The Patient Protection and Affordable Care Act, also known as the ACA or ObamaCare, will have sweeping ramifications for consumers, state officials, employers and health care providers. Many of the Act’s most consequential provisions will kick in beginning in 2014, and we all have a responsibility to be informed and in compliance with the law.

New Preventive Care and Pre-existing Condition Provisions

Several ACA provisions that are popular with consumers have already taken effect, including:

What Do I Need to Do Now?

The answer depends on what your particular situation is now, and what you think it will be beginning in January 2014. Most of us will be impacted by the ACA in some way, either by changes to our employer-sponsored or privately purchased plan, or because of the requirement for individuals without coverage to purchase it or pay a fine. You first need to find out how your existing coverage (if any) will be affected, or if you will be required to purchase coverage on your own.

Beginning in 2014, most people will be required to have health insurance or pay a fine. This is often referred to as the individual mandate . The individual mandate will be satisfied by private insurance obtained on your own or through your job, or through government programs including Medicare, Medicaid, CHIP, Veterans Affairs, Indian Health Services, or TRICARE.

Many people who have existing individual health insurance policies are receiving notice that their plans are being cancelled or “transferred” to new plans that comply with ACA coverage requirements. If you receive one of these notices, you will need to work directly with your insurance company or your McInnis Insurance agent to obtain a new, ACA-compliant plan. Or you can shop on the Louisiana health insurance exchange to find a new plan. More on the health insurance exchanges, below.

The Individual Mandate

The so-called individual mandate provision of the ACA requires that beginning in 2014, individuals must have health insurance or pay a fine. You can satisfy this provision with private insurance obtained on your own or through your job, or through government programs including Medicare, Medicaid, LaCHIP, Veterans Affairs, Indian Health Service or TRICARE.

If you have health care coverage from your employer you most likely will continue to do so, particularly if you work for a large employer. Your employer might make changes to your plan design, and you can get those details from your employer.

If you work for a small employer, other changes may be coming and your employer should keep you informed. Some small employers are choosing to no longer offer coverage to their employees because of the ACA.

If you do not get health insurance from your employer, you must purchase an individual health plan or pay a penalty. The penalty for individuals who do not obtain qualified health insurance in 2014 starts at $95 per year or up to 1% of income, whichever is greater. The penalty will rise to $695 per year or 2.5% of income by 2016.

Individuals who do not get health insurance from their employer but cannot afford to buy their own coverage may qualify for Medicaid.

Health Insurance Exchanges

If you do not qualify for Medicaid but still can’t afford health insurance, you might be eligible for government subsidies to pay for private insurance sold in the health insurance marketplace or state insurance exchanges. The exchanges are the federal and state-run health insurance marketplaces where you can shop, compare and buy health care coverage.

The exchanges opened on October 1, 2013, with coverage available for effective dates of January 1, 2014 and after. Premium subsidies are available for individuals and families with incomes between 133% and 400% of the federal poverty level, or $14,856 to $44,680 for individuals, and $30,656 to $92,200 for a family of four.

Some health insurance exchanges will be run by the states, while the federal government will run others. The federal government will run the Louisiana Health Insurance Marketplace. Individuals, families and small businesses in Louisiana must use the HealthCare.gov website to apply for subsidies and coverage. Once you have submitted an application to HealthCare.gov, you may also be declared eligible for programs like Medicaid and the Louisiana Children’s Health Insurance Program (LaCHIP). If you qualify for Medicaid you will purchase a plan through Bayou Health Plan. If you do not qualify for Medicaid or other federal financial assistance, you can continue to purchase a plan from the exchange, or you can purchase through an insurance company or your McInnis Insurance agent.

Five insurers are offering individual and family policies through the Louisiana health insurance marketplace. These are: Blue Cross Blue Shield of Louisiana, Coventry, Humana, Louisiana Health Cooperative and Vantage. Not all of these carriers will be offering plans in every parish. You can find out the details about plans and coverage areas on HealthCare.gov, or by calling us. You can also go to the Louisiana Department of Insurance for more information about health care reform in Louisiana.

Remember that there is no need to go it alone. McInnis Insurance can help you navigate the process of buying insurance on the exchange, or we can help you find a plan from a private insurance company that is not offered on the exchange. We can help you decide whether or not buying coverage on the exchange is appropriate for you, and which plans will best suit your needs.

The Employer Mandate

Beginning in 2015, businesses with 50 or more employees that do not provide health care coverage and have at least one full-time worker who receives subsidized coverage from the health insurance exchange will have to pay a fee of $2,000 per full-time employee (the first 30 workers are excluded from the fee). This is commonly referred to as the employer mandate .

The employer mandate was recently delayed by one year—it was originally set to take effect in 2014. The delay has consequences for other parts of the law. For example, employers will now not need to comply with certain reporting requirements of the ACA until 2015. But those reporting requirements were designed to make it possible for the federal government to determine if individuals are eligible for tax credits or subsidies when purchasing coverage on a government-run exchange. Without the information provided by employers, eligibility for subsidies and tax credits will be determined by a self-reported “honor system.”

Employers also face a slew of new regulations and requirements for the plans they offer to employees. Individuals who get health care coverage from their employer should expect to see drastic changes in their plans in the coming years.

Learn More

You need to learn all you can about health care reform and how it will affect you, your family and your employer. Will your employer continue to provide coverage, or will you need to purchase coverage on your own? Will you be purchasing health insurance for the first time?

HealthCare.gov is a resource for finding out what you need to know about health care reform and what it means for you, your family and your business. The independent agents at McInnis Insurance have the expertise to help Louisiana residents navigate the maze of new information, find appropriate plans and make the right choice. Contact us to day to get started.