Health Reform Changes

With the many changes taking place because of the Affordable Care Act, we wanted to give you the latest updates.


As of August 2012, most new and existing, non-grandfathered health plans will have to cover contraception with no out of pocket cost for women. Along with this change, women will also have access to HIV screenings and counseling, screenings for gestational diabetes, counseling for STDs and annual wellness exams, among other things- all at no cost to the insured. 

Insurance companies have recently started issuing rebates to their current and former customers. If you had an insurance policy in 2011 and the insurance company spent more than the allotted percentage on paying themselves and less on paying your claims, you will see a rebate of that money. Each insurance company will handle these rebates differently and will send you a letter notifying you of it, if they haven't already. 

As of September 2012, insurance companies will have to offer clearer descriptions for their offered plans in order to allow more effective comparisons between plans. These descriptions must also be easy for anyone to understand- no more complicated language. 


While most individuals are already benefiting from the new free preventive care this year, starting in January of 2012, the federal government will offer more funding to state Medicaid programs that offer preventive care at little to no cost to its members.

With the expansion of Medicaid in 2014, the Act requires that the states pay primary care physicians seeing Medicaid patients 100% of the current Medicare payment rates for 2013 and 2014. This increase in pay to physicians will be funded by the federal government. 

The final change that will be coming in January 2013 is the responsibility for providers/facilities to bundle payments for Medicare patients. If you have surgery, you will no longer receive multiple bills, one for each physician/facility/procedure. Instead they will be required to send one "bundled" bill to you that will be divided among those involved in the surgery after they receive your payment.


The Marketplace officially opens January 1, 2014 and many people who were unable to purchase insurance due to a pre-existing medical condition previously are now able to enroll in coverage. The first Open Enrollment period began on October 1, 2013 and will close April 15, 2014. If you have not purchased a plan by April 15, 2014 you will have to meet a Qualifying Event to be able to enroll in health coverage. The next Open Enrollment Period will begin November 15, 2014 and will close February 15, 2015. The period between November 15 and December 15, 2014 will be the time to apply (either for new coverage or a change in your current coverage) to get an effective date of January 1, 2015. Any applications after December 15, 2014 will have an effective date based on the day of submission. 

The penalty for not having a Qualified Health Plan applies this year. If you are not enrolled by May 1, 2014, or have a gap in coverage during the year longer than 3 months, you will be responsible for paying the larger of $95 per uncovered adult in your household ($47.50 per child) or 1% of your annual household income. This penalty will be assessed when you file your 2014 income tax in 2015. 


You will have until the end of the day on February 15, 2015 to apply for new coverage or make changes to your current coverage. After February 15, 2015 you will only be able to apply for a change or new coverage if you meet a Qualifying Event. Those events include, but are not limited to, gaining a dependent due to marriage, gaining a depended due to birth or adoption, losing your coverage due to meeting the maximum age (26) to be a dependent under your parents' policy, or losing your employer sponsored coverage due to a change in employment or a change in the amount of hours you are working. 

The penalty for not being enrolled in a Qualified Health Plan in 2015 is the larger of $325 per uncovered adult in your household ($162.50 per child) or 2% of your annual household income.   
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