What’s Coming Next Under the ACA

Last week, we started a multi-part series about the Affordable Care Act — also known as the ACA or Obamacare. Whatever you call it, the goal of this series is to give you a quick overview of the massive changes to our health-care system. In the first part of the series, we discussed what’s already in place thanks to the ACA. This week, we’ll talk about the changes that are coming. Without any further ado, let’s get right to it.

Two of the biggest changes — the Marketplaces and individual mandate — won’t affect you directly if you already get your insurance through your workplace. Two other big changes, though, will affect anyone who has insurance: denials for pre-existing conditions and yearly limits. The latter two changes, phased in over time, will be fully implemented in 2014. Here’s a bit about each:

  • Sick people can’t be denied: It still sounds crazy — the people who need insurance the most have routinely been denied coverage, with insurers refusing due to “pre-existing conditions.” Starting in January, this term goes out the window for everyone. (As of 2013, insurers couldn’t deny children due to pre-existing conditions). Insurers also won’t be able to charge you more just because you’re sick.
  • No more yearly limits: Starting Jan. 1, insurers can no longer set a yearly limit on what it will spend on your coverage. Imagine facing a catastrophic illness, and being told your coverage had run out. As of next year, that will no longer be a concern.

These two changes may not affect you, but chances are you know people who will be affected – friends, family members or co-workers who don’t have health insurance or have costly policies. Here is a brief look at the Marketplaces and individual mandate:

Meet the Marketplace

You may have noticed you’re hearing more about the ACA lately, and there’s a reason for that: various organizations (including the SEA) have stepped up educational efforts over the last month. This is leading up to the first big, visible change that’s coming: the roll-out of the health insurance Marketplaces. Starting Oct. 1, anyone can sign up for insurance through these new Marketplaces for coverage that will go into effect Jan. 1.

Generally, the Marketplace will give you exact prices for different levels of coverage, and tell you whether you’re eligible for money-saving subsidies. As of right now, the Marketplace in New Hampshire includes only one company: Anthem, which is already the state’s largest insurer. Eventually, more insurers are expected to enter the Marketplace, and the idea is that competition will bring lower prices for consumers. Anthem has been fairly quiet about its Marketplace offerings, but it did release a snapshot of rates that you can check out. We’ll go more into detail on the Marketplace next week, as we’ll have a better idea of what it will look like.

Meet the mandate

Another term you’ve likely heard around the ACA is “mandate,” or more specifically the individual mandate. The mandate, which takes effect Jan. 1, requires just about everyone to have health insurance, and those who don’t will be required to pay a penalty when they file their income tax return. Though many conservatives dislike the individual mandate, the idea actually originated with the conservative Heritage Foundation in the 1980s, and Mitt Romney enacted an individual mandate when he was governor of Massachusetts. We’ll talk a bit more about the mandate next week.

Well, that’s it for this edition. Next week we’ll talk about buying coverage, including more info on the Marketplaces and the individual mandate. For now, if this has piqued your interest, you can read more in a great feature produced by NHPR, Obamacare & You.

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