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Affordable Care Act: What You Need to Know

If you're planning to sign up for health insurance under the ACA, here's a quick rundown of what you need to know.
The Affordable Care Act must cover these essential services: 

ALL INSURANCE POLICIES AND PLANS MUST COVER THESE 10 HEALTH TOPICS:

1. Ambulatory (outpatient) services

2. Emergency room and transportation

3. Hospitalization such as surgery or illness. (Number one cause of medical bankruptcy)

4. Maternity, delivery, and newborn baby care

5. Mental health services (includes counseling and psychotherapy)

6. Prescription drugs

7. Laboratory services

8. Pediatric services

9. Rehabilitation services and devices.

10. Preventative and wellness care

**Under the new law, adult policies cannot be denied or cancelled for any reason.

YOU DO NOT NEED TO PURCHASE COVERAGE IF YOU ALREADY HAVE INSURANCE THROUGH:

1.   Your employer

2.   Medicaid or CHIP

3.   Medicare

4.   Veteran's health programs or Tricare

5.   Private insurance that meets certain requirements

6.   An approved, grandfathered plan from before ObamaCare.

 

YOU DO NOT NEED TO PURCHASE COVERAGE IF YOU ARE:

1.  An undocumented immigrant

2. A prison inmate

3.  In a religious group which is opposed to accepting health insurance

4. A member of a Native American tribe

5. Too poor to file a tax return ($10,000 single, $20,000 family)

6. Paying more than 8% of income for health insurance, minus employer credits


PENALTIES FOR BEING UNINSURED

2014      2015       2016

Adult               $95        $325       $695

Child               $47.50   $162.50  $347.50

Family*           $285      $975       $2,085

Penalties increase yearly for cost-of-living adjustments after 2016

*Family penalty is greater of: $285 or 1% of family income for 2014,

                                                             $975 or 2% of family income for 2015,

             $2,085 or 2.5% of family income for 2016


A COMPENDIUM OF LITTLE-KNOWN FACTS ABOUT OBAMA CARE, in no particular order:

Already in effect:

·     Increases the rebates on drugs that people get through Medicare

·     Allows the Food and Drug Administration to approve more generic drugs

·     Compels chain restaurants, like McDonalds, to display calorie charts

·     Forbids insurance companies from discrimination based on a disability or because an applicant is the victim of past domestic abuse

·     Creates a new 10% tax on indoor tanning booths

·     Insurers can no longer drop customers once they get sick

·     Insurers must explain to customers exactly what they spend money on

·     Creates a "high-risk pool" for people with pre-existing conditons.  Eventually all pre-existing exclusioins will be eliminated

·     No more pre-existing conditions for children under the age of 19

·     Insurers can no longer enforce a "lifetime limit" on coverage

·     Children can be covered on their parents' health insurance until age 26

·     Insurers must establish an appeal process for denied claims

·     Insurers have less ability to change the amount they charge for plans

·     New plans must provide preventative care (for mammograms, colonoscopies, etc.) without requiring any co-pay or additional charge

·     Employers must list the coverage benefits they provided to employees on their end-of-year tax forms

·     Anti-fraud funding is increased and new measures to stop fraud are created

·     Medicare patients with chronic illnesses must be monitored more closely

·     Limits are placed on insurance companies to limit possible price gouging

·     A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs.

·     If you make over $200,000 per year your taxes have gone up 0.9%.

·     Obamacare will increase Individual Market Insurance Premiums by 99% for men and 62% for women.  Forbes Magazine, 9/25/2013

·     Obamacare regulations are eight times longer than the Gutenberg Bible

·     The Central Valley has been designated as a medically underserved area.  The San Joaquin Valley has fewer primary care doctors and medical specialists than anywhere in the state except for San Bernardino-Riverside.

Effective January 1, 2014:  (Very big changes begin)

·     No more "pre-existing conditions" at all.  Customers will be charged the same regardless of their medical history

·     The "mandate" kicks in.  If you can afford insurance but did not get it, you willl be charged a fee (or tax, or fine).  The Supreme Court says its a tax and therefore is Constitutional.

·     Medicaid can now be used by everyone up to 133% of the poverty line

·     Businesses with over 50 employees must offer health insurance to full-time employees or pay a penalty. 

·     Full-time employee is now defined as working 30 or more hours per week.

·     Insurers can no longer cap annual spending.  Customers may get as much health care in a given year as they need.

·     Places a $2,500 limit on health savings accounts.  Amounts over $2,500 per year will be taxed.

·     A new tax on pharmaceutical companies.

·     A new tax on purchase of medical devices. (pending review or repeal)

·     A new tax on insurance companies based on market share.  The more market share they control, the more they will be taxed.

·     The amount deductible from taxes for medical expenses will increase.

Effective January 1, 2015:

·     Doctors' pay will be determined by the qualityof their care, not how many people they treat.

Effective January 1, 2017:

·     States can come up with their own health care plans.  If better than PPACA, they can ask permission to install them.

Effective in 2018:

·     All health care plans must now cover preventative care.

·     A new, heavier tax on "Cadillac" health care plans.

Effective in 2020:

·     Elimination of the "Medicare gap."


ESSENTIAL INFORMATION PORTALS, SITES, NUMBERS AND FACTS:

www.HealthCare.gov   Main government website for Health Care information

www.Obamacarefacts.com Administration information clearinghouse site

www.coveredca.com  Covered California website

Information Telephone 1-800-300-1506

Telephone TTY  1-888-889-4500





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