ElderLaw News — The Estate Planning & Elder Law Firm, P.C. — MD, VA, DC
ElderLaw News

ElderLaw News is a weekly e-newsletter that brings you reports of legal developments and other trends of vital interest to seniors and their advocates. This newsletter is brought to you by The Estate Planning & Elder Law Firm, P.C., William S. Fralin, Esq., President., William S. Fralin, Esq., President.

The Affordable Care Act: What You Need to Know – Part 1

President Obama signed the Patient Protection and Affordable Care Act (the “Affordable Care Act”) into law in March 2010.

While some provisions of the ACA have already gone into effect, a number of new provisions are scheduled to take effect on January 1, 2014, impacting millions of Americans’ health insurance coverage.

The Affordable Care Act was designed to increase the number of Americans with health insurance by providing more affordable and accessible options, as well as to ensure that health insurance satisfies minimum standards of coverage. Preliminary projections as to the effects of the Act are optimistic; the Congressional Budget Office has estimated that by 2023, the Affordable Care Act will reduce the number of uninsured nonelderly individuals from 55 million to 31 million, thereby increasing the percentage of nonelderly people with health insurance to 89%. The first Affordable Care Act health insurance plans will go in to effect on January 1, 2014, with open enrollment for these plans running from October 1, 2013 to March 31, 2014.

Under the Affordable Care Act, all individuals will be required to have health insurance, with financial incentives for those who enroll and penalties for those who refuse to do so. Individuals who will be exempt from this mandate are (i) those having a religious exemption; (ii) non-U.S. citizens or illegal immigrants; and (iii) incarcerated individuals. Small employers will be encouraged to provide coverage for their employees under the Act, with a tax credit for 2014 and 2015 and no penalties for failure to participate. Large employers (those with 50 or more full-time employees) will be required to offer coverage to employees with financial penalties for noncompliance.

As a result of this legislation, Health Insurance “Marketplaces” will be available to assist low and moderate income individuals and families and small businesses in purchasing health insurance plans that are eligible to receive federal subsidies. As of August 1, 2013, Virginia’s State Corporation Commission has recommended fifteen plans to compete in the Virginia health insurance Marketplace. Nine insurance carriers will offer health coverage for the individual market and six will sell coverage for small businesses, although the number of available offerings will vary across the state. Most regions of Virginia will have three or four plans available; however, several regions in southwest Virginia will have only one plan. The Department of Health and Human Services projects that on average, a Silver plan for an individual (one of the levels of coverage) will cost about $320 per month in Virginia.

Under the ACA, several aspects of health insurance plans will be regulated. All health insurance plans must have no lifetime or annual limits, no potential rescission of coverage, extension of dependent coverage, no pre-existing conditions exclusions, no excessive waiting periods for eligibility to become covered by the plan, deductible limitations, and no cost sharing for preventive care. The plan provider must provide a summary of benefits and coverage to participants; plan enrollees must be allowed to select any available participating primary care provider; premiums can be based only on limited factors; and there must be an effective process for appeals for claims determinations. Each of these requirements is designed to improve the experience of the insured individuals and to ensure greater coverage than was previously provided by health insurance companies.

The impact of this legislation is far-reaching; we will examine the Affordable Care Act’s impact on elder law in the next installment in this series of articles relating to the Act.


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The Estate Planning & Elder Law Firm, P.C.

The Estate Planning & Elder Law Firm, P.C. is an elder law firm. We represent older persons, disabled persons, their families, and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships, and public entitlements such as Medicaid, Medicare, Social Security, and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information about The Estate Planning & Elder Law Firm, P.C., please visit our website at http://www.chroniccareadvocacy.com.

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This newsletter is not intended as a substitute for legal counsel. While every precaution has been taken to make this newsletter accurate, we assume no responsibility for errors, omissions, or damages resulting from the use of the information in this newsletter. The Estate Planning & Elder Law Firm, P.C. thanks the law firm of Hook Law Center for their input to this newsletter.

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