Under the ACA, states may set up online marketplaces (also called health insurance exchanges) that allow individuals and small businesses to pool their buying power and purchase health insurance. Some states have set up their own marketplaces, while other states operate under the federal marketplace at Healthcare.gov.
A federal law that allows employees to obtain health insurance when they lose their group health insurance or change their job, even if they have a preexisting health condition. If an employee qualifies, that person cannot be denied insurance because of their medical history.
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. In addition to the monthly premium (which may be shared by the employer and employee), participants usually need to pay a small fee at the time of service called a copay (often in the range of $10 to $30), while the HMO covers 100% of the services provided.
Also known as health reimbursement accounts, HRAs permit businesses to offer pre-tax dollars to employees to help pay premiums and/or other out-of-pocket costs associated with medical care and services up to a maximum dollar amount for a coverage period. While an HRA may be offered with other employer-provided health plans, employees need not be covered under any other healthcare plan to participate. Employers own and fund the account for employees, and unused amounts may roll over to the next year.
These savings accounts are typically combined with a high-deductible health plan that allows users to put aside pre-taxed money. Because high-deductible plans generally cost less than low-deductible plans, HSAs are a good option for employers who cannot afford a comprehensive (low-deductible) health plan.
The IRS defines a HDHP as any plan with a deductible of at least $1,350 for an individual or $2,700 for a family. An HDHP’s total yearly out-of-pocket expenses can’t be more than $6,650 for an individual or $13,300 for a family.
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