You’ve read through this entire 5-part series on the Affordable Care Act. Bravo, informed citizen. Or maybe you’re just tuning in now. Either way, you might be thinking, “What do I absolutely have to remember so I can move on with my life?”
Here are the most important ACA rules and deadlines to keep in mind.
Open enrollment for health insurance
If you’re uninsured or buy your own insurance, rather than get coverage through an employer or the government, you can shop for a health plan on Maine’s new federally run health insurance marketplace (formerly called an “exchange.”) Enrollment begins Oct. 1 and lasts through March 31, 2014. The coverage takes effect on Jan. 1, 2014. Even if you buy a policy outside of the marketplace, these open enrollment dates still apply.
This six-month period will be the only time you can shop for coverage for next year, unless you have special circumstances, such as getting married, divorced or losing a job. So don’t wait until you get sick to sign up.
For small businesses, open enrollment also begins Oct. 1, but you can sign up and begin offering coverage at any time during the year. And this just in: The small-business health marketplaces, which serve businesses with fewer than 50 workers, will accept applications by phone, mail and fax on Oct. 1, but online enrollment has been delayed to November. The websites will still go live on time, but you won’t be able to shop for and compare plans for another month.
This enrollment period does not apply to employer coverage, Medicaid, Medicare, or private Medicare supplement “medigap” or Medicare Advantage policies.
Under the ACA, everyone must have health insurance by Jan. 1, 2014, or pay a penalty, with few exceptions. If you have coverage through Medicaid, Medicare, the VA, or your employer, breathe easy, that satisfies the requirement. If you’re a poor adult living below the poverty level in a state that didn’t expand Medicaid, like Maine, you’re exempt.
Otherwise, you’ll need to either buy a plan or pay the penalty. The penalty kicks in if you don’t have coverage by Jan. 1, 2014, but there’s a grace period for this first year. So procrastinators, you technically have until the end of March to buy a plan.
For 2014, the penalty will be 1 percent of family income or $95 per adult and $47.50 per child (up to $285 per family), whichever is more. It ramps up from there in future years.
Businesses with 50 or more “full-time equivalent” employees” must offer affordable, comprehensive health coverage to their employees next year. Those businesses will be fined $2,000 per worker, excluding the first 30 employees, if they don’t offer coverage to employees who average 30 or more hours per week.
Employer marketplace notifications
Most businesses must notify employees in writing by Oct. 1 about the new health insurance marketplaces. There’s no fine or penalty under the law for failing to notify employees, however.
Since 2010, the law has required most private health plans to cover a range of preventive care services to adults and children at no cost. Blood pressure and cholesterol tests, colonoscopies, vaccines and other services must be provided without charging you a co-pay or co-insurance, even if you haven’t met your yearly deductible.