The Supreme Court is expected to rule by the end of this month on some key constitutional challenges brought by states against the 2010 health care overhaul law. The decision will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.
While some of the key features don’t kick in until 2014, the controversial law already has altered the health care industry and established a number of consumer benefits.
Here are some frequently asked questions about some of the law’s provisions that are already up and running as well as major features of what’s to come, if the law stays in place.
A: The court’s decision should have minimal impact on your current health insurance. But if the court strikes down the law, insurers might decide to change some provisions of your coverage that were mandated by the law, such as allowing an adult child to stay on your policy until age 26 and requiring insurers to provide some preventive services at no out-of-pocket cost to you.
A: Right now, you aren’t required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year or up to 1 percent of income – whichever is greater – and rise to $695 or 2.5 percent of income by 2016.
For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater, by 2016 and beyond.
A: Health plans can’t cancel your coverage once you get sick – a practice known as "rescission" – unless you committed fraud when you applied for coverage.
Children who have pre-existing medical conditions can’t be denied coverage (this will apply to adults in 2014).
Insurers have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.
A: Depending on your income, you might be eligible for Medicaid, the state-federal program for poor people and those with disabilities. Currently, in most states nonelderly adults without minor children don’t qualify for Medicaid. But beginning in 2014, anyone with an income at or lower than 133 percent of the federal poverty level – which currently would be $14,856 for an individual or $30,656 for a family of four – will be eligible.
A: You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, that are slated to begin operating in 2014. Exchanges will sell insurance plans to individuals and small businesses.
These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for families of four, based on current poverty guidelines.
A: Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.
A: No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The companies’ first 30 workers would be excluded from the fee.
However, if you have a company with 50 or fewer people you won’t face any penalties.
In addition, if you own a small business, the health law offers a tax credit to help cover the cost of providing insurance. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.
A: The law is narrowing a gap in the Medicare Part D prescription-drug plan known as the "doughnut hole." That’s when seniors who’ve incurred a certain initial amount in prescription costs have to pay for all their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.
The coverage gap will close entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.
The law also has expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries.
Medicare also will pay for an annual wellness visit to the doctor.
The health law reduced the federal government’s payments to Medicare Advantage plans, which are run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare does. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits – such as free eyeglasses, hearing aids and gym memberships – that they now provide.