August Healthcare Reform Updates

August Healthcare Reform Updates

By Working Nurse
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Better living through technology The ACA includes many incentives for healthcare providers to develop and use technology to streamline medical services. Above, a nurse checks an app that reports on emergency room patients. 

Health Coverage for Young People  
Understanding the options

Under the Affordable Healthcare Act (ACA), many young adults will soon have new opportunities for health coverage, but also face penalties for not signing up for health insurance. There are several options to consider:

1. Employer-provided insurance.
If you are employed, look into the plans offered by your workplace. Even if you need to pay part or all of the premiums, the cost could be less than what you will pay in penalties if you don’t buy insurance. You may also be able to pay your share of the premiums out of your pretax wages — that is, before withholding is calculated.

2. Your parents’ policy. You already have the option of remaining on your parents’ policy until the age of 26, even if you are independent, married or employed. You can do this even if you and your parents live in different states, but that obviously isn’t the best choice if your parents’ policy only covers a specific group of providers hundreds or thousands of miles away from you.

3. Student insurance. Most colleges and universities already require students to have health insurance and many schools offer policies for current students. If you’re eligible for financial aid, you may be able to apply it to your student health coverage as well as your tuition. Ask if there is an option to continue coverage after graduation.

4. Private health insurance. Beginning next year, preexisting conditions can no longer disqualify you from insurance coverage, but private insurance is probably still the most expensive option. However, you can lower the cost by opting for a higher deductible and more limited coverage. One advantage of this type of coverage is that it is usually portable, going with you wherever you live or work.

5. Covered California. Starting October 1, California residents will be able to purchase a policy through Covered California, the state’s new health insurance exchange. In many cases, you will be eligible for subsidies and some low-income people will be eligible for Medi-Cal.

What happens if you don’t buy insurance? The IRS will begin imposing penalties starting in 2014 and those penalties will increase each year through 2016. Thereafter, the penalties will be adjusted according to the cost of living, although they will never be greater than the national average for a medium-priced policy purchased through the insurance exchanges.

You also won’t be penalized if you’re without coverage for short periods such as when transitioning from job to job.


The 80-20 Rule 
You may be due a refund

Working nurses may have been surprised to find a check from their insurance company in the mail in the past few weeks. The ACA requires insurance companies to spend 80 percent of premiums directly on healthcare services. Only 20 percent can be spent on marketing, salaries and other administrative overhead. Insurance companies that violated the 80-20 rule were required to issue a rebate to their policyholders on Aug. 1, 2013. The average refund for an individual plan was $151.


“The Affordable Care Act is going to change a lot of things for healthcare providers. From our experience, we know that the organizations that best adapt to change have transparent leadership, motivated employees, and practices that build cohesion among administrators, physicians, nurses, and all who collaborate on the delivery of patient care.”

— Sarah Cooke, managing consultant, Great Places to Work

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