The Affordable Care Act, signed into law in 2010, is geared to increase affordability and rate of health insurance and reduce health care costs. Some of the most important provisions of the law go into effect this year.
Open enrollment on the new Health Benefits Exchange begins on October 1 and ends on March 31, 2014. Health care coverage purchased through the exchange may start on January 1, 2014. Residents will not be able to use the Health Benefits Exchange to purchase insurance after March 31, 2014 unless they qualify for special enrollment.
Officials expect that 91.25 percent of uninsured Kentucky residents will qualify for Medicaid or some tax credit for health insurance. The other 56,000 people must use the Health Benefits Exchange to buy private insurance or get it from their employer by March 31, 2014.
On September 13, Kentucky signed contracts with managed care organizations, Anthem, Humana and Passport, to provide health care services to residents who are newly eligible for coverage under the expansion of Medicaid.
Beginning October 1, residents of 104 counties who are eligible may choose Athem, Humana or Passport as their provider, effective January 1, 2014. Coventry and WellCare also serve these counties.
Here are a few things local residents should know about the law:
•People who are over the age of 18 who are uninsured or who have an insurance plan does not meet the minimum requirements of the new law must take action.
•Beginning January 1, 2014, health insurance companies can no longer discriminate on the basis of gender or pre-existing medical conditions.
•Beginning January 1, 2014, health insurance companies can no longer set limits on the coverage they provide.
•Beginning January 1, 2014, health insurance companies must provide eligible people with free preventive care without requiring them a co-pay or deductible.
•The new law establishes 10 categories of essential health benefits that all insurance plans must cover: ambulatory patient services (or outpatient services), emergency medical services, hospitalization, maternity care, newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services (including oral and vision care).
•Beginning January 1, 2014, states must opt-in to expand Medicaid eligibility to more people.
•The new Health Benefit Exchange, an online place for people and small businesses to enroll in new health insurance plans, begins with open enrollment on October 1.
•The federal tax credit provision of the act goes into effect on January 1, 2014, when people may be eligible to receive subsidies to purchase private insurance via the Health Benefit Exchange and receive tax credits to purchase health insurance based on their income.
•The new law includes an individual mandate for every person and family who aren’t covered with insurance through their employer, Medicare or other insurance plan. Individuals must become insured or pay a penalty in 2014. The penalty equals $95 or one percent of their income, whichever is greater.
•The new law includes an employer mandate for all businesses that have more than 50 full time employees. Those businesses must provide health insurance to employees or pay a $2,000 fine per uncovered employee in 2015.
•There is no requirement for businesses with 50 or fewer full time employees and businesses with 25 or fewer full time employees will receive a tax incentive for providing health insurance. For more information, visit http://healthbenefitexchange.ky.gov.
•Kentucky residents may compare the benefits and prices of health insurance plans and enroll in government plans like Medicaid through Kynect, an online database that becomes available on October 1 at http://kynect.ky.gov.
•There will be four categories of insurance plans on the Kynect Health Benefits Exchange, “bronze” plans that pay lower premiums and higher out-of-pocket costs, and “platinum” plans that pay higher premiums and the lowest out-of-pocket costs. The “silver” plans and the “gold” plans fit between those two categories.
•Kynect will also offer “catastrophic” plans to people under the age of 30 and to people who have very low incomes.
•Individuals seeking health insurance through kynect will provide their age, home address, tobacco use and household income to find quality, affordable health insurance plans.
Household income alone determines the amount of the kynect discount. An individual earning up to $45,960 a year will qualify for a discount; a family of four earning up to $94,200 will also receive a discount.
•Small businesses with 50 or fewer full time employees may also use the Kynect Health Benefits Exchange through its Small Business Health Options Program, or S.H.O.P.
•To get assistance from trained “Kynectors” about the new Health Benefits Exchange, call 855-4Kynect (855-459-6328).