CONSTRUCTING HEALTH CARE

CHANGES COMING
Oct. 1, 2012
Hospital performance will be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients perception of care. to Medicare. For example, a surgery may generate multiple claims from the surgeon, an anesthesiologist, etc Under bundling, the entire team is paid a set amount. Health care exchanges are to be established. If your employer doesnt offer health insurance, you can buy it from one of the exchanges. The exchanges are intended to be competitive insurance marketplaces that offer a choice of health plans that meet certain benets and cost standards. The mandate takes effect. Most individuals who can afford basic health insurance will be required to buy it or pay a penalty. Initially the penalty will be $95 per adult and half that for a child. By 2016 it will rise to $695 for an adult and $347.50 per child. Certain workers who cant afford the coverage provided by their employer can take that money and put it towards a more affordable plan in the new exchanges. States that choose to expand Medicaid coverage to those earning less than 133 percent of the poverty level about $14,000 for an individual and $29,000 for a family of four will be reimbursed 100 percent by the federal government for the rst three years and 90 percent after that. Those with income of as much as 400 percent of the poverty level - $88,000 for a family of four will be eligible for tax credits if they arent eligible for affordable coverage. The tax credits will be available every month, so consumers dont have to wait for tax time to claim the money. Annual limits on coverage will be eliminated. Insurance companies will be prohibited from refusing to sell coverage or renew policies because of an individuals pre-existing condition. In the individual and small group health-insurance market, insurance companys wont be allowed to charge higher rates based on gender or health status. The second phase of a tax credit takes effect for certain small businesses that provide health insurance for their employees.

A BRICK-BY-BRICK GUIDE TO HEALTH CARE REFORM

Jan. 1, 2014

Jan. 1, 2013

States that choose to provide Medicaid coverage for preventative care get extra money to cover all or nearly all of the cost. The federal government will fund higher payment increase to doctors for Medicaid. The rates will be the same rates as Medicare. Payments to doctors can be bundled into a at rate, rather than many separate bills

Jan. 1, 2015

Physician payments will be tied to the quality of care.

SCENARIOS
Married, two children. Both parents work full time and earn $42,000, but dont get health insurance at work. One son has asthma.
HEALTH LAW EFFECT: The family will be able to buy insurance through a state-based exchange in 2014 and be eligible for subsidies to help pay the premiums. The children will remain eligible for the Childrens Health Insurance Program. With subsidies, their monthly health insurance will cost about about $190 per month or 5.35 percent of their income, but their could be additional premiums for CHIP. Because their family income is less than 250% of the poverty level, they will also be eligible for assistance to lower what they pay out-of-pocket in the form of deductibles and copayments.

WHOS AFFECTED?
Some provisions of the law already in place, and how they affect people in our region

Seniors with Medicare getting preventive services at no cost to them

Young people under 26 now on a parents health plan

Covered by pre-existing condition insurance plan

SOURCE: whitehouse.gov

23-year-old male, single, no children and no health issues. Works part-time earning $23,000 per year. Uninsured.
HEALTH LAW EFFECT: If his parents have health insurance coverage, he can be covered on their plan until he turns 26. This coverage will be available even though he does not live with his parents and is not claimed as a dependent on their taxes. He will also be eligible to purchase coverage in the state health insurance exchange. Based on his income, he will be eligible for a subsidy that will lower his premium to $120 per month or a little more than 6 percent of his income. If he chooses not to get coverage, hell have to pay a penalty of $95 in 2014, increasing to $695 in 2016.

WILL YOU BE REQUIRED TO BUY HEALTH INSURANCE?

The health care law requires virtually all Americans to either have health insurance or pay a penalty. Find out where you stand. START HERE by answering this question: DO ANY OF THE FOLLOWING APPLY?
Youre an undocumented immigrant Youre in prison You belong to an Indian tribe Your family income is below about $9,350 for an individual or $18,700 for a family of four. You have to pay more than 8 percent of your income for health insurance You belong to a religion opposed to accepting health insurance

NO PENALTY FOR BEING WITHOUT INSURANCE

THE PENALTIES

2014
$95 per adult and $47.50 per child, up to $285 for a family OR 1 percent of family income, whichever is greater

2015
NO PENALTY, HEALTH INSURANCE REQUIREMENT IS MET
$325 per adult and $162.50 per child, up to $975 for a family OR 2 percent of family income, whichever is greater

HEALTH LAW EFFECT: She will be able to buy insurance through the state exchange and, because she makes less than 400 percent of the poverty level, shell get a subsidy to lower her premium to about $85 per month.

NO
SOURCE: The Henry J. Kaiser Family Foundation

YE

S TO

AN

Single woman, 33-years-old, earning $20,000 per year working full-time, but no coverage. No children and no health issues.

IF YOU ANSWERED

IF YOU ANSW

D ER E

YE

TO

ANY

2016 and beyond

$695 per adult and $347.50 per child, up to $2,085 for a family OR 2.5 percent of family income, whichever is greater
Note: The penalty is pro-rated by the number of months without coverage, though there is no penalty for a single gap in coverage of less than three months in a year.

NO

WERE YOU INSURED FOR THE WHOLE YEAR THROUGH ANY OF THESE PLANS?
An employer plan Medicare Medicaid or the Childrens Health Insurance Program The militarys TRICARE program The veterans health program Private individual insurance that meets requirements A grandfathered health plan

PENALTY PENALTY FOR NO FOR BEING HEALTH WITHOUT INSURANCE INSURANCE

STEVE REED/THE COURIER-JOURNAL