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Health Care Reform: What Does it Mean for You?

How health care reform legislation affects you varies greatly depending on your age, who you work for and many other factors. So what does it mean for you? Below is a list of how health care reform affects a number of common categories.

The elderly now receive free preventive services under Medicare, annual wellness visits and personalized prevention plan services. Once those with Medicare prescription drug coverage enter the “doughnut hole” coverage gap, they will be entitled to 50 percent off certain brand-name medications.. Medicare beneficiaries earning $85,000 or more will pay higher Part B premiums until 2019. Those with Medicare Advantage plans may lose some benefits or experience an increase in copayments.

Employees of a large company
Employers with 50 or more employees will be required to provide coverage or pay a penalty starting in 2014. Existing coverage packages will be grandfathered in, but new plans have to meet minimum requirements. Caps on out-of-pocket spending are intended to keep costs down.

Low-income employees
Even without children or a disability, those among the lowest-income workers will be eligible for Medicaid as of 2014. Those who earn less than 400 percent of the federal poverty level (about $88,000 for a family of four) will be eligible for subsidies to help buy coverage. The expansion of funding for community health centers, designed to offer free and reduced-cost care, will also provide relief.

Health care reform affects each American differently based on many different factors.

Children with a pre-existing condition
Group health plans and health insurance issuers may not impose exclusions on coverage for children with pre-existing condition. Provision applies to all employer plans and new plans in the individual market.

Adults with a pre-existing condition
Starting 2014, adults with pre-existing conditions will be able to obtain individual coverage through an insurance exchange and pay the same rate as other participants in same age group. Insurers cannot place annual or lifetime limits on coverage, nor can they deny coverage or charge higher premiums due to a pre-existing condition.

Unemployed and uninsured
Most individuals who are unemployed and uninsured likely qualify for Medicaid under the coverage expansion that began in 2010. The expansion of funding for community health centers, designed to offer free and reduced-cost care, will also provide relief. Certain uninsured individuals with pre-existing conditions can obtain coverage through the temporary high-risk pool as well.

Small-business owners
Organizations with 25 or fewer workers may be eligible for a tax credit to help provide coverage for employees. Those with 50 or more employees must provide benefits or incur a penalty starting in 2014. Small-business owners will be able to buy insurance for employees through insurance marketplaces by 2017.

Young adults
Children may stay on their parents’ policies until age 26. Those who buy coverage on their own or through the exchanges can obtain cheaper catastrophic coverage. Individuals who obtain traditional benefits packages will pay less than those who are older than age 26. Starting 2014, individuals age 26 or younger must obtain coverage unless qualified for an exemption.