The Patient Protection and Affordable Care Act is a federal statute which was signed into law in 2010. It is often referred to as the Affordable Care Act, ACA, “Obamacare” or health care reform. The following information is about programs resulting from the ACA.
Health Insurance Marketplace
If you are uninsured, purchase individual coverage or believe your employer provided coverage is inadequate or unaffordable, you may be able to shop for coverage directly in the federal Health Insurance Marketplace -- a marketplace where you can shop for and compare health benefit plans. Open enrollment for coverage in 2016 was November 1, 2015 through January 31, 2016. Open enrollment for coverage in 2017 is November 1, 2016 through January 31, 2017. For more information, visit: www.healthcare.gov.
Healthy Michigan Plan:
Some Michigan residents may be eligible for the Healthy Michigan Plan. To be eligible for the Healthy Michigan plan, you must be:
For more information, visit www.HealthyMichiganPlan.org or call 855-789-5610.
Financial Help to Purchase Health Care Coverage
Federal tax credits to assist with the cost of health coverage in the Health Insurance Marketplace may be available for those with income between 100 percent and 400 percent of the federal poverty level who are not eligible for other affordable coverage. (The federal poverty level is adjusted annually. In 2016, 400 percent of the poverty level for Michigan residents was $47,080 for an individual or $97,000 for a family of four.) To apply for the tax credit, visit the Health Insurance Marketplace: www.healthcare.gov.
Health Coverage Requirement
The “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA) requires that people obtain health insurance or pay a federal tax penalty. If you currently have coverage from Medicare, Medicaid, an employer or you have a major medical plan that you purchased yourself, you are considered covered and will not pay a tax penalty.
Those who do not have or do not obtain coverage will pay a tax penalty. The amount of the penalty for an individual is phasing in as follows:
You may be exempt from paying the penalty for not having coverage if you have a financial hardship, religious objection, belong to a Health Care Sharing Ministry, or if it would cost more than 8% of your income to purchase coverage. For more information on the Health Coverage Requirement, click here.
Essential Health Benefits
The ACA ensures that health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following ten categories: ambulatory patient services; emergency services; hospitalization; 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; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services as well. For more information on Essential Health Benefits, click here.
No Denial for People with an Illness or Chronic Condition
No insurance company can turn you down, charge you more or impose a waiting period for coverage because you have a pre-existing medical condition.
No-Cost Preventive Care
New health plans cannot impose any cost-sharing for certain preventive services. Health carriers cannot charge a deductible, copay, or coinsurance for preventive care measures such as flu shots and other immunizations, mammograms and other cancer screenings, diabetes screenings and more.
No Lifetime Limits on Your Health Care Costs
For new plans, health carriers will be prohibited from setting lifetime limits on significant benefits, such as hospitalization and emergency services.
Extended Coverage for Young Adults
Most health carriers and employers providing dependent coverage to children are required to make coverage available to adult children up to age 26. This applies to adult children who do not have access to coverage from their own job and regardless of whether or not they are students, financially dependent on their parents, live with their parents or are married. If you are in a health plan for retirees, also known as a retiree-only plan, these plans are exempt from this requirement and do not have to offer coverage for children up to age 26. If you are in a retiree-only plan, check with your plan to determine its policy for covering young adults.
Medicare Prescription Drug Discounts
Seniors who are in the Medicare prescription drug coverage gap known as the “donut hole” will receive discounts on covered prescription drugs and the donut hole will be phased out by 2020.
Help for Small Business
Some small businesses may qualify for a small business tax credit to help offset the costs of providing health insurance for employees. To be eligible for the credit, the small business must purchase coverage in the SHOP Marketplace. Small businesses may wish to contact an agent or carrier to assist with purchasing coverage from the SHOP Marketplace or visit www.healthcare.gov/small-businesses.
Other Helpful Resources:
For more information on the Affordable Care Act, visit: www.healthcare.gov.
Disclaimer - The information provided is only intended to be general summary information for the public. It is not intended to take the place of either the written law or regulations. If you have questions about whether a provision applies to your plan, contact your health carrier, plan administrator, employer or the Department of Insurance and Financial Services - HICAP (DIFS-HICAP@michigan.gov).