Obamacare Overview

Below is a general overview of the impact the NC Obamacare (aka Affordable Care Act, Health Care Reform) will have on health insurance.  In March of 2010 Congress passed the highly debatable Affordable Care Act (ACA).  The purpose of the law was to address what many have deemed to be a problem with our current healthcare system, namely:

  • More accessibility to health insurance
  • Implement certain reforms for the health insurance industry
  • Improve the quality of health care
  • Slow down the rapid growth of health care cost

Since the passing of the Act many of the provisions of ACA have been implemented throughout the years since 2010 and will continue through 2018.  However, the major implementation of the reform will take full effect on January 1, 2014.  These:

  • Require that everyone purchase health insurance, known as the Individual Mandate
  • Establish Federal Subsidies for individuals and families that fall under the 400% Federal Poverty Level (FPL)
  • Medicaid expansion
  • Require employers with 50+ employees to offer group health benefits (Pay or Play)
  • Guarantee Issue(GI) – requires carriers to take all applicants regardless of health status
  • In addition to GI, carriers can no longer base rates on health status.  This therefore eliminates Medical Underwriting.
  • Community Rating
    • Limits premium ratio to no more than 3 to 1 for adults
    • Limits premium ratio for tobacco to no more than 1.5 to 1
    • Rates can no longer be based on gender
  • At a minimum all plans must cover Essential Health Benefits (EHB’s)
  • Creation of Health Insurance Exchanges.  This is essentially an online portal to compare plans offered by various carriers that meet the ACA requirements

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