"The Affordable Care Act": What is going to change for you? [fr]

Jean-Paul BARRE, Director of an insurance firm in Miami, gives us the most important changes induced by the reform of the American health care coverage known as "The Patient protection and Affordable Care Act", "the Affordable Care Act" or "Obamacare", whose full implementation is scheduled for January 2014.

e-Toile: What are the major changes expected by people in January 2014 in the health insurance field?

Health reform began on January 1st 2011 with significant requirements for insurance companies to abide by:
-  No cap on lifetime and yearly health insurance coverage
-  No time restrictions on health insurance coverage
-  No contract terminations while insured is paying insurance premium
-  Insured against insurance companies rate increases
-  Free preventative care Ex: vaccines, annual check-up, etc. ...
-  No refusal of coverage to children under the age of 16 with pre-existing conditions.

Also required after January 1st, 2014 health insurance will cover:

-  Mental illnesses
-  Maternity
-  Pre-existing illnesses

e-Toile: Tax penalties but also tax credits are provided under the Affordable Care Act. In what context, can these penalties of credits come into play?

Penalties: Because insurance companies can no longer deny the people insured for pre-existing conditions, starting 2014 there will be obligations for residents on American soil, to subscribe to health insurance.

All residents must provide a certificate proving insurance from an authorized insurance company in the State of residence.

If not done so, the person will have to pay a penalty tax. This penalty tax will be calculated as follows:


Tax credits: To help individuals become insured, the administration has put in place a system that directly benefits a person’s health insurance premium with discounts given by the federal state.

These tax credits are available to individuals and families who meet certain income requirements and have no access to health insurance through their employer or another government program.

Access to tax credits amounts are based on a standard called the "federal poverty level". This is based on household income and number of dependents.

Individuals and families with incomes between 138% and 400% of the federal poverty level may be eligible for a tax credit.
This means that a single person earning less than $45,960 and a family of four earning less than $ 94,200 may qualify for a tax credit.

You can only qualify for a tax credit if you subscribe to insurance through the "Health Insurance Marketplace".

e-Toile: Various American health insurance plans exist and many of us are already affiliated with U.S. health insurance plans. For those medically insured, what are the effects of these reforms and is there any advantage in changing their plan?

Not necessarily, it depends on the level of coverage of your contract. The contracts will be classified by levels, platinum, gold, silver and bronze so that the comparison between contracts will be easier.

On the other hand, we can expect a relatively large increase in insurance premiums after January 1st, 2014 to offset the additional guarantees required.

e-Toile: Does the State of Florida have any distinctive features under the Affordable Care Act?

Health insurance is now cheaper in Florida than in other states like New York or California.

We await details of the implementation of Florida’s Insurance Market Place. Several major companies should be able to sell their specific products in the market.

e-Toile: Who or what organizations should you contact if you want to ensure you are medically covered in this new environment.

The best contact is an insurance agent, who have all the resources to help their clients and make sure that they have the best plan in accordance with their needs and budget.

e-Toile: Can you tell us who are the "navigators" who we can turn to for help in choosing health insurance?

The "navigators" will be in charge of helping the consumer, their service will include:

- Determining tax credit eligibility
- Help in finalizing insurance applications
- And providing training and knowledge of the Health Insurance Marketplace

e-Toile: Does the holding of the French-American dual nationality or French nationality have any effect in health insurance coverage?

No, the only important criterion is the residence of the person. If you live more than six months per year in the United States, therefore you are resident and have the same obligation as an American, make sure you are assured with a domestic American insurance company.

e-Toile: So, what are the choices that will be offered to French citizens living in the United States from 2014?

As I said above, health insurance will become mandatory in the United States and insurance companies will no longer be able to refuse someone for pre-existing health reasons. This is the most important result of this reform.

If it was not mandatory to be insured, a person could wait to be diagnosed with cancer and go knocking on the door of an insurance company. This would not work for very long.

In France, there is no denial for pre-existing conditions, but we are required to adhere to the Social Security and the contributions made by the population are very high.

It is also easy to show that health insurance is less expensive here than in France, in the majority of cases, especially in Florida, where one is assured within the American system. This will become even more so with tax credits.

e-Tiole: What will you need to know if you are an employer?

The reform obligations for employers have been postponed to 1 January, 2015.

Requirements will depend on the size of the company, less than 50 people, 50 to 100 people and more than 100 people.

e-Toile: Finally, what are some sources of information that you recommend to anyone interested in these changes?

There are various interesting information sources:

1) The Florida Department of Financial Services (SDS) website is to ensure that the insurance company or insurance agent with whom you want to work is certified and licensed in the State of Florida.

2) One of the best websites on health care reform is, The Harry J. KAISER FAMILY Foundation: http://kff.org/

It is even possible to calculate online the amount of potential tax credit someone is eligible for based on their personal and family circumstances: http://kff.org/interactive/subsidy-…

Contact: Jean-Paul Barre, ALPAGOS INS INC

Article published September 11, 2013.

Dernière modification : 19/09/2013

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