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Changes to Individual Health Plans in 2014

With the passing of the Affordable Care Act (ACA) in 2010 come many changes to individual coverage, many of which may be affecting you. Here’s an outline of what major individual health insurance changes to expect come 2014.

Eligibility for Subsidies. Certain individuals participating in the exchanges will be eligible for government tax credits, or subsidies to help them buy coverage in 2014. U.S. citizens and legal immigrants who earn income from 133 percent to 400 percent of the federal poverty level will be eligible for tax credits.

People earning more than 400 percent of the federal poverty level will not be eligible. The tax credits will be structured according to income so that the premium an individual or family must pay does not exceed a specified percentage of his or her income.

Additional Benefits. The ACA expands insurance options and benefits for individuals, including women. Essential health benefits such as pregnancy and newborn care will be covered in all new individual, small business and exchange plans. Other preventive services such as mammograms, vision and dental care for children and more will be covered with no out-of-pocket costs.

The ACA also expanded mental health and substance use disorder coverage. Starting 2014, individual and small group plans are required to cover 10 “Essential Health Benefit” categories including mental health and substance use disorder services.

New plans under the Affordable Care Act must cover checkups, vaccinations and other preventive care without charging out-of-pocket costs like co-pays. All plans will be affected by 2018.

Guaranteed Coverage. Insurance companies can no longer drop an individual when he or she gets sick, including children under 19. Starting January 1, 2014 insurers are prohibited under law from discriminating against or charging higher rates for individuals based on gender or any pre-existing medical conditions.

No Annual Spending Caps. Annual dollar limits have been set at increasingly higher amounts until January 1, 2014, when insurers will be banned from establishing annual spending caps. Lifetime caps on the amount of insurance payout an individual can receive will be banned.

Open Enrollment Period. For those who do not receive employer coverage, the ACA requires that all uninsured consumers purchase coverage in 2014, or face a penalty. Individuals will have the chance to shop for coverage through the new health insurance marketplaces which begins in October 1, 2013 and run through March 31, 2014.

Countdown to Open Enrollment:

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