health insurance changes by: jenna, lexi, bethany, kendra, evie

Health Insurance Changes

By: Jenna, Lexi, Bethany, Kendra, Evie

Tax Changes Related to Health InsuranceLexi

Individuals are reimbursed through an HRA and it excludes the costs for over-the-counter drugs, not prescribed by a doctor. Effective January 1, 2011.


A new Medicare tax of 0.9 percent was added on January 1, 2013. The 0.9 percent applies to wage, Railroad Retirement Act, and self-employment that exceeds a threshold anywhere from $125,000 to $250,000.


● Raises the Medicare Part A tax rate from 1.45% to 2.35% on married couples filing jointly whose income is greater than $250,000.


● Raises the Medicare Part A tax rate from 1.45% to 2.35% on individual taxpayers who make over $200,000 a year.

Tax Changes Related to Financing Health Reform

For non-profit insurers, only 50% of net premiums are taken into account in calculating the fee.

different laws include:

impose tax of 10% on the amt. paid for indoor tanning services (starts July 1, 2010)

impose a tax of 2.3% on the sale of any taxable medical device (starts for sales after December 31, 2012)

Exclude improcessed fuels from the definition of biofuel for purposes of applying the biofuel producer credit (starts January 1, 2010)

BY: Bethany


New annual fees on the pharmaceutical end of the sector, according to the following schedule:

$2.8 billion in 2012-2013

$3.0 billion in 2014-2015

$4.0 billion in 2017


$2.8 billion in 2019 and later

Bethany


Impose an annual fee on the health insurance sector, according to the following schedule:

$8 billion in 2014

$11.3 billion in 2015-2016



For many years, the fee shall be the amt. from the previous year increased by the rate of premium growth.

Bethany

Tax Changes Related to Health Insurance

● It is clarify application of the economic substance doctrine and increase penalties for underpayments attributable to a transaction lacking economic substance

○ effective upon enactment

Creation & Structure of Health insurance exchanges

● Key component of the Affordable Care Act (ACA)

● Individuals and small businesses will be able to shop for coverage

● States can build a fully state-based marketplace, enter into a state-federal partnership marketplace, or default to a federally-facilitated marketplace

● States planning to operate a state-based marketplace were required to submit an Exchange Blueprint to the federal Department of Health and Human Services (HHS)

Kendra

Eligibility to purchase in the exchanges

Must live in the United States

Must be a U.S. citizen or national ( or a lawfully present)

Can't be incarcerated

Kendra

Multi-State plans● One must be non-profit

● Another must not provide coverage for abortions beyond those permitted by federal law.

● Both must be licensed in each state & also meet the qualification of a qualified health plan

● If the state has a lower age than 3:1 the may require plans to meet the more protective age rating rules

● They will be offered separately from the Federal Employees Health Benefit Program the then they will have a separate risk pool

Kendra

Consumer Operated and Oriented Plan

● It’s an organization to foster the creation of non-profit, member-run health insurance company in all 5o states

○ Provide consumer Choice

○ Greater control

○ Greater plan accountability

○ Promote better models of care

Kendra

Healthcare Benefit PlansBronze Plan

Minimum creditable coverage

Provides essential health benefits

Covers 60% of benefit costs

Out-of-pocket limit equal to Health Savings AccountSilver Plan


Covers 70% benefit costs

HSA out-of-pocket limits

Jenna

Healthcare Benefit PlansPlatinum Plan


Covers 90% of benefit costs.

HSA out-of-pocket plan Catastrophic Plan

Available up to age 30

OR to ones that are exempt from the mandate to purchase coverages

Only available in the individual coverage

Jenna

Qualifications of Participating Health Plans

Require qualified health plans meeting marketing requirements:

have adequate provider networks

contract with community providers & navigators to conduct enrollment assistance

use enrollment form and standard format to present plan information

Provide information on: payment policies, number of claims denied, cost-sharing requirements, enrollee rights in plain language

Jenna

Insurance Market & Rating Rules

Everyone gets accepted with guaranteed issue allowing rating variations based only on age.

premium rating area

family composition

tobacco use

Took effect on January 1, 2014

Jenna

Health Insurance Exchanges

Health insurance exchanges are where you go

to sign up during open enrollment. If your

state doesn’t have one you have to sign up

under the federal exchange. They are the

ones that process your application and

decide what subsidies and plans you are eligible for. Evie

Basic Health Plan

The states can create a basic plan for people who are just above the poverty level (133-200% of the federal poverty level), but the coverage can’t exceed the amount that they would get under Obamacare. States would then receive funds that would equal 95% of the funds that would have been paid as federal cost-sharing subsidies.

Evie

Abortion Coverage

The states can prohibit abortion coverage. If they allow the coverage of abortions then no federal subsidies can be used to pay for that part of the insurance that covers more than the federal funds are normally permitted. They also can’t require abortion coverage in the basic health plans.

Evie

Essential Benefits Package

Essential benefits are considered to be necessary for the prevention and treatment of sickness. In order to be able to sell insurance on the Health Insurance Marketplace, each plan must include coverage in at least 10 areas.

Evie

Works CitedThe Healthline Editorial Team. "Health Insurance Exchanges: The Affordable Care Act Explained." Healthline. N.p., 24 Nov.

2015. Web. 07 Jan. 2016.

"Summary of the Affordable Care Act." Summary of the Affordable Care Act. N.p., 25 Apr. 2013. Web. 07 Jan. 2016.

"Establishing Health Insurance Marketplaces: An Overview of State Efforts."Establishing Health Insurance Marketplaces: An

Overview of State Efforts. N.p., n.d. Web. 08 Jan. 2016.

"Essential Health Benefits." HealthCare.gov. N.p., n.d. Web. 11 Jan. 2016.

health insurance changes by: jenna, lexi, bethany, kendra, evie

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