8 Ways the Affordable Care Act Might Affect Your Employer-Based Health Insurance

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If  you’re among the 150 million Americans who get their health insurance from their employers, you might be wondering how the Affordable Care Act (ACA) will affect your coverage.

Effective January 1, 2015, employers with 50 or more full-time equivalent employees (defined as working an average of 30 hours a week) must provide health insurance to their employees.

If your company falls into this category, here are eight things you should know:

1. Your company must offer health insurance or pay a penalty. That insurance has to meet certain requirements, including covering all preventive care and screenings and at least 60% of your medical costs.

2. Your insurance must be affordable. That means that your premium for an individual plan can be no more than 9.5% of your household income.

3. You can cover your kids longer. Since 2010 you’ve been able to keep your children on your policy until they turn 26, even if they get married. Previously, health insurers could remove children once they turned 18.

4. You get “free” preventive care. All health insurance now covers 100% of the cost of preventive care and screenings, like checkups and mammograms. That means you don’t have to pay copayments or coinsurance.

5. The definition of “full time” changed. You are entitled to health insurance if you work an average of 30 hours a week or more. However, if your hours vary from week to week, you may not be eligible for insurance unless you average 30 hours over a certain period, typically one year.

6. You don’t have to wait. Employers can no longer make you wait before your insurance kicks in. Now you have to be covered after three months on the job (or before). In fact, if your company employs more than 200 people, it has to automatically enroll you in a plan unless you opt out.

7. You may pay less out of pocket. The ACA limits the amount you have to pay for deductibles, copayments, and coinsurance. In 2017, the maximum out-of-pocket limit is $7,150 for an individual plan and $14,300 for a family plan.

8. You may not get a subsidy on the individual exchanges. If your employer offers a plan that meets the ACA’s requirements, you are not eligible for any tax subsidies to help you pay the premium. Still, it’s worth checking to see whether you can get a comparable plan to what your employer offers for a lower premium and other out-of-pocket costs.

Key Takeaways

• The Affordable Care Act has an impact on your employer-provided insurance.

• Effective in 2015, employers with 50 or more full-time equivalent employees must provide health insurance to their employees or pay a penalty.

• Your insurance plan needs to meet minimum requirements outlined by the new health law.

• Provisions in the law help protect you from being uninsured or paying too much money for health coverage.

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  1. 2016 Employer Health Benefits Survey. Henry J. Kaiser Family Foundation. http://kff.org/report-section/ehbs-2016-summary-of-findings/

  2. Glossary: Full-Time Employee. HealthCare.gov. https://www.healthcare.gov/glossary/full-time-employee

  3. Glossary: Out-of-Pocket Maximum/Limit. HealthCare.gov. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit

  4. HHS Proposes 2017 Out-of-Pocket Health Plan Caps. Society for Human Resource Management. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2017-oop-caps.aspx

  5. Odd-Hour Workers Face Loss of Employer Health Plans. Wall Street Journal. http://www.wsj.com/articles/SB10001424052702303873604579495942025149938

  6. Summary of the Affordable Care Act. Henry J. Kaiser Family Foundation. http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/  

  7. Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Businesses and fFmilies. U.S. Department of Labor. http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

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