What Healthcare Reform Will Mean to You

The nation's 39 independent Blue Cross and Blue Shield companies recognized that many young people could lose their coverage because of their age, student status, graduation from school or other factors prior to when the new law goes into effect for plan years beginning September 23, 2010. The BCBS companies proactively announced in April that they will offer to their accounts continued overage of these hundreds of thousands of young adults under age 26 on the health insurance policies their parents purchase through the individual marketplace effective June 1. Young adults may be eligible regardless of whether they are financially dependent on their parents. This extension of coverage is also being offered to employer accounts for their members.

Many state laws and employers' policies already allow older dependents to remain on a parent's policy. Because policies vary, you should contact your employer's human resources department to determine eligibility.

No. The new law will be implemented over the next several years. Blue Cross and Blue Shield companies will continue to provide excellent service and will work to implement the new healthcare laws to best serve their members.

The 39 independent Blue Cross and Blue Shield companies are reviewing the legislation and any potential impact on our members. We will also be working to ensure a smooth transition with state and federal regulators who will be drafting the required regulations.

• Beginning in July 2010 – Consumers with health problems who have been uninsured for 6 months may be eligible to obtain coverage through a new high risk pool program. And a temporary reinsurance program will help employers who provide coverage to their retirees in maintaining this coverage.
• Beginning in plan years on or after September 23, 2010 – Pre-existing condition exclusions are prohibited for children under 19, dependents up to age 26 will be able to obtain coverage through parents’ health plans, routine preventive care will be covered without cost-sharing, limits on lifetime coverage will be eliminated along with other changes.
• In 2014 - Individuals and small businesses will be able to purchase coverage through state-based exchanges. Consumers will be able to purchase health insurance regardless of health status and premiums cannot vary because of health status. Individuals will be required to purchase health insurance or pay a penalty. Subsidies will be available on a sliding scale to help individuals or families with incomes up to 400 percent of the federal poverty level to purchase insurance through new state-based exchanges.

Yes. Blue Cross and Blue Shield companies have long supported guaranteeing that everyone could purchase health insurance coverage regardless of their health condition coupled with a requirement for everyone to obtain and maintain coverage. Beginning in 2014, the new law requires that all individuals have coverage and insurers must offer coverage to anyone regardless of health status and cannot vary premiums based on health status.

There are a number of factors that are driving health insurance premiums. Increasing utilization attributable to an aging population, obesity and chronic illnesses; new treatments; prescription drugs and expensive new technologies are the biggest causes of increasing healthcare premiums. The new law establishes a few pilot programs, but does not aggressively attempt to control rising healthcare costs.

We believe that premiums will increase as a result of provisions in the reform legislation that will guarantee richer levels of benefits than most consumers who obtain their own insurance purchase today. Insufficient discounts for the young and healthy will encourage many of them to forgo coverage. New fees and taxes mandated by the new law will also likely increase the cost of premiums as they are phased in.

Blue Cross and Blue Shield companies will continue to work with doctors, hospitals, employers and consumers to rein-in costs and insurance premiums while improving access to quality healthcare. In doing this, many of the Blue Cross and Blue Shield companies have initiatives to reduce unnecessary hospital readmissions, eliminate infections acquired during hospital visits and promote paying doctors and hospitals for quality outcomes to help achieve this goal.

Many Blue Cross and Blue Shield companies already offer low-cost health insurance options that you may be able to enroll in today. You can find coverage options through your local Blue Cross and Blue Shield company.

Beginning in 2014, state health insurance exchanges will enable consumers to compare benefits, prices and networks of providers and purchase coverage.

Prior to the establishment of state exchanges in 2014, a temporary high risk pool program will be created by the federal government to provide coverage to high-risk individuals who have not been covered during the prior 6-month period or do not have access to coverage, to purchase coverage. A majority of states already have high-risk pools for their residents.

Beginning in plan years after Sept. 23, 2010, the new law allows dependents up to age 26 to obtain coverage under their parents’ plans that offer dependent coverage. In April 2010, the 39 independent Blue Cross and Blue Shield companies offered to voluntarily extend coverage in their group and individually insured health plans to allow young adults to remain on their parents’ policies.

