Affordable care act

By law, all individuals will be required to carry health insurance coverage. Those who are uninsured for three or more months will pay a penalty during the 2015 tax filing season. Each state is required to provide a Health Benefit Exchange to provide access to affordable health insurance coverage to individuals who are unemployed, who are not offered insurance by their employer or who cannot afford private insurance.
Small businesses will also have the opportunity to participate and receive tax credits for extending benefits to employees. Employers with fewer than 25 full time employees may be eligible for tax credits if the business pays at least 50 percent of the employee’s premium. To qualify the average annual wage for the employees must be under $50,000. Qualifying businesses can earn a 35 percent tax credit on all health insurance premiums paid for employees since 2010, with the credit increasing to 50 percent in 2014.
In New York State, the NY State of Health is the Official Health Plan Marketplace, where New Yorkers can shop for, compare and enroll in health insurance coverage. New York residents will have a choice of health plans and can receive help determining which plan is the right fit. The Marketplace will officially open on Oct. 1, 2013 with coverage taking effect Jan. 1, 2014.
Provisions included in the Affordable Care Act (ACA)
The Affordable Care Act is more than a mandate for all individuals to have health insurance. It also brings several changes to the health insurance industry and provides expanded benefits to individuals.
Prior to the ACA, insurance companies were able to deny coverage if an individual had a pre-existing condition or if the individual had exceeded a lifetime benefit cap. “If you have a pre-existing condition you cannot be disqualified from insurance,” Buxton explained, “and  there will no longer be a lifetime benefit cap. If a five year old child contracts cancer, the cost of surgery, care, etc would blow past a lifetime benefit by age 7 and never be eligible for insurance again.” That scenario will no longer be possible.
Preventative care visits, cancer screenings and other services will now be provided with no co-pay. “It is encouraging people to take care of problems ahead of time before they become a big problem,” she added.
Under the new law, young adults will also benefit. Parents are now able to carry their children on their own health insurance until their 26th birthday. In the past, coverage for many ran out well before then. Health care will also be more affordable for individuals between 26-30 who may be in school or searching for employment. “The Affordable Care Act is making insurance more available to young people who often don’t have it,” she said.
The ACA also adds additional protections for individuals who with denied claims. In the event a claim is denied, the individual can take the claim to a neutral medical party for further investigation and to petition for coverage of the denied services.
Insurance providers must meet minimum standards set by the government. Individuals will have the opportunity to choose between four levels of coverage: Bronze, Silver, Gold and Platinum. Eligibility will be determined by overall household income, which must be less than $50,000 a year. “Currently, an individual living in Albany, earning $17,000 a year spends $905 a month on health insurance (if not provided by the employer),” she explained, “starting January 2014, that individual would pay $57 per month in premiums.”
Even though there will be an influx of individuals seeking insurance, premiums are expected to drop. How is it possible to add 2.8 million people to the insurance system and have premiums drop? “Right now there are a lot of sick people on the government dole,” she explained, “when you add healthy people who pay a little bit, you are actually paying less per person.”
The Federal government projects a 66 percent decrease in rates. “That may be extreme,” Buxton admits, “but there has been a pretty consistent reduction in premiums of 30-40 percent in states like California and Massachusetts, where they have already instituted the benefit exchange system,” she said.
More information about the Affordable Care Act and the New York Health Exchange is available at healthbenefitexchange.ny.gov. Or you can call Washing County Cornell Cooperative Extension agents, Sandy Buxton at 518-380-1498, Kirk Shoen or Ashley Pierce at 518-272-4210.

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