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Given the results of the recent national election, the Patient Protection and Affordable Care Act (PPACA) — also known as “Obamacare” or the “healthcare reform law” — is here to stay. As insurance professionals, it’s our job to understand how the PPACA will affect our clients and help them navigate the new regulations.

Here’s an overview of the significant changes the PPACA will bring in 2013:

  • Plan Summaries — One change that many consumers will welcome — and that should be helpful to you in educating your clients — are clear, easy-to-comprehend summaries of what a plan does and doesn’t cover.
  • Higher Premiums — Carriers are already anticipating higher costs of care again in 2013 and, subsequently, will raise premiums; as a result, employers will look at options for increasing employee contributions.
  • Health Insurance CO-OPs – The federal government has funded approximately 20 Consumer-Oriented and -Operated Plans, (CO-OPs), including one in Colorado, where Alliance is based. These organizations should be fully operational for the fall 2013 open enrollment season. You may want to begin vetting your local CO-OP to see if it’s an option for your clients late next year.
  • Health Insurance Exchanges – These are online marketplaces where individuals and small businesses can shop for, compare and purchase health insurance. Some states are starting to build their own exchanges which, if ready, will be in play for the 2013 open enrollment season. Agents should monitor their progress and ask, locally, how agents will be rewarded for bringing business through the exchange.
  • Annual Spending Limits Limits on how much a carrier will pay for individual care will rise from $1.25 million in 2012 to $2 million in 2013. This limit will be eliminated entirely in 2014.
  • Flexible Spending Account (FSA) Limits — FSAs (which allow health plan members to set aside pre-tax money for prescriptions, physician visit copayments, and other out-of-pocket health costs) will be limited to $2,500 for 2013.

To find out more about changes in healthcare reform in 2013 and beyond, here’s a detailed PPACA timeline. Also, look to your MGA for ongoing information and advice as more elements of the PPACA go into effect.

Posted 3:32 PM

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