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Here are a few important pieces of the Affordable Care Act (ACA) that will come to fruition in the near future.  Many people will have to take action as early as October 1, 2013.

Pre-Existing Conditions and Premium Calculation
After January 1, 2014, pre-existing medical conditions will no longer be a factor in calculating your health insurance premiums.  Everyone will be eligible for guaranteed-issue health insurance.  Health insurance premiums will be driven by age, location (county), tobacco usage (up to 50% higher premiums for any tobacco usage), and of course the type of plan you request.  Gender will not be a factor, so a 30 year old male nonsmoker and a 30 year old female nonsmoker will have the same monthly premium for the same plan.

Open Enrollment
This will be similar to employers that have an “open enrollment” period for employees to sign up for group health insurance or make changes to their existing health insurance.  The 2014 Open Enrollment period is as follows:

Effective Date : Application Date
January 1, 2014:  Apply between October 1, 2013 and December 15, 2013
February 1, 2014: Apply between December 16, 2013 and January 15, 2014
March 1, 2014: Apply between January 16, 2014 and February 15, 2014
April 1, 2014: Apply between February 16, 2014 and March 15, 2014
May 1, 2014: Apply between March 16, 2014 and March 31, 2014

If you do NOT apply during that time, you may not be able to get coverage unless you have a qualifying event (i.e., losing employer coverage).  Otherwise, if you break your leg in July and you’re in the ER, you can’t just sign up for insurance at that point and have it covered.  You’ll have to wait until October 15, 2014 to apply for a January 1, 2015 effective date.  Also, you could be subject to an IRS penalty if you do not have health insurance during a given tax year beginning with 2014.

What will be covered?
All ACA-compliant plans effective on January 1, 2014 or later must cover at least the following Essential Health Benefits (EHBs):

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

How much will my premiums be?
As of today (August 2, 2013), the premiums in Illinois are unknown.  These should be available sometime mid-September.  If you’d like to see if you qualify for a government subsidy, you can use the calculator here:  http://kff.org/interactive/subsidy-calculator/.  If you qualify for a subsidy, you must purchase your health insurance through the state exchange (“marketplace” will most likely be the term used).  The Manno Group will be able to help those who qualify for a subsidy.

How can I apply?
Tom Manno will be certified to offer ACA-compliant health insurance policies in Illinois both through the state exchange/marketplace, as well as the traditional route outside of the state exchange.  The Manno Group website will have more information as it becomes available, and you’ll be able to quote/compare the different plans in Illinois.  The application process will also be online, making things easier for you and minimizing processing time.

There are many other provisions of the ACA that will affect the health insurance landscape in the next year.  MannoGroup.com has more detailed information, including a Consumer Guide on the ACA.

If you have any questions or concerns regarding how you, your family, or your business will be affected by the new healthcare reform, please call Tom any time at 708.646.9280 or email tom@mannogroup.com.