employer-provided coverage.

In addition to expanding benefits, ACA…

  • limits how much a family or individual will spend out of pocket on expenses each year
  • most plans must meet new ACA standards for minimum coverage, and only those plans that are maintained in their original form are grandfathered, therefore, many current plans will not be continued.

Four basic plan levels…
Each plan will have their own various levels of premium costs, deductibles and amounts paid by the insurance company and the consumer.

  • Bronze
  • Silver
  • Gold
  • Platinum

A fifth catastrophic plan covers the minimum requirements with the maximum high deductible and the same out-of-pocket limits as a health savings account: $6,350 in 2014. Note: this is available only to people under 30 years of age.

To encourage participation in the health insurance marketplace, the ACA institutes a series of penalties, tax credits and subsidies.The ACA has also set a number of requirements for employers.

Our firm can assist business and individual clients regarding these issues and the changes impacting your unique health care issues.