If you are among the 149 million Americans who get their health insurance from their employers, you might be wondering how the Affordable Care Act (ACA) will affect your coverage.
Effective January 1, 2015, employers with 50 or more full-time equivalent employees (defined as working an average of 30 hours a week) must provide health insurance to their employees.
If your company falls into this category, here are the things you should know:
Your Company Must Offer Health Insurance or Pay a Penalty
That insurance has to meet certain requirements, including covering all preventive care and screenings and at least 60 percent of your medical costs.
Your Insurance Must be Affordable
That means that your premium for an individual plan can be no more than 9.5 percent of your household income.
You Can Cover Your Kids Longer
Since 2010 you have been able to keep your children on your policy until they turn 26, even if they get married. Previously, health insurers could remove children once they turned 18.
You Get “Free” Preventive Care
All health insurance now covers 100 percent of the cost of preventive care and screenings, like checkups and mammograms. That means you do not have to pay copayments or coinsurance.
The Definition of “Full Time” Changed
You are entitled to health insurance if you work an average of 30 hours a week or more. However, if your hours vary from week to week, you may not be eligible for insurance unless you average 30 hours over a certain period, typically one year.
You Do Not Have to Wait
Employers can no longer make you wait before your insurance kicks in. Now you have to be covered after three months on the job (or before). In fact, if your company employs more than 200 people, it has to automatically enroll you in a plan unless you opt out.
You May Pay Less Out of Pocket
The ACA limits the amount you have to pay for deductibles, copayments, and coinsurance. In 2015, the maximum out-of-pocket limit is $6,600 for an individual plan and $13,200 for a family plan. In 2016, the maximum out-of-pocket limit is $6,850 for an individual plan and $13,700 for a family plan. Learn what these terms mean »
You May Not Get a Subsidy on the Individual Exchanges
If your employer offers a plan that meets the ACA’s requirements, you are not eligible for any tax subsidies to help you pay the premium. Still, it is worth checking to see whether you can get a comparable plan to what your employer offers for a lower premium and other out-of-pocket costs.