On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law, which resulted in the phasing in of many provisions to be implemented over time. The goal of the ACA was to increase the access and affordability of health insurance and to lower the amount of underinsured and uninsured citizens by expanding Medicaid and providing for public exchanges. Below are some commonly asked questions related to the ACA legislation and the impact on an employees or retirees existing health insurance coverage.
Q: When do the different provisions of ACA go into effect?
Many ACA provisions went into effect immediately or soon after the health reform law was enacted in 2010, and others have been phased in over time. Several major reforms, including Medicaid expansion, insurance exchanges and minimum coverage provisions went into effect in 2014. Other mandates such as employer pay or play mandates, minimum essential coverage (MEC) and the employer reporting mandate (ERM) will go into effect starting in 2015. Pay or play mandates, MEC and ERM are all intended to ensure that employers are offering health insurance plans to their employees and retirees that meet or exceed certain specified benefit levels, and that the employee’s contribution toward the premium for the health insurance plan they elect is not excessive.
Q: Will I be able to keep my insurance plan?
As long as the plan(s) offered by your employer meet the minimum actuarial value criteria of 60% (which all plans at all CASHIC member districts do), and as long as there are no negotiated changes by your district impacting plan design, your plan will not be terminated as a result of ACA legislation.
Q: How has the ACA legislation impacted the premiums charged by the carrier to my district?
There has been a minimal impact to your district’s rates as a result of any benefit mandates associated with ACA (i.e. coverage for dependents to age 26), however, starting in 2014 all employers are paying approximately 3 to 4% more in premium to account for premium taxes, re-insurance taxes and PCORI fees (Patient Centered Outcome Research Institute) mandated by the ACA legislation.
Q: Are there lifetime or annual limits in my health insurance plan?
As long as you receive services “in-network” from participating providers, there are no lifetime or annual limits related to your medical or prescription drug program.
Q: Are there coverage limitations for pre-existing conditions if I change medical plans?
None of the programs offered by any CASHIC member district contained pre-existing condition requirements prior to ACA. Additionally, ACA now prohibits any health insurance carrier from enforcing pre-existing condition requirements.