PPACA and Households
Major Provisions
- Health Coverage for Older Children. Health coverage for an employee’s children under 27 years of age is now generally tax-free to the employee. This expanded health care tax benefit applies to various work place and retiree health plans. These changes immediately allow employers with cafeteria plans –– plans that allow employees to choose from a menu of tax-free benefit options and cash or taxable benefits –– to permit employees to begin making pre-tax contributions to pay for this expanded benefit. This also applies to self-employed individuals who qualify for the self-employed health insurance deduction on their federal income tax return. Learn more by reading our news release or this notice.
- Pre-existing Condition Restrictions. People with illnesses or disabilities may be unable to obtain private health insurance or may find that the coverage offered them is so costly that they cannot afford it. In the Affordable Care Act, Congress provided relief for these people that will roll out in two phases. First, as of 2010, insurers can no longer deny or restrict coverage for children who have been diagnosed with an illness (that is, a preexisting condition). Also, from 2010 to 2014, a new, temporary Pre-Existing Condition Insurance Plan program will offer uninsured adults with preexisting conditions coverage in special state-based “pools.” In a second phase, from 2014 on, all health plans will be prohibited from restricting coverage of preexisting conditions or charging higher premiums to individuals with health problems.
- Pre-Existing Condition Insurance Plan. Health Affairs Policy Brief, 11.30.2010
- Medicare Part D Coverage Gap “Donut Hole” Rebate. The Affordable Care Act provides a one-time $250 rebate in 2010 to assist Medicare Part D recipients who have reached their Medicare drug plan’s coverage gap. This payment is not taxable. This payment is not made by the IRS. More information can be found at www.medicare.gov.
- Medicare Advantage Plans. The ACA cuts $136 billion from Medicare Advantage Plans over its first 10 years. The Medicare actuary estimates this will reduce the projected number of seniors enrolled in such plans in 2017 from 14.8 million to only 7.4 million.
- Restrictions on Health Spending Accounts. Starting in 2011, individuals will no longer be able to use tax-advantaged money from an FSA, a health savings account or a health reimbursement account for over-the-counter drugs that are not prescribed by a doctor. Starting in 2013, the health-care-reform law caps annual FSA contributions at $2,500 per year (previously, there was no maximum contribution amount for medical FSAs).
PPACA and Taxes (link to new page)
Links
On-line Resources
- The Foundation for Health Care Coverage, Health Care Options Matrix™ is the only hand-held guide available that outlines all of each state’s public and private health coverage choices for individuals and groups in almost every demographic profile, as well as offering a reference list of program contact information. A separate profile is available for each state.
- AmericasFairHealthCare.org, America’s Health Care provides general information on health reform focused on consumers.
- Endowment for Health Pilot | Health Reform Resources by Age Group (child, young adult (18-26), adult, mature adult (50-64), senior (65+)
- Endowment for Health Pilot | Health Reform Resources by Source of Coverage
- Endowment for Health Pilot | Health Reform Resources by Health Status (chronic health condition, preventive care, mental health, prescriptions, oral health)
- Health Care and You is a place where individuals, families, small business owners and health care professionals can turn for help in understanding the law and how it impacts them.
- HealthReformReport.com, Individuals provides detailed information about provisions affecting individuals, listed by topic and providing an implementation timeline focused on these changes (non-group insurance, uninsured, Medicare, Medicaid)
Calculators
- Kaiser Family Foundation, Health Reform Subsidy Calculator estimates the size of the premium subsidy for individuals obtaining coverage through the exchange.
Research and Analysis
- How Will Consumers be Affected? (Urban Institute)
- The Effect of Health Reform on Drug Prices (Congressional Budget Office)
News
- HealthReformReport.com, Individuals includes consumer-related health reform news.
