Health Care Reform Resources
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Health Care Reform Frequently Asked Questions
- My child is under 26 years of age. When will I be able to get him or her on my plan?
As of September 2010, insurance companies are required to let your child stay on your plan until age 26. This law applies to all plans in the individual market, new employer plans, and existing employer plans, unless your child has an offer of coverage through his or her own employer.
- My child has a pre-existing condition. When will I be able to buy insurance for him or her?
As of September 2010, insurance companies are no longer allowed to deny health care coverage to your child because of a pre-existing condition. This applies to all new employer plans, new plans in the individual market, and existing employer plans.
- I have a pre-existing condition. When will I be able to buy insurance?
When the health insurance exchanges open in 2014, insurance companies will no longer be allowed to deny adults health care insurance because of a pre-existing condition. To help people who have been uninsured for six months or more and have a pre-existing condition, health reform invests $5 billion to create high-risk pools this year. These high-risk pools will make temporary coverage available to people with pre-existing conditions until 2014.
- Is it true that health reform will require everyone to buy insurance?
Most people will be required to have health insurance starting in 2014. If you like the insurance you have now, you can keep it. After 2014, if you do not have health insurance and do not qualify for an exemption, you will pay a penalty of $95 for 2014; $325 for 2015; and $695, or up to two percent of your income, in 2016. The penalty will be capped at the cost of the average premium of the most basic plan sold in your state’s new health insurance exchange. Families that do not have health insurance and do not qualify for an exemption will pay half the penalty amount for children. Possible penalties are capped at a maximum $2,250 per family.
The requirement for most people to buy health insurance is essential to keeping the cost of health insurance premiums affordable. Right now, the average American family’s insurance costs are inflated by about $1,100 to subsidize the cost of care for the uninsured.
- Will I go to jail if I don’t buy health insurance?
No. Health reform specifically prohibits the IRS from confiscating your assets or imposing criminal penalties of any kind - including jail time - if you don’t have health insurance.
- I am a small business owner. How do I know if I get a tax credit?
As of January 1, 2010, small businesses with up to 25 employees that choose to offer health care coverage can get tax credits of up to 35 percent of the premiums they pay to cover their workers. In 2014, the value of this credit will increase to 50 percent of premiums.
Your business qualifies for the credit if you cover at least 50 percent of the cost of health care insurance for your workers, pay average annual wages below $50,000, and have fewer than 25 full time employees. The credit is offered on a sliding scale, so that it is targeted toward smaller businesses. This means that the size of your credit will depend on your average wages and the number of employees you have.
- Will small businesses be fined if they do not offer their employees insurance?
There is no requirement for small businesses to offer insurance. No business with fewer than 50 employees will have to pay a penalty for not offering insurance to their employees.
- I am a senior with Medicare drug coverage. Will I get a rebate?
Seniors who hit the gap in Medicare prescription drug coverage commonly known as the “donut hole” received a $250 rebate in 2010. The coverage gap starts once you have had about $2,830 in drug costs. About 800,000 of the more than four million Californians on Medicare reach this gap in coverage in any given year.
As of 2011, seniors in the donut hole are eligible to receive a 50 percent discount on prescription drugs. In addition, Medicare will bear an increasing share of costs in the donut hole, until it is closed completely in 2020.
- Health reform provides free preventive care for Medicare beneficiaries. When does it start and what does it cover?
As of January 1, 2011, proven preventive services are free and seniors will also get a new, free annual wellness visit with their doctor.
- I already have insurance. How will I be affected by health care reform?
If you like the health insurance you have, you can keep it.
As of September 2010, your health insurance company is no longer allowed to impose a lifetime cap on the benefits that you get from your insurance policy. This applies to all new plans and existing plans.
As of September 2010, your health insurance company is no longer allowed to kick you off your insurance if you become sick. This prohibition on so-called “rescissions” applies to all new plans and existing plans.
As of September 2010, all new individual market and group health plans must cover preventive services. Recommended prevention and vaccination services must be covered without any deductibles or copayments.
- How does health reform keep insurance companies from hiking up rates?
Insurance companies must now provide public justifications of rate increases. Insurance companies with a track record of unjustifiably high rate increases can be barred from selling policies through the health insurance exchanges that will open in 2014.
In addition, consumers will get rebates from insurance policies that spend less than 80 percent of the premiums they collect on health care.
- How will health reform address the shortage of doctors in my area?
Health reform invests fund to build and expand community health centers into 8,000 additional communities. It also expands student loan programs, scholarships, and loan repayments for 17,000 health professionals who agree to practice in areas where there is a shortage.
- Will my health care be rationed because of health care reform?
No. As of September 2010, health reform requires all new health plans to have an effective process for appeals of coverage determinations and claims. Health plans are also prohibited from imposing lifetime caps on coverage, and there are new restrictions on the annual limits that private insurance plans often use to limit the amount of benefits their customers receive.
- I do not currently have insurance. Will health care reform help me find a plan?
You can find more information on insurance plans to help shop for affordable coverage by visiting www.healthcare.gov.