Affordable Care Act

As part of the Affordable Care Act (ACA or health care reform law), starting in 2014 ALL Americans must have a minimum amount of health insurance or be taxed by the government. The law also requires each state to have a health insurance exchange where people can buy health insurance coverage. People who don’t get health insurance at work, or can’t afford it, may be able to get it through an exchange. The exchanges do not replace buying health insurance privately. They are simply a new place to shop and buy.

Qualified Health Plan (QHP) requirements

All health plans must follow new coverage and benefit rules starting in 2014 (see the chart below and read on for details about exchange coverage and essential health benefits). These requirements are based on:

• If the plan is offered on or off the exchange.
• If the plan is fully insured or self-insured.
• Group size.

Premiums for these individual and small group plans will not be based on health status. Instead, they will be based on family tier, age, geography and tobacco use. (State-specific rules may vary when a federally run model is not in place.) These plans also must use “3 to 1” age bands. This means the highest premium cannot be more than three times the lowest premium for the same plan. All of these requirements may have an impact on rates, although the specific effects are difficult to define at this time as qualified health plans continue to be developed.