Sebelius. The PPACA includes numerous provisions to take effect over several years beginning in 2010. There is a grandfather clause on policies issued before then that exempt them from many of these provisions, but other provisions may affect existing policies. • Guaranteed issue requires policies to be issued regardless of any medical condition, and partial community rating requires insurers to offer the same premium to all Applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding tobacco use). • A shared responsibility requirement, commonly called an individual mandate, requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, secure an approved private-insurance policy, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship. The penalty for not securing coverage changed from $695 to $0 beginning with plan year 2019. • Health insurance exchanges operate in each state, offering a Health Insurance Marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible). • Low-income individuals and families above 100% and up to 400% of the federal poverty level may receive federal subsidies on a sliding scale if they choose to purchase insurance via an Exchange. • The text of the law expands Medicaid eligibility and simplifies the CHIP enrollment process. In National Federation of Independent Business x. Xxxxxxxx, the Supreme Court effectively allowed states to opt out of the Medicaid expansion, and some states (including Georgia) have chosen to exercise their opt-out privilege. States that choose to reject the Medicaid expansion can set their own Medicaid eligibility thresholds, which in many states are significantly below 133% of the poverty line; in addition, many states do not make Medicaid available to childless adults at any income level. Because subsidies on insurance plans purchased through exchanges are not available to those below 100% of the poverty line, this may create a coverage gap in those states. • Minimum standards for health insurance policies, to include Essential Health Benefits, have been established and annual and lifetime coverage caps are banned. • Firms employing 50 or more people but not offering health insurance pay a shared resp...
Sebelius. The PPACA includes numerous provisions to take effect over several years beginning in 2010. There is a grandfather clause on policies issued before then that exempt them from many of these provisions, but other provisions may affect existing policies. • Guaranteed issue will require policies to be issued regardless of any medical condition, and partial community rating will require insurers to offer the same premium to all Applicants of the same age and geographical location without regard to gender or most pre-existing conditions (excluding tobacco use). • A shared responsibility requirement, commonly called an individual mandate, requires that all individuals not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs, secure an approved private-insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect exempted by the Internal Revenue Service, or waived in cases of financial hardship. • Health insurance exchanges will commence operation in each state, offering a Health Insurance Marketplace where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible). • Low-income individuals and families above 100% and up to 400% of the federal poverty level will receive federal subsidies on a sliding scale if they choose to purchase insurance via an Exchange. • The text of the law expands Medicaid eligibility and simplifies the CHIP enrollment process. In National Federation of Independent Business v. Sebelius, the Supreme Court effectively allowed states to opt out of the Medicaid expansion, and some states (including Georgia) have chosen to exercise their opt-out privilege. States that choose to reject the Medicaid expansion can set their own Medicaid eligibility thresholds, which in many states are significantly below 133% of the poverty line; in addition, many states do not make Medicaid available to childless adults at any income level. Because subsidies on insurance plans purchased through exchanges are not available to those below 100% of the poverty line, this may create a coverage gap in those states. • Minimum standards for health insurance policies, to include Essential Health Benefits, have been established and annual and lifetime coverage caps are banned. • Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government ...
