• WHATare the facts?
  • HOWdoes this affect me?
  • WHENis this happening?
  • WHEREdo I get more info?

Flexible Spending Account (FSA) limits are set

If you have a health care FSA through your employer, you can no longer set aside more than $2,500 per year into that account. Your employer may choose to limit your annual deferral even further.

What does it mean to me?

Starting with tax year 2013 and beyond, your maximum pretax contribution from your salary is $2,500. Anything more is not allowed.

Where can I learn more?

Check with your employer’s health benefits administrator if you have questions regarding FSA limits.

Medicare payroll tax increases for higher earners

The Medicare payroll tax increased by 0.9 % on individuals making more than $200,000 and couples making more than $250,000 per year. Unearned income, which has been exempt from the payroll tax, is now subject to a 3.8 % tax.

Medical device sales tax increases

Medical device manufacturers must now pay a 2.9 % sales tax on the products they sell, except for eyeglasses, contact lenses and hearing aids. If you need a medical device that is eligible for the sales tax increase, such as a heart pacemaker, the manufacturer may pass the additional cost on to you (although technically, it’s their responsibility to pay it.)

Open enrollment in the Health Insurance Marketplace begins.

Individuals and small businesses begin buying more affordable qualified health benefit plans in the new Health Insurance Marketplace. This first open enrollment lasts from October 1, 2013, through March 31, 2014.

Individuals using the Health Insurance Marketplace must purchase coverage by December 23, 2013, in order for insurance to be effective on January 1, 2014.

Health insurance now mandatory for individuals

When ObamaCare takes full effect the health care law will require most people to purchase health care coverage by January 1, 2014, or pay a penalty. Individuals using the Health Insurance Marketplace have until March 31, 2014, to purchase coverage and avoid a penalty. In 2014, the penalty is the greater of $95 or 1% of income. There is no penalty for a gap in coverage of less than three months.

Not insured through your employer?

You still have options. You may qualify for the state’s Medicaid program.

or

you may be eligible to buy health insurance, but pay less for it. Based on your income, you may qualify for “advance premium tax credits” to help you pay your monthly premiums and cost-sharing reductions to help reduce your out-of-pocket costs.. Even if you’re not currently on government assistance, earning below a certain income means you will most likely get help with your health care costs.

or

you may buy health insurance directly, on your own, if your income is above a certain level.

Federal subsidies become available

If you’re an individual and you purchase coverage on your own, you may qualify for federal subsidies, available in the form of tax credits, to help ease the cost. The Congressional Budget Office estimates that about 20 million American households will be eligible for subsidies.

Plans must meet “essential benefits” requirements

The law says that to be a “qualified” part of the Health Insurance Marketplace, health care plans must include, at the very least, “essential health benefits.”

What does this mean to you?

When you choose a qualified plan, you can be sure that it covers a pre-determined range of basic, “essential” benefits. Preventive care services will be also be included as recommended by the Centers for Disease Control and Prevention. Plus, the plans must cover pediatric (children’s) services, including vision and dental care.

No more denials for pre-existing conditions

Currently, individuals 19 years of age and younger cannot have coverage denied based on pre-existing medical conditions. Starting in 2014, this provision will extend to all individuals, regardless of age.

How does this impact you?

If your child was previously denied coverage due to a pre-existing medical condition, contact your health care plan to reapply for coverage now that the provision has gone into effect. In 2014, you may also reapply if you’re over 19 and have been previously denied.

Open Enrollment

Open enrollment for coverage starting in 2015 is November 15, 2014 – February 15, 2015.

Large employers must now offer health insurance or pay a penalty

Beginning in 2015, if you’re an employer with 100 or more full-time equivalent employees, do not offer affordable health benefits and at least one of your full-time workers receives a premium tax credit to reduce the cost of coverage they buy through the Marketplace, you will be charged a $2,000 fee for each uninsured full-time employee if 70 percent of your full-time workers are not covered. The first 80 employees are exempt from the penalty.

Mandatory insurance penalty increases for individuals

The law requires you to purchase health care coverage by 2014 or pay a penalty of whichever is greater: $95 or 1 percent of your annual income. In 2015, that goes up to $325 or 2 percent of your annual income.

Open Enrollment

Though the dates are not yet finalized, the Administration has proposed that the open enrollment period for coverage effective on January 1, 2016 will run from October 1, 2015 – December 15, 2015

Mandatory insurance penalty increases for individuals—again

The law requires you to purchase health care coverage by 2014 or pay a penalty. In 2016, the penalty increases from $325 or 2% of annual income penalty to whichever is greater: $695 or 2.5% of income.

Coverage now available across state lines

If your state enters into a Health Care Choice Compact with another state you may be able to purchase health insurance from insurers outside your state. This is designed to spark competition, which could lower costs. If you’re a business owner, you can now consider coverage options outside of the state in which you operate your business.

More companies may now participate in the Health Insurance Marketplace

Companies with 100 or fewer employees may be allowed to participate in the SHOP Health Insurance Marketplace.

Midsize businesses (with 50-99 employees) and large businesses

All businesses with 50 or more full-time equivalent employees must offer coverage to at least 95 percent of full-time employees in 2016 or be subject to a penalty if at least one of their full-time workers receives a premium tax credit through the Marketplace. The first 30 employees are exempt from the penalty.

Excise tax enacted on “Cadillac” plans

This provision will add a 40% non-deductible excise tax or “Cadillac tax” on high cost employer-sponsored health plans. The 40% tax is imposed only on the total cost of coverage that exceeds certain thresholds. These threshold are initially set at $10,200 for self-only coverage and $27,500 for other coverage, but may be adjusted due to a number of factors.

Medicare Prescription Drug Donut Hole Closed

Currently, if you have Medicare and the cost of your prescription drugs exceeds the initial coverage amount of your plan, you are required to pay the higher cost of those drugs until you reach the catastrophic-coverage threshold of your plan (this in-between phase is called the “donut hole”). By the start of 2020, the coverage gap will have closed, there will be no more donut hole” and you will pay only 25% of the costs of your drugs until you reach your yearly spending limit.

As the events and milestones of health care reform continue to evolve we will update the timeline to reflect the most current and pertinent information for you.