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Feds continue to tweak Obamacare rules 

1/8/14

Considering the complexity of the U.S. healthcare system and variations among the 50 states, it’s no surprise that federal and state agencies continue to respond to issues surrounding the implementation of the Affordable Care Act (ACA).

Over the past few months, the federal government has issued new rules regarding a ‘grace period’ for out-of-pocket limits, the individual mandate deadline and policy cancellations on the individual market.

Deadline extended
The Obama administration granted a six-week extension until March 31, 2014 for Americans to sign up for coverage and avoid new tax penalties under the president’s health care overhaul law.

The change had been expected since there was a “disconnect” in the implementation of the law. Under the new rule, people who sign up by the end of open enrollment season won’t face a penalty.

Previously you had to sign up by the middle of February, so your coverage would take effect March 1, 2014. Now you have until the end of March. The extension is for 2014 only.

Out-of-pocket expenses
The second rule change will allow some insurers to delay for a year the new limit on consumers’ out-of-pocket expenses.

The ACA explicitly sets annual limits—$6,350 for individuals and $12,700 for a family—on out-of-pocket expenses. However, both the feds and California are treating 2014 as a transition year.

In California, for 2014 only, the limit for policies sold to individuals, small businesses and all policies sold in the Covered CA Exchange will be $6,350 on all medical expenses, plus $1,000 for dental benefits for children. Insurers who sell to large purchasers (more than 50 employees) can have two out-of-pocket limits of $6,350 each.

Effective in 2015, the limit on out-of-pocket expenses for covered benefits from in-network providers will be a total limit of $6,350 for covered benefits.

The one-year delay was granted because some insurers use different administrators to process their medical and prescription coverage and said they needed more time to adjust their processing systems.

Furthermore, other significant consumer protections also go into effect next year: Insurers will no longer be able to discriminate against people with pre-existing conditions, they can no longer impose annual dollar limits on total coverage, and they must offer certain baseline, “essential” health benefits.

The third rule change, concerning policy cancellations in the individual market, garnered significantly more media coverage.

Policy cancellations
The ACA requires health insurance policies that begin after Jan. 1, 2014, to offer new consumer protections, including prescription drug, hospitalization and maternity coverage. Many health plans that were on the market did not offer these protections.

So while most Americans who get health insurance either through an employer or a government program were not affected, about 15 million people who buy their insurance in the ‘individual market’ were facing the potential cancellation of their health insurance.

After health insurance companies began notifying policyholders that their coverage would soon be canceled because of the new healthcare law, the Obama administration announced a new rule that allows insurers to extend current health plans into 2015.

Instead of having to renew their existing plan by Dec. 31, 2013, consumers would now have until Oct. 1, 2014. Since health plans typically last a year, that means a consumer could stay on a health plan without the new protections until Sept. 30, 2015.

However, if many insurers were allowed to renew existing policies, then fewer healthy people might join the new Covered CA Exchange. That could destabilize these marketplaces, which rely on healthy customers to keep insurance premiums in check. If there are not enough healthy consumers enrolled, premiums on the Exchange could soar in 2015.

For that reason, Covered CA decided not to permit insurance companies to extend the policies into next year. So California consumers who have an individual policy and received cancellation notices should begin shopping for a new health insurance policy.

California shuts down fake ACA websites
The California attorney general’s office has shut down 10 websites that mimicked the state’s official health insurance marketplace, CoveredCA.

“These websites fraudulently imitated Covered California in order to lure consumers away from plans that provide the benefits of the Affordable Care Act,” Attorney General Kamala Harris said. “My office will continue to investigate and shut down these kinds of sites.”

The sites all used domain names similar to coveredca.com, including coveredcalifornia.com and californiabenefitexchange.com, and they used phrases like “Get Covered” and “Covered California” to attract consumers. However, the sites were operated by private health insurance brokers not affiliated with the state’s official exchange.

Resources
Learn more about the ACA and what it means for you at www.csea.com/healthcare