Affordable Care Act Changes in 2014
The majority of the changes in the ACA occur in 2014. Check out the list below to see what changes are on the horizon.
Changes for Individuals
- U.S. citizens must have a Qualified Health Plan or pay a fine. There will be exceptions for:
- Financial hardship (if the cheapest available health insurance plan costs more than 8% of your household income)
- No insurance for less than three months. (Example: changing jobs.)
- Religious objection
- Native Americans
- You will be allowed to buy a 'catastrophic' plan if you:
- Fall into one of the exceptions above, or
- Are under age 30
- Your out-of-pocket expenses will be limited.
- People in qualified health plans will not pay more each year than:
- $5,950 per person out-of-pocket, or
- $11,900 per family out-of-pocket
This will increase in future years based on inflation.
- People with incomes near the federal poverty level (FPL) will have even lower out-of-pocket expenses:
% FPL Earned Amount Individuals Pay Amount Families Pay 100-200% $1,983 $3,967 200-300% $2,975 $5,950 300-400% $3,987 $7,973
- Your deductible cannot be more than $2,000/individual or $4,000/family if you buy your insurance as part of a small group.
- You will not wait more than 90 days for coverage.
- You will be able to compare and buy health insurance through your state's exchange.
- You may be able to get a subsidy to help you pay for insurance. If your household income is between 134% and 400% of the FPL, you will get a subsidy. Click here to see a table of the 2011 FPL.
- You will be eligible for Medicaid if your household income is below 134% of the FPL.
- Some hospitals receive extra money from Medicaid. This encourages them to serve people with low incomes. These are called Disproportionate Share Hospitals. This year the extra money will be reduced.
- Each state's Medicare Disproportionate Share Hospital amount will be reduced.
- Medicare Advantage plans must spend at least 85 cents of every dollar of premium it collects on providing health care services. They cannot spend more than 15 cents of every dollar on administrative costs and profits. This is called medical loss ratio.
Changes for Employers
- Employers with 200 or more employees that offer health insurance to their employees must:
- Automatically enroll new, full-time employees in the group health plan with the lowest premium, and
- Give the option to change a different plan if offered, or
- Allow the employee to refuse coverage
- Employers with 50 or more full-time equivalent employees must offer all their employees an affordable qualified health plan. If they do not they may be fined.
- Employers can offer employees rewards up to 50% of the cost of coverage for:
- Participating in a wellness program, and
- Meeting certain health-related standards
- States can offer similar rewards to people with individual health plans.