The bulk of the Patient Protection and Affordable Care Act (“ACA” or “Obamacare”) legislation kicks in on January 1st, 2014. This includes an individual mandate requiring all citizens to have an in force health insurance plan covering themselves and their dependents. Failure to have such a medical policy in force will subject individuals to a tax penalty every year.

Depending on where you live, individuals who are not offered health insurance through their employers will be able to secure coverage through a federal or state exchange. Residents of New York will have access to these plans through the NY Benefits Exchange, or through an insurance broker who has access to the NY state exchange.

The ACA also requires that every insurance plan sold through an exchange (as well as most plans sold outside of an exchange) carry a minimum set of coverage’s, known as “Essential Health Benefits”. Plans that meet Essential Health Benefits are known as “Qualified Health Plans” (or QHP’s). Here are the ten different coverage areas that make up the Essential Health Benefits criteria:

-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Mental health and substance use disorder services
-Prescription drugs
-Rehabilitative and habilitative services and devices
-Laboratory services
-Preventive and wellness services and chronic disease management
-Pediatric services, including oral and vision care

Open enrollment of the exchanges (where coverage begins on 1/1/14) is October 1st, 2013. We will provide more information as we get closer to this milestone date.