The ACA in 2014

What to expect from the ACA in 2014: covering the individual mandate, pre-existing conditions, preventive services, and more...



What to Expect from the ACA in 2014

Individual Mandate

If you don't have health insurance by March 31st, you'll have to pay a penalty for 2014; the greater of $95 or 1% of your income - and the penalty goes up over the following years. However, there are exceptions to this, the most notable being if your plan was canceled by your insurance carrier. President Obama has said that if you want to keep your plan, you can keep it. So when carriers started dropping plans because they didn't meet all the requirements of the ACA, people felt misled. Therefore, a hardship exemption has been put in place for those whose plans were canceled. The exemption allows those affected to purchase catastrophic plans, regardless of age, or to avoid carrying insurance altogether in 2014 without being subject to the penalty.

Pre-Existing Conditions

As of January 1st, insurance carriers can no longer deny coverage, limit coverage or charge more based on pre-existing health conditions.

Preventive Services

Preventive services like wellness checks and cancer screenings will not cost you anything out-of-pocket.

Medicaid Expansion

Twenty-six states expanded Medicaid eligibility, meaning that if your income is low (138% of poverty - about $16K for an individual and about $32K for a family of 4), they government will pay for all of your insurance costs. Utah was the most recent state to get on board with the ACA's Medicaid expansion; Governor Herbert made the announcement on January 23rd. Details about Utah's program are currently being decided during the ongoing legislative session, but the Governor said that turning down the ACA incentive - nearly $4 million each month in Federal funds - was simply not an option for Utah. Medicaid expansion was one of the key provisions of the ACA, but the Supreme Court ruled that States could refuse expansion.

Employer Mandate

Employers have been granted a delay of the Employer Responsibilities provisions until 2015, but that doesn't mean employers should do nothing in 2014 to prepare. Employers who employ around 50 employees, especially if those employees work variable hours or seasonally, should be tracking hours to determine if they will be considered liable under the employer mandate. Our clients have access to data-driven lookback reports, and can use the info to make important decisions about their business.

The shortcomings of when it launched last October have been well-documented. But over the last several months, the president's administration has presumably worked out the website's kinks. The site still has a lot to prove over the next few months of open enrollment, but things seem to be improving and officials say over two million people have enrolled to date.


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