Health Care Reform
What is Health Care Reform?
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. The law put in place a significant number of health insurance reforms that have rolled out over the last five years. Some of the final and most notable changes of the law took effect on January 1, 2014.
The best way to summarize the impact of the ACA is to say that it will make insurance more accessible to you. There are a number of provisions throughout the law that help you afford coverage, as well as guarantee you access to insurance with a minimum level of benefits.
Primary among these reforms is assistance for individuals and families to purchase health insurance with federal subsidies through the Exchange and expanded eligibility for Medicaid; as well guaranteed access to health insurance regardless of health status.
Since January 1, 2014, you could no longer be declined coverage or be charged more for health insurance because of a health issue you have now or had in the past. You will also be guaranteed a minimum set of health benefits known as “Essential Health Benefits”
Other notable market reforms include:
- Extending dependent coverage to age 26.
- Covering with no expense to the consumer of most preventive services and immunizations.
- Insuring that all carriers in the individual and small group markets must spend at least 80 cents of every dollar collected from consumers on medical care and services to improve general health.
- Prohibiting annual and lifetime dollar limits on essential health benefits.
Finding Help Affording Health Insurance
Many Nevadans who do not receive health insurance coverage from their employer are potentially eligible for premium assistance under the Affordable Care Act or enrollment in the Medicaid program. For individuals and / or families that earn up to 400 percent of the Federal Poverty Level (FPL) subsidies are available for purchases through Healthcare.gov. Nevadans can determine the amount of assistance available toward premium or if they might qualify for Medicaid on the NevadaHealthLink.com. The below chart illustrates the levels of assistance available.
It’s also important to know that since January 1, 2014, most people are required to have health insurance or will pay a fine. For individuals, the penalty for the entire year will be $325 per adult and $162.50 per child, up to a family maximum of $975 or 2 percent of the family’s income, whichever is greater.
For 2016 and subsequent years, the full penalties will be $695 per adult, $347.50 per child, and a family maximum of $2,085 or 2.5 percent of the family’s income.
The requirement to have coverage can be waived for financial hardship or religious beliefs.
The individual shared responsibility provision requires you and each member of your family to have qualifying health care coverage (known as minimum essential coverage), qualify for an exemption from the responsibility to have minimum essential coverage, or make an individual shared responsibility payment when you file your federal income tax return. Publication 974 provides additional information to help you determine if your health care coverage is minimum essential coverage.
Health Insurance Rates
One result of the ACA is that Nevada expanded its review of health insurance rates. Nevada continues to review all health insurance rate changes in the individual and small group insurance markets.
The law also requires insurance companies to spend the majority of your premium dollars on health care. This means that insurers selling policies to individuals or small groups must spend at least 80% of premiums on direct medical care and efforts to improve the quality of care or provide a premium rebate to their customers.
A similar requirement applies to large group health insurance; insurers selling to large groups (51 or more employees) must spend 85% of premiums on care and quality improvement.
The Nevada Division of Insurance is committed to consumer protection and transparency regarding the cost of your health insurance. Read more about health insurance rates in Nevada here.
Read more about how Health Care Reform affects you and your family.