Blue Cross and Blue Shield companies offer many different options, including many that are much more affordable than many people realize. Talk with your local Blue Cross and Blue Shield company about options that could fit your needs. Consumers who purchase coverage on their own may qualify for federal subsidies to help offset higher premiums beginning in 2014. Federal agencies must work out how subsidies would be paid. The Congressional Budget Office estimates that about 20 million American households will be eligible for subsidies. In addition, eligibility in Medicaid, the federal-state program that provides health coverage to millions of Americans, will expand to cover families with incomes up to 133 percent of the federal poverty level.

We will provide updated information on this FAQ. Submit your questions here.

You can find additional information about healthcare reform in your state, enter your ZIP code here: Blue Finder.

If you are looking to purchase individual health insurance coverage, enter your ZIP code here: AskBlue.

One of the earliest changes for employer-provided coverage will be the requirement that beginning in plan years on or after September 23, 2010, employers pay the full cost of preventive coverage, including immunizations, breast cancer screening and recommendations of the U.S. Preventive Services Task Force and other agencies such as the Centers for Disease Control.

Effective with plan years on or after September 23, 2010, dependents up to age 26 will be allowed to remain on their parents’ policies. In April 2010, the 39 independent Blue Cross and Blue Shield companies announced that they would voluntarily offer to allow young adults who would age-off before September 23 to remain on their parents’ policies.

Another requirement effective with plan years beginning on or after September 23, 2010, employers may no longer set lifetime limits on essential benefits. “Reasonable” annual limits on essential benefits are permitted until 2014. The secretary of the U.S. Health and Human Services will define reasonable limits.

Employers with more than 200 employees must also automatically enroll full-time employees as soon as they are eligible for coverage. Employees, however, may opt-out of coverage.

Beginning in 2014, businesses with 50 or more employees that do not offer coverage and have at least one full-time employee who receives a federal tax credit to purchase health insurance on his own through an Exchange, must pay the federal government a $2,000 per-employee penalty. The first 30 employees would be excluded from this assessment.

Employers with 50 or more employees that do provide coverage, but have at least one full-time employee who receives a federal tax credit to purchase health insurance on his own through an Exchange, will be assessed a penalty that will be the lesser of $3,000 per employee receiving a premium tax credit or $2,000 for each full-time employee, excluding the first 30 employees.

Large businesses – those with more than 200 full-time employees – that offer health insurance will have to automatically enroll workers into a health plan. An employee, however, may choose to opt out of this automatic enrollment into their employer’s health plan.

Many small businesses will be eligible for tax credits of up to 35 percent. Businesses that employ fewer than 25 employees, pay average annual wages of $50,000 and pay at least half the cost of single coverage for their employees may be eligible to receive a tax credit.

Employers with 10 or fewer employees that pay annual average wages of $25,000 or less per year may be eligible for up to a 35 percent tax credit in 2010.

In 2014, the tax credit for eligible small businesses will increase to 50 percent of premiums paid.

Full eligibility details will be provided by the Internal Revenue Service. You should review and discuss the full criteria with a tax professional to determine whether your business will qualify.

Yes, but there are certain rules that may apply. Plans in existence on March 23, 2010 are “grandfathered,” meaning that they do not have to comply with certain provisions of the new law unless they are changed. Federal officials will have to clarify what changes would alter a plan’s grandfathered status via regulation. The statute only specifies that enrolling new employees or adding family members will not affect grandfathered status.

The new healthcare reform law creates a temporary retiree insurance program that will reimburse employers for qualifying retiree medical expenses. Employers may be reimbursed for up to 80 percent of expenses between $15,000 and $90,000. Retiree expenses of employees over age 55, but not yet eligible for Medicare will be eligible. Employers must submit claims to the Secretary of HHS for reimbursement.

Part-time employees will count toward the size-limits requiring coverage on a pro-rated basis based on the number of hours worked.

We will provide updated information on this FAQ. Submit your questions here.

You can find additional information about healthcare reform in your state by entering your ZIP code here: Blue Finder.

If you are looking to purchase individual health insurance coverage, enter your ZIP code here: AskBlue.