Patients are changing the way they relate to the Affordable Care Act, according to a recent study by Forrester. The company reported that between 2013 and 2014, the number of negative mentions of the ACA have decreased and sentiment for the bill has shifted the conversation about healthcare has shifted from politics to experience – and, in particular, to a focus on cost.
As the ACA increases in scope to include more companies with fewer employees, Forrester recommended that businesses use insurance agencies that offer efficient and high quality care in the digital sector. Essentially, the conversation has transitioned from politics to patient care. The insurance industry has moved away from regulatory issues and further towards helping the consumer as directly as possible.
There is a shift towards a consumer-based method of helping patients – in other words, insurance companies and hospitals are starting to compete with each other on how much value they give to their patients. This can only be good for companies because it means that employees will receive better medical care and businesses can help their workers shop around for the best health insurance option at a price they can afford.
Potential misconceptions having to do with ACA
The ACA is complex and multifaceted. In addition, many of the rules have not yet been invoked in the courts enough for a precedent to be set. Thus, many companies are confused about what to do when it comes to ambiguities in the law. The best solution is to discuss the details of the ACA law with your group health insurance broker and come up with a strategic plan to remain in compliance with the new regulations.
One of the more common misconceptions about the ACA is that the public health insurance marketplaces are the only place where ACA rules apply. In fact, individual health plans that were bought off the marketplace must still obey the same rules. For example, according to Omaha.com, there can be no more pre-existing condition exclusions, there must be limits on out-of-pocket expenses and there must be a community rating of the insurance plan.
At the same time – this is where the law becomes complex – the ACA does not always apply to all health insurance plans the time. Individual and fully-insured small group plans do not affect fully-insured large group plans. Self-funded group plans also do not get subjected to certain ACA provisions. Plans that existed prior to the ACA, called grandfathered plans, do not need to comply with certain provisions, either.
Additional ACA complications
Further complicating the ACA, there are two penalties associated with the employer mandate, according to S. Stevens Health Care. These penalties are only activated based on specific actions made by the employees, rather than the employer.
The first is the pay penalty, which is when employers do not offer a qualifying ACA health plan. This is only triggers if:
- An employee accesses the insurance marketplace
- That employee is found to be eligible for a health insurance subsidy by the government
- The same employee also buys coverage that can be found on the insurance marketplace
If none of these actions are taken, then the employer does not pay a penalty.
The other penalty is the play penalty, which means the employers are offering an insurance plan that is either not affordable or offers less than minimum coverage. In such a case, the employer only pays a penalty if the same three steps are taken above.
In both cases, all three actions must be taken by at least one employee to activate the penalty.