Health Care Reform

Impacting You

Learn about the requirements

Health Care Reform changes how people get health care, how they get health coverage, what it costs and who pays for it.

Health plans have wider coverage because of the Health Care Reform law. Some of the benefits:

  • Children with pre-existing conditions, such as asthma, cannot be denied coverage
  • Certain preventive care services are covered with no cost-sharing
  • No lifetime dollar limits on essential health benefits
  • Expanded dependent coverage. Young adults can now stay on their parent’s health plan until they are 26, even if they are:
    • Married
    • Not living with their parents
    • Attending school
    • Not financially dependent on their parents
    • Eligible to enroll in their employer’s plan

IMPACTING YOU

  • The Individual Mandate
    The law requires everyone (with few exceptions) to have health coverage or pay a tax penalty each year.  Individuals are required to maintain minimum essential coverage for themselves and their dependents. Some may qualify for an exemption, while others may receive financial assistance to help cut the cost of health coverage. 


    What type of coverage satisfies the individual mandate?

    Everyone must have minimum essential coverage, which includes:

    •  Individual coverage under an employer-sponsored plan;
    •  Plans in the individual market;
    •  Grandfathered plans;
    •  Government programs such as Medicare, Medicaid, CHIP, or TRICARE; and
    •  Certain other coverage.

    Specialized coverage, such as a dental-only policy, is not required to meet the minimum essential coverage requirements.

     

    Who may qualify for an exemption from the mandate?

    The law includes a list of exemptions to the individual mandate. You may qualify for an exemption if you meet any of the following criteria:

    •  You are uninsured for less than three months of the year;
    •  The cost of purchasing coverage is more than 8% of your household income;
    •  You belong to a Health Care Sharing Ministry;
    •  Your income is below the federal income tax filing limit;
    •  You are a member of an Indian tribe;
    •  You have a religious exemption;
    •  You are incarcerated and not awaiting the disposition of charges against you; or
    •  You do not lawfully reside in the U.S.


    To apply or learn more about an exemption, call the Health Insurance Marketplace at 1-800-318-2596; TTY: 1-855-889-4325, or visit their website www.healthcare.gov.

  • Guaranteed Coverage
    Health plans can no longer deny coverage or charge a higher premium to adults because of a pre-existing condition.

    The law stops health plans from limiting both annual and lifetime coverage limits for essential health benefits.

    Regardless of how sick you may get, your health plan cannot cancel your coverage or place a dollar limit on your essential health benefits.

  • Essential Health Benefits
    Every health plan is required to cover Ten Essential Health Benefits (EHBs), which include:

    1.  Ambulatory patient services  (Outpatient care you receive without being admitted to a hospital)

    2.  Emergency services  (Care for conditions that if not immediately treated could result in a serious disability or death)

    3.  Hospitalization (Care you receive as a patient in a hospital, such as surgery and tests administered during your stay)

    4.  Maternity and newborn care (Care women receive before and after their baby is born)

    5.  Prescription drugs (Drugs prescribed by a doctor to treat an acute illness)

    6.  Laboratory services (Tests administered to help a doctor diagnose a medical condition and monitor effectiveness of treatment)

    7.  Pediatric services, including oral and vision care

    8.  Preventive and wellness services and chronic disease management

    9.  Mental Health and substance use disorder services, including behavioral health treatment

    10.  Rehabilitative and habilitative services and devices

  • How much is the penalty for not having coverage
    If you do not have a health plan, you will pay a penalty when filing federal income taxes, unless you qualify to receive an exemption.  The tax penalties for individuals and families are phased-in as follows:

     

    In 2016, the penalty is $695 per adult ($347.50 per child) with a maximum of $2,085 for a family or 2.5% of taxable income, whichever is greater.


    In 2017, the penalty is $695 per adult ($347.50 per child) with a maximum of $2,085 for a family or 2.5% of taxable income, whichever is greater.

  • Expanded Medicaid Eligibility
    Michigan’s Medicaid expansion program Healthy Michigan Plan covers households who earn up to 133% of the federal poverty level. To learn more about the program go to www.michigan.gov/healthymiplan

  • Affordable Care Act & Taxes
    Affordable Care Act & Taxes
  • Claims Payment Policies
    Claims Payment Policies
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