a result of the ACA, small-business employers can now
receive substantial tax rebates
for supplying health insurance
to employees.” Businesses that
employ fewer than 25 employees
can receive a credit of up to
35 percent of the overall cost
of providing health insurance
(for certain plans). In 2014,
that number will increase to
50 percent. For nonprofit
organizations, the credit is
less, but still substantial— 25
percent now, and 35 percent in
2014. Your employer can learn
more at
healthcare.gov/using-insurance/employers/small-business/ index.html.
If you are coming out of an
employer plan, “COBRA is an
option,” says Erickson. And if
COBRA is coming to an end,
she recommends calling your
state’s division of insurance to
see if an extension or subsidy for
COBRA premiums is available.
Defining the terms
As the ACA takes effect, you will begin to see some of the
following standardized terms used in health insurance plans.
Co-insurance: The percentage of allowed charges for covered
services that you’re required to pay. For example, health insurance
may cover 80 percent of charges for a covered hospitalization,
leaving you responsible for the other 20 percent.
Copayment: A flat dollar amount you must pay for a covered
program.
Deductible: The amount you must pay for covered care before
your health insurance begins to pay.
Formulary: A list of drugs your insurance plan covers. A
formulary may include how much you pay for each drug. (If
the plan uses “tiers,” the formulary may list which drugs are in
which tiers.)
Out-of-pocket limit: The maximum amount you will have
to pay for covered services in a year. Generally, this includes the
deductible, co-insurance and copayments. This definition may vary
from plan to plan.
Pre-existing condition coverage
In 2014, discrimination against
pre-existing conditions—such
as MS—by health insurance
companies will be officially
prohibited. However, it’s still
2012 and that prohibition
currently applies only to children
up to age 19. Until it goes into
effect for everyone, people with
MS who have been denied
coverage can explore the Pre-
Existing Condition Insurance
Plan, or PCIP. For information,
go to
healthcare.gov and search
for “PCIP.” Then click on
“Pre-Existing Condition
Insurance Plan” for a clickable
map of the United States. Click
on your state for information
about premiums, out-of-pocket
costs and how to apply.
Medicare
This year, people using Medicare
won’t see many changes,
although they will continue
to receive the benefits added
to Medicare since the ACA
was enacted, including certain
screening tests and vaccines,
and;major;discounts;on;drugs
they need while in the Medicare
coverage gap, otherwise known
as the “donut hole.” However,
Erickson points out, “In 2012
and beyond, ACA provisions
address the providers’ side,
such as linking payments to
quality outcomes.”
This year’s open enrollment
period for Medicare began Oct.
15 and continues until Dec. 7. To
compare drug and health plans,
visit
medicare.gov.
Learn more
To learn more about provisions
of the ACA and what they mean
for your healthcare coverage,
visit
nationalMSsociety.org/
ACAFAQs. Or call an MS
Navigator® at 1-800-344- 4867. n
Marcella Durand is on the editorial
staff for Momentum.
