Healthcare Reform Timeline

Providers

 

What You Need to Know About Healthcare Reform

  1. Your patients may qualify for financial help with their insurance coverage.
  2. Benefits and coverage rules will be changing in 2014.
  3. The Affordable Care Act aims to improve healthcare quality and efficiency.
  4. The Affordable Care Act mandates a three-month grace period.
  5. You may be affected as an employer.

1. Your patients may qualify for financial help with their insurance coverage.

Starting in 2014, almost everyone needs to have healthcare coverage or pay a penalty. To help more people afford high-quality health coverage, the government is assisting with the cost of coverage for people at certain household income levels. To get financial help, they must:

In addition to Medicaid, two types of financial assistance are available:

  • Tax credits – People whose household income is between 100 percent and 400 percent of the federal poverty level may qualify for a tax credit. Learn more about the premium tax credit.
  • Cost-sharing reductions – For people whose household income is between 100 percent and 250 percent of the federal poverty level (up to 300 percent for Native Americans), the government may also help pay part of copayscoinsurance, and deductibles. Learn more about the cost-sharing reduction program.

2. Benefits and coverage rules will be changing in 2014.

One of the first benefit changes that many people experienced under the Affordable Care Act was 100 percent coverage for certain preventive services, which started in 2010. In 2014, benefits will continue to expand. Many health plans will cover 10 categories of essential health benefits without annual or lifetime dollar limits.

Many of these benefits are already included in traditional health plans, such as hospital care and laboratory services. However, others are new, such as children’s dental and vision coverage. These benefits will go into effect as your patients’ plans renew throughout 2014. Large employer and grandfathered plans may not offer these benefits.

Also in 2014, all adults can get coverage even if they have pre-existing conditions. While Blue Cross has always offered coverage to anyone during open enrollment—no matter their health status—many plans did not.

For more information on 2014 benefit changes, please see the Provider FAQs.

3. The Affordable Care Act aims to improve healthcare quality and efficiency.

The law includes a number of provisions to help improve coordination of care, simplify administration, and cut costs, including:

  • Standardization of billing and rules for (and investments in) the secure, confidential, electronic exchange of health information (effective 2012).
  • Improved transitions of care from the hospital to home for high-risk Medicare beneficiaries through the Community-based Care Transitions Program, which will help reduce readmissions (effective 2012).
  • Establishment of a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children’s Health Insurance Program (effective 2011).
  • Funding of the The Patient-Centered Outcomes Research Institute, which conducts research to provide information about the best available evidence to help patients and providers make more informed decisions (effective 2012).

4. The Affordable Care Act mandates a three-month grace period.

This grace period applies to individual members who receive a premium subsidy from the government and are delinquent in paying their portion of premiums. It only applies to individuals who meet all of the following:

  • Enroll through HealthSource RI (or their state’s health insurance marketplace/exchange).
  • Receive a premium subsidy in the form of a tax credit and/or cost-sharing reduction.
  • Have paid for at least one month of coverage. 
 
For more information on how the grace period will be handled, please see the Provider FAQs.

5. You may be affected as an employer.

Many providers are also small business owners, so the Affordable Care Act may affect any health coverage you offer your employees. If you have fewer than 50 full-time or full-time equivalent employees, you are not required to offer coverage. To learn about how your plan benefits may change, and your options for buying coverage, please see the small employer page.  You may also want to read the information for all employers.

  • Enroll through HealthSource RI (or their state’s health insurance marketplace/exchange).
  • Receive a premium subsidy in the form of a tax credit and/or cost-sharing reduction.
  • Have paid for at least one month of coverage.
  • For more information on how the grace period will be handled, please see the Provider FAQs.