Frequently Asked Questions About Health Care Reform

What provisions have begun?
Children up to age 26 are allowed to remain on their parents' health plan. People with pre-existing medical conditions are eligible for a federally funded "high-risk" insurance program. Insurance plans are barred from setting lifetime caps on coverage and can no longer cancel policies when a patient gets sick. Health plans also are prohibited from excluding pre-existing conditions from coverage for children.

When do the main reform changes kick in?
In 2014. That’s when insurance marketplaces, or exchanges, would be set up in states to offer competitive pricing on health policies for individuals and small businesses that don’t have coverage. People with a pre-existing condition will no longer be denied coverage, and all lifetime and annual limits on coverage will be eliminated. Medicaid expansion is implemented to cover more low-income Americans.

What is an "Exchange" and how will it work?
Through the health care reform law, states and/or regions will set up an Exchange, which is an online marketplace where Americans without insurance will be able to purchase coverage, possibly with the help of a tax subsidy based on their income level. In short, it is a place for consumers to shop for health insurance, with the assurance that they will get a quality product with a guaranteed level of benefits. Because the Exchanges will encourage a large purchasing pool with lower administrative costs, a wide range of health care coverage should be available at a reasonable price.

What are the requirements for individuals to buy insurance?
Starting in 2014, a person who did not obtain coverage will pay a penalty of $95 or 1% of income, whichever is greater. That penalty is scheduled to rise to $695 or 2.5% of income by 2016. The lowest-income people will be exempt from the insurance requirement.

Medicaid will be expanded to cover those under age 65 with an income of up to 133% of the federal poverty level (below $29, 327 for a family of four).

To make coverage more affordable, the legislation will offer premium subsidies for people with incomes more than 133% but less than 400% of the federal poverty level ($29,327 to $88, 200 for a family of four).

In addition, people in their 20s will have the option to buy a lower-cost "catastrophic" health plan.

How will small employers be affected by the changes?
Employers with 50 or more workers will face fines for not providing insurance coverage. Businesses with smaller workforces, though, would be exempt. Companies would get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000.

I’m covered by a large employer. How will it affect me?
Large employers can run their health plans as they do now, so there won’t be much change. Even though they have more insurance-buying clout, large businesses have seen steadily rising insurance premiums over the past decade without reform, as medical costs have increased. That pattern isn’t likely to change much, at least immediately.

How does the bill affect Medicare recipients?
Seniors now receive help on the "doughnut hole" - a gap in their coverage for prescription drugs. In 2012, Medicare recipients began receiving a 50% discount on the cost of brand-name drugs if they are in the doughnut hole. Meanwhile, preventive screenings and Medicare enrollment exams are now free to beneficiaries.

What changes will occur in Medicaid?
Individuals and families with incomes up to 133% of the federal poverty level (below $29,327 for a family of four) will gain coverage. The federal government will pay all the states’ costs for the newly eligible Medicaid beneficiaries for three years. And primary-care doctors treating Medicaid patients will get an increase in their fees.

Will reform reduce health insurance costs?
Many health care experts say that while it contains some cost-cutting provisions and pilot programs, the legislation doesn’t go far enough to control costs. People with chronic medical problems, though, generally would see their premiums

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