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Two Important Affordable Care Act (ACA) Milestones Preexisting Medical Conditions: Jan. 1, 2014 Insurers may not deny coverage, charge higher premiums or provide coverage that excludes coverage of essential health benefits due to preexisting medical conditions or past history of a medical condition. Individual Responsibility: Jan. 1, 2014: Most individuals will be required to obtain health insurance coverage: Ÿ Tax penalties for those who do not comply Ÿ Exceptions will be made for financial hardship and religious objections The FAQs provided in this article are courtesy of Cover Missouri, a project of the Missouri Foundation for Health. For more information, visit CoverMissouri.org. Will I have to buy health insurance? Beginning in 2014, most people will be expected to carry insurance or pay a fine (with exceptions for those with financial hardship and certain religious beliefs). Individuals and families will be able to choose from a variety of basic plans offered in a newly established Exchange, or health insurance marketplace. All of the plans will cover preventive care without co-pays and will not have set limits on lifetime or annual spending. Low-and middle-income individuals who are not offered insurance through their work can receive subsidies to help pay for insurance premiums. What does health care reform mean for businesses? Health care reform is intended to make it easier and more affordable for businesses to offer insurance to employees. Currently, small businesses pay 18 percent more for their insurance than large businesses. Through health insurance Exchanges, Affordable Care Act: Closing the Donut Hole for Seniors businesses with fewer than 100 employees will be able to comparison shop for a private insurance plan that offers quality and affordable coverage. Tax credits will be offered to businesses with fewer than 25 employees to help with the cost of purchasing insurance for employees. In Missouri, nearly 136,000 small businesses could be eligible for these credits. How will health care reform affect rural communities? In rural communities, the lack of access to health care providers is a significant barrier to receiving health care. Health care reform addresses access problems by creating programs to increase the number of health professionals practicing in these underserved areas. In the short term, rural doctors, pharmacies and hospitals will see their Medicare payments increase by up to 10 percent. Increasing Medicare payment rates could attract more providers to areas where they are needed most. In the long term, the law creates a program to help rural health care workers repay their student loans which creates an incentive to work in rural settings. How will health care reform affect the cost of my health insurance? The most significant way the cost of insurance is addressed in the law is through the creation of a Missouri health insurance Exchange. An Exchange is a marketplace where individuals and businesses will be able to compare insurance plans and purchase affordable coverage that meets a basic standard. An Exchange should be open in Missouri by 2014. More than 150,000 small businesses in Missouri may be eligible to take advantage of the cost savings resulting from competition between insurance plans. Another approach to controlling the costs of health insurance includes new regulations on the health insurance industry. Insurance companies will be required to use 85 percent of premiums on health care services or give consumers a rebate. Other helpful web sites: Ÿ ShowMeHealthAnswers.org Ÿ HCFGKC.org/resources/health- reform Ÿ ReformReality.org If you have Medicare Part D, you could be at risk of falling into the coverage gap often referred to as the "donut hole." For instance, once you reach $2,930 in prescription drug costs, which includes both your share of covered drugs and the amount paid by insurance, you will be in the donut hole. As a countermeasure, the Affordable Care Act allows for a 50 percent discount for brand-name drugs and a 14 percent discount for generics for Medicare recipients who hit the donut hole this year. However, if you receive "Extra Help," a Medicare program to help people with limited income pay Medicare prescription drug costs, you do not have a coverage gap so the discounts will not apply to you. One result of the Affordable Care Act of 2012 is that the donut hole is projected to gradually narrow until it disappears in 2020. For more information, visit accessHealthnews.net or find us on Health

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