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What Supreme Court health-care ruling means to you

Updated: August 2, 2012 10:37AM

It’s historic, but what does the U.S. Supreme Court ruling upholding the Obama administration’s health-care reform law mean for you?

According to benefits and human resources consulting experts at Aon Hewitt, Buck Consultants Chicago and the Henry J. Kaiser Family Foundation, here’s how various groups will be affected by the law, including some provisions already in effect:

Those insured through employers: Preventive health-care services without co-pays. Insurers cannot impose lifetime limits or rescind your coverage, except in cases of fraud. Adult dependents can have coverage up to age 26. Beginning next year, employees will be able to contribute only up to $2,500 to their flexible-spending health accounts. Some employers’ plans will see improvement in women’s preventive care benefits next year.

Those who buy insurance directly: States will establish health-care exchanges where you can purchase insurance. The exchanges are meant to make insurance more affordable.

Those who don’t have insurance: Individuals who haven’t been able to purchase insurance because of a pre-existing condition will be able to buy insurance, and insurers will not be able to discriminate against them. Beginning in 2014, low-income individuals will be eligible for federal subsidies if they enroll in a plan through exchanges.

Those who choose not to buy insurance: They’ll have to pay a penalty — with exemptions for financial hardship. The penalty is $695 per year up to a maximum $2,085 per family, or 2.5 percent of household income. The penalty is to be phased in starting in 2014.

Small-business owners: Employers with no more than 25 employees and average annual wages of less than $50,000 who purchase health insurance for employees will receive a tax credit. Employers with 50 or more full-time employees face fees under certain circumstances if they don’t offer coverage starting in 2014.

Employees at small businesses: Employers may opt to continue current workers’ coverage or drop coverage, sending workers to exchanges.

Large employers: Employers with more than 200 employees will be required to automatically enroll employees into health insurance plans, although employees may opt out. Employers will face a penalty in 2014 if minimal, essential health-care coverage is not made available to full-time employees.

Medicare beneficiaries: The Part D doughnut hole — the gap in drug coverage during which beneficiaries have to pay the full cost of drugs — will be eliminated by 2020. Under the law, Medicare recipients received a one-time $250 rebate check in 2010 if they entered the hole. Last year, they received a 50 percent discount on brand-name drugs. They will continue to pay less and less until the coverage gap is closed.

The poor: The court ruled that the government can’t force states to expand Medicaid by cutting Medicaid funding. For states that don’t expand Medicaid eligibility to 133 percent of the federal poverty level, there could be a gap where people don’t qualify for a federal subsidy in the exchanges but don’t qualify for Medicaid either. But some states will expand Medicaid benefits.

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