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How Does the Affordable Care Act Affect Me?

October 28, 2013

As millions of Americans struggle with the rollout of the Health Care Exchange, tens of millions more will soon be impacted by the law’s mandates, tax increases and user fees.  And they may not even know it, yet. 

As part of the Affordable Care Act (ACA), beginning in 2014, numerous new provisions go into effect that mandate employers offer “qualified” health care coverage that is “affordable.”  The result?  The health care that 160 million Americans receive through their employer, and millions who purchase coverage on their own, will also see changes.

How the law will change your health care depends on your own situation.  But with the open enrollment season underway, here are five important questions that any American should ask as they select a health plan for next year:

Q:  How much more will I pay in premiums?  How will my paycheck be affected?

A:  Compare your current monthly premium to the proposed premium for 2014.  Multiply by 12.  This is your total premium increase.  Remember to compare the same size plan and same type of plan (HMO, PPO, POS).  Keep in mind, some plans may no longer be available (see next question).

2014 monthly premium  – 2013 monthly premium = monthly premium increase
 x 12 months
 = total premium increase

Q:  Is my current plan still being offered?

A:  Many Americans will find that the plan they have and like is no longer available.  In order to meet the law’s mandates, including affordability tests, minimum essential coverage, and actuarial requirements, employers may not be able to continue to offer the same plans.  In order to offer the same plan, many employers will need to make changes to meet the law’s requirements, which may result in premiums going up.

Q:  What will my deductible and co-payments be?

A:  As one way to limit premium increases, plans may expect families to pay more through increased cost-sharing.  If you’ve never had a deductible, this new cost will be the amount you need to pay before the plan picks up any costs.  Also, co-payments may go up, not just for primary care visits, but also for drug coverage, specialist visits, and out-of-network coverage.  All of these costs are expenses outside of the monthly premium.  Read plan options carefully.

  2013  2014   Increase
Primary care co-pay      
Specialist co-pay      
Generic Drug co-pay      
Brand Drug co-pay      
Specialty Drug co-pay      
Out of Network Co-pay      

Q:  Will my doctor still see me?

A:  Check carefully.  In order to keep cost increases from going through the roof, some plans will change the networks of physicians that you can see.  There is no guarantee that the physician on your plan this year will be on the plan next year. Also, make sure to review the plan’s cost-sharing requirements.  The specialist you need to see may get more expensive (see previous question).

Q:   Is my spouse still covered?

A:  To hold down cost increases resulting from the ACA’s coverage mandates and a new $63 per-covered life fee, many employer plans are dropping spousal coverage, dropping it if your spouse is covered by another plan, or increasing spousal premiums.  However, a plan is required to offer coverage to any dependent children up to age 26.