Healthcare Reform - Changes for 2014 and beyond
- Medicaid participation is expanded to cover low-income individuals under age 65 up to 133% of the Federal Poverty Level (FPL) – approximately $28,300 for a family of four.
- Employers begin paying penalties if they do not provide qualified health care coverage to employees.
- Individual mandates begin with subsidies for individuals and families up to 400% of the FPL and penalties for non-participation begin to apply.
- Guaranteed issuance, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) become effective.
- State individual and small group health insurance exchanges become operational.
- Independent Payment Advisory board starts its work to oversee Medicare payments to providers, drug and medical device companies and insurance plans.
- Pre-existing condition exclusions are prohibited.
- Additional new taxes on health insurers.
- Minimum medical loss ratio of 85% required for Medicare Advantage plans.
- In 2017, businesses with more than 100 employees can purchase insurance through exchanges.
- In 2018, the Cadillac Tax is imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.
- In 2018, the Cadillac Tax is imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.
- In 2020, the Donut Hole coverage gap is closed. Seniors continue to pay the standard 25% of drug costs until the threshold for Medicare catastrophic coverage is reached.
