The health care reform law, the Affordable Care Act, was passed by Congress in March of 2010. It brings a lot of changes and it can be confusing. Florida Blue is here to help you understand what it means and to help you make the right health care decisions for your family or your business. Part of what makes this law seem so confusing is all of the new terminology. Here’s our health care reform glossary of the key words you may have heard and what they mean.
- Employer Benefits Exemption: Tax exemption for workers based on the value of their health benefits provided by employers.
- Essential Health Benefits: Starting October 1st the law requires that non-grandfathered individual and group health plans include essential health benefits such as: preventive care, emergency services, hospitalization, prescription drugs, maternity and newborn care, pediatric services (including dental and vision care), lab services and more.
- Grandfathered plans: Individuals enrolled in a health plan that took effect before March 23, 2010 may be able to keep their plan, even if it has fewer benefits than the Affordable Care Act requires.
- Individual mandate: The provision of the Affordable Care Act that requires most everyone in the United States to have a health insurance plan or pay a tax penalty.
- Marketplace: The government is setting up an insurance Marketplace where individuals can shop and compare health plans online or in person. From October 1, 2013 through March 31, 2014 you’ll be able to buy a health plan.
- Medicaid: A government health benefit program for lower income Americans. For more information on Medicaid, please visit myflorida.com/accessflorida.
- Medicare: Federal health insurance offered primarily to people age 65 years and older and the disabled under the age of 65. It covers about 49 million Americans. For more information on Medicare, please visit Medicare.gov.
- “Metal” plans: The Marketplace will offer four different levels of health insurance plans (called ‘metal’ plans because their names are Bronze, Silver, Gold and Platinum). They will offer similar health benefits, with different out-of-pocket costs and premiums.
- Pay or play: The Affordable Care Act requires employers to provide health insurance for their workers or pay a fee or penalty to the government. Also known as an “employer mandate”, it will exempt some small businesses from having to provide insurance to their employees if they meet certain criteria.
- Pre-existing conditions/guaranteed coverage: Starting October 1, 2013, no one can be turned down for health coverage because of his or her health history. Everyone can get a health plan.
- Small Business Tax Credit: Employers with fewer than 25 full-time employees that provide health care benefits may be eligible for a federal tax credit if they meet certain requirements. : The employer must contribute at least 50% of the cost toward each employee’s single health insurance. For tax years beginning in 2014, the credit will be available only to small businesses that purchase health coverage through the exchange (SHOP). The maximum credit will increase to 50% for small business employers and 35% for small tax-exempt employers
- Subsidy: If you qualify, the government may help you pay part of the bill for your health plan. This subsidy amount depends on things like income, age, where you live and family size and is paid to the insurance company to help lower the cost of your monthly health plan premium. It does not pay for doctor or hospital visits, prescriptions, etc. You still pay for some of those costs, however, financial assistance may be available to help qualifying individuals pay for out-of-pocket health care costs.
- Summary of Benefits and Coverage (SBC): The SBC is a new standardized template, created by a national coalition, which provides a high-level summary of a health plan’s benefits. It outlines cost-sharing information such as copays, coinsurance, and deductibles, as well as exclusions and limitations (what is not covered).
- Underinsured: People who have health coverage, but their health plan has high out-of-pocket costs for medical services.
Be sure to bookmark our Health Care Reform website dedicated to keeping you informed and updated with all things related to health care reform. You can also call us at 1-800-633-6808 or call your local agent. Or feel free to visit your local Florida Blue Center.
In the meantime, we’ll continue to add to the health care reform glossary. Leave us a comment below with any terms you’d like us to include!
This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of the provisions of the Affordable Care Act (ACA). It does not attempt to cover all of the law’s provisions and is not intended as tax or legal advice.