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Health-care reform changes - Geisinger Health Plan®
A historic $1.05 trillion health-care overhaul that guarantees coverage for uninsured Americans was signed into law in March 2010. The first changes will take effect by the end of September 2010. Most changes would not kick in until 2014.
The Congressional Budget Office estimated that the legislation would cut federal budget deficits by an estimated $143 billion over a decade. More than 30 million people will gain coverage, and by 2016 about 95 percent of eligible working-age adults and their families would have health insurance. Most would buy their coverage through health insurance exchanges, new state-based purchasing pools.
Temporary high-risk pool for individuals with pre-existing conditions is created
Lifetime dollar limits or rescission are prohibited
Cost sharing for preventive services is eliminated
Denial of children with pre-existing conditions is prohibited
Health plans must report administrative costs vs. medical expenses. Rebates are provided to consumers if medical expense less than 85% for large groups and 80% for small groups and individuals
An institute to support comparative effectiveness research is established
2013
Consumer Operated and Oriented Plan (CO-OP) to foster non-profit, member-run health insurance companies all 50 states will be established
Simplification provisions will be adopted. This applies to eligibility verification and claims status, electronic fund transfers, and health-care payment and remittance, enrollment and disenrollment, premium payment and referrals and more
Threshold for itemized tax deduction for unreimbursed medical expenses will be increased from 7.5% of adjusted gross income to 10%
The Part A tax rate on wages will be increased by 0.9% on earnings over $200,000 for individuals and $250,000 for married couples. A 3.8% assessment on unearned income for higher-income taxpayers will be added
Excise tax of 2.3% on sale of any taxable medical devise will be added
2014
The American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will be created. Individuals or small businesses with up to 100 employees can purchase coverage through the Exchange
Guaranteed issue and renewability is required by insurance companies. Rating variations will be based only on age, premium rating area, family composition and tobacco use in the individual and small group market and the Exchanges
Fees will be imposed on the health insurance sector. These include a premium tax on not-for-profit insurers, while large, self-funded insurers will not be taxed
2015
Excise tax imposed on insurers of employer-sponsored plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage
Dependent coverage expanded for adult children up to age 26
Tax credits provided to small employers with 25 or fewer employees and average annual wages of less than $50,000
Retiree health plan subsidy for small businesses is in place until 2014
2011
Grants will be provided for up to 5 years to small employers that establish wellness programs
2013
Tax-deduction will be eliminated for employers who receive Part D retiree drug subsidy payments
2014
Small employers are able to get coverage through the Exchange
Employers with 50+ employees that don't offer coverage but have at least one FTE receiving premium tax credit will be assessed. Employers will pay the lesser of $3,000 for each employee receiving credit or $2,000 for each full-time employee
Employers with 200+ employees must enroll employees into employer's health insurance plan. Employees may opt out
Deductibles in small group market will be limited to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits
Waiting period for coverage will be limited to 90 days
The Office of Personnel Management will contract with insurers to offer at least two multi-state plans in each Exchange. At least one must be by a non-profit entity and at least one must not provide coverage for abortions beyond those permitted by law
States can create a basic health plan for uninsured individuals with incomes between 133-200% FPL
States can merge individual and small group markets
Employers will be permitted to offer rewards up to 30%, increasing to 50% if appropriate, of the cost of coverage for participating in wellness program and meeting health-related standards
Provides a $250 rebate to individuals who reach Part D coverage gap. The gap will be gradually eliminated by 2020
2011
Only proven preventive services will be covered and the cost-sharing for preventive services will be eliminated. Medicare payments for certain preventive services will be increased to 100% of actual charges or fee schedule rate
Access to comprehensive health risk assessment will be provided, personalized prevention plan and incentives to complete behavior modification program will be created
RX manufacturers required to provide 50% discount on brand-name prescriptions filled in the Part D gap. Federal subsidies for generic Rx filled in the gap will be phased in
Payments to MA plans will be restructured, setting payments to different percentages of Medicare FFS rates
Income threshold for income-related Part B premiums for 2011-2019 will be frozen
2012
Accountable Care Organizations (ACOs) will share in the cost savings they achieve for Medicare program
2013
Federal subsidies for brand-name prescriptions filled Part D coverage gap phased in
National Medicare pilot program to develop and evaluate bundled payment for acute, IP hospital services, physician services, outpatient hospital services and post-acute services for an episode of care will begin
2014
Medicare Advantage plans will be required to have medical loss ratios no lower than 85%.
2015 and later
Medicare payments to certain hospitals for hospital-acquired conditions will be reduced
