Overview of the Key Provisions of Health Reform • Intermountain Agency, Inc.
The Patient Protection and Affordable Care Act (ACA) is a piece of legislation with many provisions phasing from 2012 to 2014. Below, we have provided a brief outline of the key provisions taking effect over the next 3 years.
Key Provisions of the Affordable Care Act That Take Effect in 2012
• Medicare hospital value-based purchasing program
• Increase in physician quality reporting requirements in Medicare
• Additional Medicare pilot programs on alternative payment methodologies, (e.g. accountable care organizations)
• Increased requirements for hospitals to maintain not-for-profit status
• Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund
Key Provisions of the Affordable Care Act That Take Effect in 2013
• Increase Medicare payroll tax by 0.9% on high-income earners
• Impose a 3.8% tax on net investment income of high-income individuals
• $500,000 cap on health insurers’ deduction for executive compensation
• Eliminate employer deduction for Medicare Part D subsidy
• FSA limitations
• Excise tax on medical device manufacturers and importers
• Medical expense deduction floor increases to 10%
• Nationwide bundled payment pilot begins in Medicare
• Increased Medicaid reimbursement for primary care
• Medicare physician comparison data available to the public
• Reductions in Medicare payments for select hospital readmissions
• Expanded coverage of preventive services by Medicaid
Key Provisions of the Affordable Care Act That Take Effect in 2014
• Employer mandate and individual mandate
• Employer and insurer reporting requirements
• New health insurance market reforms take effect
• State health insurance Exchanges established
• Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
• Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
• Annual fee on health insurers
• Medicare/Medicaid DSH payment cuts begin
• Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target
Encouraging Coverage: Individual Mandate
The Individual Penalty is the counterpart to guaranteed access to health insurance with no waiting periods. The purpose is to encourage healthy people to purchase and maintain coverage rather than waiting to obtain coverage until they need insurance to cover a health need.
Encouraging Coverage: Individual Mandate
The Individual Penalty is the counterpart to guaranteed access to health insurance with no waiting periods. The purpose is to encourage healthy people to purchase and maintain coverage rather than waiting to obtain coverage until they need insurance to cover a health need.
Year |
Penalty for Not Maintaining Health Coverage |
2014 |
$95/adult + $47.50/child, up to $285 for a family |
2015 |
$325/adult + $162.50/child, up to $975 for a family |
2016 |
$695/adult + $347.50/child, up to $2,085 for a family |
2017 and Beyond |
Increased Annually by the Cost of Living |
Penalties are paid at end of 2014 when you file Taxes in 2015
LINKS & RESOURCES
The links below is a Premium Subsidy calculator. Premium assistance for coverage in the exchanges.
• View calculator here
• IRS Affordable Care Act Tax Provisions
• Penalties for employers not offering affordable coverage.
