The Affordable Care Act continues to be implemented in the United States in 2016, bringing plenty of changes brokers’ clients should be aware of. These include changes to policy, enrollment options, and pricing.
Plenty of policy-related changes are happening in the new year, writes Tony Nista for Employee Benefit News. As the ACA rollout continues, transitional relief periods for those like “applicable large employers” are ending. And, “under the Tier 1 penalty of the ACA, employers are required to offer minimum essential coverage to at least 95 percent of their full-time employees and their eligible dependents,” Nista writes. “While that requirement was reduced to just 70 percent for 2015, it will increase back to 95 percent beginning in 2016.”
The new year will also bring changes to how the IRS calculates whether an employer plan is considered affordable. “Health care plans will not be considered affordable if an employee’s contribution to the plan for employee-only coverage exceeds 9.66 percent of the employee’s household income,” Nista writes.
Options are also changing, especially those offered during open enrollment, which ends January 31st. “When consumers enroll for 2016 health coverage via exchanges under the Affordable Care Act, they are less likely to find a preferred provider organization plan (PPO), which could limit their doctor and hospital choices,” writes Bruce Japsen for Forbes.
These plans can be more expensive because they allow the insured to go to doctors and hospitals outside a defined network. According to Japsen, “two-thirds of the insurance companies that offered PPO plans in the marketplaces last year reduced the number of PPO plans they offered or stopped offering PPO plans altogether for 2016.”
Instead, insurers are offering plans with narrower choices because they keep costs low for all of an insurer’s individual members across a select state. Brokers’ clients should also be paying attention to rising costs, and not just on premiums, writes Lisa Zamosky for U.S. News and World Report Health.
“You’ll see a bigger jump in premiums for 2016 than in previous years: an average of 7.5 percent for benchmark plans, which are the second lowest cost silver plans sold in each market and the plans to which tax credits are tied,” Zamosky writes. If premiums go down, clients and consumers should carefully evaluate out-of-pocket costs.
“Too often, consumers focus exclusively on the monthly cost of their plan – the premium – and overlook other expenses that can lead to higher-than-expected medical bills,” she writes. “Review carefully what you’ll be required to pay in the form of deductibles, copays and co-insurance when you go to the doctor or fill prescriptions.”