Individual Insurance Coverage Mandate
All U.S. citizens and legal residents will be required to have “qualifying” health insurance, which includes coverage through your job, a government plan (such as Medicaid, Medicare, Veterans Administration, and the Armed Services), or a health plan you have purchased on your own.
If you don’t have health insurance, you will pay a tax penalty that will be phased-in starting in 2014 with a fine of $95. In 2015, the penalty will increase to $325, and in 2016 to $695 or a percentage of your taxable income. After 2016, your penalty will be increased every year according to the changes in the cost of living.
Employer Insurance Mandate
Companies with more than 200 employees will be required to routinely enroll their employees into health plans offered by the employer. Any employee may opt out of coverage.
A company with more than 50 employees that does not offer health coverage will be fined $2,000 per full-time employee. The first 30 employees are excluded from this assessment.
Update: Implementation of the employer insurance mandate has been delayed until January 1, 2015.
Health Insurance Exchanges
Beginning on January 1, 2014 health insurance exchanges will be created where an individual or small business (up to 100 employees) can compare the costs of various health plans and different types of health coverage benefits. The purpose of the health insurance exchanges is to make health insurance more affordable and easier to purchase for small business and individuals.
Health plans will be required to both issue and renew your policy regardless of any pre-existing health conditions. What you pay for your monthly premium can vary based only on your age, where you live, your family’s composition, and tobacco use.
Your out-of-pocket limit, or yearly maximum, will be decreased based on your income as a percentage of the Federal Poverty Level.
If you purchase insurance through an exchange, you will be able to choose health coverage that is best for you and your family. Each of the health plans to be offered will include an essential set of benefits that provide comprehensive health care services with different levels of cost sharing.
The federal government will contract with health insurers to offer at least two multi-state health plans in each health insurance exchange.
If your family income is 133% to 400% of the Federal Poverty level, you may be eligible for a premium credit (or subsidy) to help you purchase insurance through your state’s health insurance exchange.