The Patient Protection Affordable Care Act of 2010 (PPACA) brought sweeping changes to our nation’s healthcare system. With that in mind, city officials need to stay updated on various rules and requirements that are part of the PPACA and when they become effective. It is also wise for officials to work closely with health benefits advisors as well as the city attorney to see how the new system will affect their city.
What’s the difference between Health Care Reform, the Affordable Care Act, PPACA and Obamacare?
There is no difference. These are different names for the same law.
What is changing because of PPACA?
• Health plans must meet requirements about who is eligible and what is covered
• Insurance “exchanges” or “marketplaces” have been created to help individuals find coverage
• People who have medical problems should be able to get insurance
• Larger employers must provide coverage to all full-time employees or pay penalties
What is the requirement to have health insurance?
Under the original provisions of the law, most Americans and other people legally in the U.S. were required to have “minimum essential” coverage or they would have to pay a penalty on their federal income tax. The “individual mandate” was essentially repealed as part of sweeping tax reforms that were passed in December 2017; however the requirement is still in effect for 2018.
What is “Minimum Essential Coverage”?
“Minimum essential coverage” is basic medical coverage. It can be provided by:
• An employer
• The government (Medicare, Medicaid, CHIP, TRICARE, VA, etc.)
• An individual policy (which can be purchased through or outside the Marketplace)
What kinds of employer-provided coverage will meet the health coverage requirement?
Most employer-provided medical coverage will meet the requirement. This includes PPOs, HMOs, high deductible health plans, and health reimbursement arrangements, whether they are insured or self-funded. Grandfathered plans will meet the requirement. Plans that provide limited coverage, like dental only, vision only, hospital indemnity, accident only, certain diseases only, and plans with lifetime or annual dollar limits will not meet the requirement. You will receive a Summary of Benefits and Coverage with your open enrollment that tells you whether your plan provides minimum essential coverage. You can be covered as an employee, spouse, retiree, or COBRA participant under the employer-provided coverage. It does not matter what kind of employer it is – private/for profit companies, state and local governments (including schools), churches and non-profit organizations all qualify.
What’s a Health Insurance Marketplace?
A Marketplace is an online organization that has been set up in each state to make it simpler for people and small businesses to compare health insurance options. The Marketplaces will not provide insurance, but they will make sure the insurance plans offered through the Marketplaces meet requirements to cover certain types of care at certain benefit levels. They will also provide services to help individuals choose a plan.
Who can buy coverage through a Marketplace?
Although most people who can buy insurance through their employer or Medicare are expected to keep that coverage, you and your family members will be able to buy coverage through the Marketplace, instead of your employer, if you prefer.
Are there any advantages to having coverage through my employer instead of the Marketplace?
You will not be able to buy Marketplace coverage with pre-tax dollars. It is unlikely your employer will contribute to a Marketplace plan as it does for its own plan.
Where can I get information?
You can visit the government website – www.healthcare.gov. TrueNorth provided content for this page. TrueNorth is an endorsed program of the League and provides employee benefit information and services to local governments.