The Affordable Care Act, otherwise known as health care reform or Obamacare, requires those who are uninsured to get health insurance. While the start dates of some key programs have been postponed, enrollment in health insurance programs has begun, and several other key provisions of the act will become effective in the New Year. The Pennsylvania Institute of Certified Public Accountants (PICPA) provides some insights and advice to help you understand what these changes mean.
If you’re confused about the law and its requirements, you’re not alone. A telephone survey conducted for the American Institute of CPAs by Harris Interactive found limited knowledge of the health care law and its implications. Forty-one percent said they are not at all knowledgeable about the law, and another 48 percent said they were only somewhat knowledgeable. Young people were the least knowledgeable, with nearly half of adults aged 18 to 34 saying they had no knowledge. When it came to knowledge of some of the law’s key provisions, 69 percent knew that it required uninsured people to get health insurance but just 51 percent realized that a health insurance exchange would be available in their state, according to a recent USA Today/Pew poll.
The Marketplace Opens
The newly created Health Insurance Marketplace will provide coverage choices for those who don’t have insurance and those who have it but are interested in exploring other, potentially lower-cost options. Consumers in every state can set up an account, file an application
, and learn if they’re eligible for lower-cost premiums or out-of-pocket costs. The plans are offered by private insurers, and they cover a set of essential health benefits defined by the law. The Health Insurance Marketplace plans must accept those with pre-existing conditions and cover those conditions. They also can’t charge different prices based on gender. Pennsylvania residentd can find more information at the health insurance exchange/marketplace
Open enrollment in the Health Insurance Marketplace was set to begin Oct. 1, though technical problems are slowing online registration. Coverage can start as early as Jan. 1, 2014. Most employers were required to notify employees of their Health Insurance Marketplace options by Oct. 1. Open enrollment closes March 31, 2014, and will not open again until October 2014. It’s only possible to enroll outside of open enrollment if you have a qualifying life event, (marriage, divorce, or new baby), certain changes in income, or a move to another state.
Coverage Available Now
Those who need insurance before Jan. 1 can turn to the government’s Plan Finder
website for help in locating private insurance plans. Be aware that since many of the law’s provisions aren't yet in effect, consumers may not receive the protections that will be available through the Health Insurance Marketplace, such as lower premiums based on income and coverage for pre-existing conditions.
Small Business SHOP Marketplace
If you work for or run a small business, learn about the Small Business Health Options Program (SHOP)
, a separate marketplace for companies with 50 or fewer full-time employees. Online enrollment for qualifying companies to use the SHOP Marketplace was set to begin Oct. 1, but in late September the Obama administration announced that company owners who want to enroll now would have to mail or fax in their information at least until Nov. 1. Coverage can begin as early as Jan. 1. Once a company selects a plan, employees can sign up online through the SHOP Marketplace. Companies that purchase coverage in 2014 through the SHOP Marketplace may be able to take advantage of a small business health care tax credit of up to 50 percent of premium costs. If you have questions about whether your company qualifies, be sure to consult your CPA. Note: If you’re self-employed without any employees, you would use the individual Health Insurance Marketplace, not SHOP.
Your Local CPA Can Help
Health care and the cost of health insurance coverage are critical issues for consumers and businesses. For understandable answers and advice, be sure to turn to your local CPA. He or she has the expertise to answer your most complicated financial questions. To find a CPA in Pennsylvania by location or area of expertise, ask your family or friends for recommendations or use PICPA's CPA Locator