Insurance Reforms

The Affordable Care Act Makes large, sweeping changes to the way health insurance it packaged, priced, and delivered.

 

Insurers may no longer rate people based on their health status and must meet certain pricing restrictions

 

Individual Mandate

The individual mandate is a widely recognized provision of the Affordable Care Act. Most individuals are required to purchase insurance or pay a penalty.

 

In 2014, the penalty is of the greather of $95 or 1% of income and becomes greater every year following, maxing out in 2016 at the greater of $695 or 2.5% of income.

 

Subsidies

The Affordable Care Act got its name from the provisions intended to make health insurance coverage more affordable to the majority of the uninsured individuals in the country. The law accomplishies this primarily through two kinds of subsidies: one covers a portion of the premium and one reduces eligible consumers out of pocket expenses.

 

These subsidies; offered exclusively through the Exchange, are only available to qualifying individuals and families who are at 400% of the federal poverty level in 2012, that results in those with an income of less the $45,960 for individuals and less than $94,200 for families of four.

 

Essential Health Benefits

The Affordable Care Act includes a requirement that all non-grandfathered individual and small business insurance plans must cover a certain set of services within 10 categories established by the Institued of Medicine.

 

Ambulatory patient services

Emergency services

Hospitilization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventative and wellness services and chronic disease management

Pediatric services, including oral and vision care

   

In North Carolina, the benchmark plan is BCBSNC plan and covers a comprehensive set of services that all North Carolina health plans must now offer in the individual and small group markets.

   

Health Care Reform 101: The Basics

 
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