Insurance & Employee Benefits
The Affordable Care Act, the law commonly known as health reform, passed in 2010 and aims to make health care available to all Americans. It's a complex law, but here's a summary of how health reform works:
Everyone, with few exceptions, is required to have health insurance. Health insurance is based on the idea of sharing costs across a large group of insured people.
People who choose not to buy health insurance must pay a penalty, or fee, each year. They must also pay for the costs of all their health care. Most health insurance plans include new benefits, like preventive care with no cost-
Large companies (50 or more employees) typically offer health insurance plans to employees. Many also help pay for these plans. For people who work in large companies, getting insurance through their employer is often the easiest way to get a plan and likely the best option.
Small businesses (fewer than 50 employees) can also provide health insurance to their employees – and some do this already. People who work in small businesses may be able to get health insurance through their employer. Employers may work with the insurer either through the SHOP Marketplaces or outside the Marketplaces (like they do today). Employers can purchase insurance directly or through a broker, or with the help of Navigators in SHOP Health Insurance Marketplaces.
Health Insurance Marketplaces
Exchanges are a new way for people to shop for and buy a plan. Marketplaces are meant to help people find a plan that meets the standards set by the federal government. While every state's Marketplace will offer plans from insurance companies, the Marketplaces themselves are set up and run either by the state, the federal government, or both together.
Each state's Marketplace will be divided between Individual (for families and individuals) and SHOP (health plans for small employers) Marketplaces.
Insurance companies can sell plans through employers or directly to people – just as they have done in the past. Under health reform, they can also sell approved plans through the Marketplaces.
Health Care Providers
Health care providers are encouraged to provide efficient, quality care. Hospitals, doctors, and other providers may get paid more when they provide care that improves patient health, and less when they don't. To improve the delivery of health care and improve patient health, providers are finding ways to become more efficient by adding technology, streamlining processes, and coordinating care more effectively.
Role of Government
Federal and state governments run the Marketplaces. They also support specially trained people called "Navigators." Navigators provide helpful information to people and small businesses looking for health insurance.
Taxes and penalties
Taxes and penalties paid by employers help offset the costs of health reform. Insurance companies, drug makers, medical device makers, and others also pay taxes and fees to help offset the cost.
Next: How could health reform affect you? Link to UHC.com