Ten Things that one should know about the Affordable Care Act and how it will affect you!!!


Ten Things that one should know about the Affordable Care Act and how it will affect you!!!


In March 2010, President Obama signed comprehensive health reform, The
Patient Protection and Affordable Care Act (ACA), into law. The law
makes preventive care, including family planning and related services
more assessable and affordable for many Americans. While some provisions
of the law have already taken a fact, many more provisions will be
implemented in the coming years.

Important Dates

  •       03/23/2010 —- PPACA Signed into Law
  •       01/01 2013 —- State and Regional Exchange Certification
  •       10/01/2013 —- Open Enrollment begins, will remain open until March 31, 2014
  •       01/01/2015 —- Exchanges financially sufficient
  •       01/01/2017 —- Tentative date for large groups

Big Picture- Affordable Care Act rolls out in phases that began in 2010 and continue through 2019


  • Standards for Minimum health benefit plan offerings
  • State based Health Benefits Exchanges
  • Mandates for Employers and Him individuals to provide/purchase coverage
  • Premium Credit or cost share subsidies to qualified individuals
  • Taxes and Fees
  • Requirements that insurance companies spend a certain percentage of premium dollars on patient care
  • Certain preventive care services covered without cost-sharing (out-of-pocket expenses)
  • Insurance market reforms
  • Expanded appeal rights for consumer

Changes to Medicare reimbursements


  • Grandfathered Plans, any plan in effect on or before March 23, 2010
  • not required to implement a number of health reform laws including:
  • Rating restrictions associated adjusted community ratings
  • Capping deductibles and/or implementing out-of-pocket limits
  • Providing essential health benefits (small group only)
  • Providing coverage for clinical trials

Public Exchanges

  • Each State must have an exchange (State or Federally run)
  • A place where individuals are employees who cannot afford employers plans’ can purchase insurance coverage
  • 3 Models
    • State Run facilitator – Carriers compete in an Open market. Any
      carrier meeting minimum
      requirements can participate
    • State Run Active Purchaser- state (s) solicits bids from carriers
      and determines which plans to offer;
      state (s) directly negotiates with carriers
    • Federally Run model- U.S. Department of Health and Human Services (HHS) runs the exchange for the state who do not create one

Exchange Plans

  • Bronze plans will have the lowest monthly premium, but costs shares will be more when health care services are needed
  • Platinum plans will have highest monthly premium but costs shares will be low

Essential Health Benefits Required:

  • Ambulatory patient services
  • Emergency Services
  • Hospitalization
  • Maternal and Newborn
  • Mental Health Services
  • Prescription drugs
  • Rehab services
  • Labs
  • Preventive and Chronic Disease Management
  • Pediatric Services, including oral and vision care

Tier Levels:

  • Platinum- 90% coverage
  • Gold- 80% coverage
  • Silver- 70% coverage
  • Bronze- 60% coverage

Individual Mandate-Buy a plan through either: Employer, Individual Market or traditional market or Go uninsured and pay penalty

  • 2014 – Greater of $95 or 1% of annual income
  • 2015 – Greater of $325 or 2% of annual income
  • 2016 – Greater of $695 or 2.5% of annual income
  • 2017 and beyond – Annual adjustments

Affordable Care Act doesn’t require employers to contribute to monthly premium or offer dependent coverage.

Companies can: Offer health insurance that meets the minimum coverage definition and affordable

Offer some level of coverage but does not meet minimum requirements and pay penalty

Stop offering coverage that employees purchase through exchange, and pay employer penalty

  • Note – ACA doesn’t require employers to contribute to monthly premium or offer dependent coverage
  • Mandate
    • Minimum coverage is not offered to full-time employees and one
      employee gets subsidize coverage equal $2000/employee after first 30 FTE
      (Full-time equivalent)
    • Minimum coverage is offered to full-time employee but it is not
      affordable an employee gets subsidized coverage +$3000/employee
      receiving subsidize coverage

The Affordable Care Act soon will be rolled out and like most Americans and Companies we all will have many questions. There’s no foolish question. As we all will be learning on the go. Feel free to call me, Mark S. Gardner at 214 – 762 – 2327. If I’m on another call don’t hesitate to leave your name and number and the reason you’re calling. Either I or one of my associates will contact you to see how we can help you. Stay tuned there is more to come with Obama Care.