Changes Affecting Consumers in 2014

Many of the most important parts of the federal health care reform law – the Affordable Care Act – began in 2014. Here is a quick rundown of the 2014 changes that could affect you:

You’re now required to have health insurance: Most Americans are required to have health insurance coverage as of January 1, 2014. If you do not have coverage, you must enroll in coverage. If your employer or organization doesn’t offer you coverage, you must obtain individual coverage or you could face a tax penalty. This is called the “individual mandate.”

If you don’t have coverage, you’ll pay a fine: The penalty generally for failing to have coverage, either through your employer or by buying your own individual coverage, starts in 2014. For next year, it’s $95 per adult and $47.50 per child or 1 percent of family income – whichever is greater. The penalty increases over the next two years. In 2016 on, the penalty is $695 per adult and $347 per child or 2.5 percent of family income.  Certain caps on the penalties apply.

Health insurance exchanges: An exchange (also called a marketplace) is a website where you can shop for some health insurance coverage options available to you. You can also enroll using a paper form or over the phone. Some exchanges are run by the state while others are operated by the federal government.

For coverage beginning in 2014, residents of each state were able to shop on a public exchange during an open enrollment period that ended March 31, 2014. For coverage beginning in 2015, enrollment will run from November 15, 2014 to February 15, 2015. If you experience certain life events, you could qualify for a special enrollment period between open enrollment periods. See our exchange pages to learn more.

Financial help: As of 2014, the law helps Americans with low or moderate incomes afford health insurance purchased through public exchanges. Financial help available under the law includes premium subsidies that would be provided in the form of tax credits, as well as cost-share reductions for eligible Americans. The sliding scale of available subsidies is tied to your income level. You can find out more about whether you qualify for savings on this page.

You can’t be turned away for health reasons: Health insurers must accept any individual and employer who applies for coverage, with very limited exceptions. You cannot be denied coverage because of your health status.

New rules for pricing health plans: You cannot be charged more in premiums because of your health status, claims experience or gender. Premiums can vary by age, geography, family size and tobacco use but only to a limited extent.

Certain benefits must be included: Regardless of what plan you purchase, if its individual coverage or coverage through a small employer, the coverage must generally include a government-defined benefits package, called “essential health benefits.” It includes, for example, emergency services, hospitalization, maternity and newborn care, prescription drugs and lab services. For more detail, visit healthcare.gov.