Shortcut Navigation:

What You Need to Know about the Health Care Law

Are you covered? The Affordable Care Act, otherwise referred to as health care reform, requires those who are uninsured to get health insurance. While the start dates of some key programs have been postponed, enrollment in health insurance programs is expected to begin this fall and several other key provisions of the act are becoming effective in the new year. Here are some insights and advice to help you understand what these changes mean.  

Uncertainty Abounds

First, if you’re confused about the law and its requirements, you’re not alone. A new telephone survey conducted for the American Institute of CPAs by Harris Interactive survey found limited knowledge of the healthcare law and its implications. Forty-one percent said they are not at all knowledgeable about the law and another 48% said they were only somewhat knowledgeable. Young people were the least knowledgeable, with nearly half of adults aged 18 to 34 saying they had no knowledge. When it came to knowledge of some of the law’s key provisions, only 69% knew that it required uninsured people to get health insurance and just 51% realized that a health insurance exchange would be available in their stat, according to a recent USA Today/Pew poll.

The Marketplace Opens

What provisions should you focus on right now? Beginning next year, the newly created Health Insurance Marketplace will provide coverage choices for those who don’t have insurance and those who have it but are interested in exploring other, potentially lower-cost options. Consumers in every state can set up an account, file an application and learn if they’re eligible for lower-cost premiums or out-of-pocket costs. The plans are offered by private insurers and they cover a set of essential health benefits defined by the law. The Marketplace plans must accept those with pre-existing conditions and cover those conditions. They also can’t charge different prices based on gender.

Key Marketplace Dates

Open enrollment in the Marketplace was set to begin October 1, and coverage can start as early as January 1, 2014. Most employers were required to notify employees of their Health Insurance Marketplace options by October 1. Open enrollment closes on March 31, 2014, and will not open again until October 2014. It’s only possible to enroll outside of open enrollment if you have a qualifying life event, such as a marriage, divorce or new baby, certain changes in income or a move to another state.

Coverage Available Now

Those who need insurance before January 1 can turn to the government’s Plan Finder website for help in locating private insurance plans. Be aware, though, that since many of the law’s provisions aren’t yet in effect, consumers may not receive the protections that will be available through the Marketplace, including lower premiums based on income and coverage for pre-existing conditions.

Small Business SHOP Marketplace

If you work for or run a small business, you should be aware of the Small Business Health Options Program (SHOP), a separate marketplace for companies with 50 or fewer full-time employees.  Online enrollment for qualifying companies to use the SHOP Marketplace was set to begin October 1, but in late September the Obama administration announced that company owners who want to enroll now would have to mail or fax in their information at least until November 1. Coverage can begin as early as January 1. Once a company selects a plan, employees can sign up online through the SHOP Marketplace. Companies that purchase coverage in 2014 through the SHOP Marketplace may be able to take advantage of a small business health care tax credit of up to 50% of premium costs. If you have questions about whether your company qualifies, be sure to consult your CPA. Note: If you’re self-employed without any employees, then you would use the individual Health Insurance Marketplace, not SHOP.

Health care and the cost of health insurance coverage are critical issues for consumers and businesses. For understandable answers and advice, be sure to turn to your local financial professional, like a CPA. He or she has the expertise to answer all your most complicated financial questions.