Basic Requirements of Obamacare

Everyone is asking … What do I need to know?  Can you make it simple?  So here are the basics of the new laws as we can best describe:

Beginning in 2014, individuals will be required to buy government-approved, private health insurance or else pay a penalty.

As far as it relates to the health insurance companies, they will be required to spend at least 80% of the premium payments they receive from individual and small-group plans (and at least 85% from large group plans) on medical care.  The federal government will define what constitutes medical care.

It all started in 2010, this was what happened:
Creating temporary high-risk pool with subsidized premiums for certain people with pre-existing conditions.
Imposing new taxes on some facilities, such as tanning parlors.
Health insurers raised premiums for Americans as a direct result of President Obama’s health care overhaul.

The Insurance Companies were required to do the following:
Prohibit bans on pre-existing health conditions in children, lifetime and annual limits on expenses, and limits coverage exclusions of pre-existing health conditions in adults.
Requires family policies to include children up to age 26.
Does allow states to form compacts in order to allow the interstate sale of insurance.
Requires direct access to obstetrical and gynecological care, which might include abortion.
Creates (by 2014) health insurance exchanges or marketplaces that will be state-based and state-administered, but states can opt out of this if certain conditions are met; insurance can be sold within the exchange only if government-approved, but insurance can be sold outside of the exchange.
Prohibits health plans from discriminating against providers, but plans are not required to contract with any provider.
Requires health plans to develop politically correct language services, community outreach and cultural competency trainings.

Employer are required to do the following:
The law requires employers having more than 50 full-time employees must provide health insurance or pay a penalty.
Employees having 25 or less full-time employees and average salaries of $50,000 or less can apply for tax credits to provide health insurance to their employees.

With regards to Medicaid:
ObamaCare expands Medicaid (medical care for the poor) to everyone (under the Medicare age of 65) who has income less than 133% the federal poverty level (% may vary by state). States must pay this enormous new burden, but federal government promises to reimburse costs of newly eligible patients under this program from 2014 to 2016.

These are the BASICS of the requirements of Obamacare.  For more information, please contact us 877-740-8683 or  we will be happy to assist you.

2 thoughts on “Basic Requirements of Obamacare

    1. Good question. Everyone in the US will be required to get an ACA compliant plan in order to avoid a tax penalty. Obamacare is just the nickname for the bill that has been passed, Affordable Care Act requiring insurance companies to make certain plans available to everyone and the fact that everyone should participate or face a penalty. Your insurance will still be purchased through an insurance company, insured by an insurance company, and paid to an insurance company. The government does not have a plan called Obamacare.

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