ACA, or the Affordable Care Act Changes

Helping workers make informed benefits decisions during open enrollment can be a challenge. Changes resulting from the Affordable Care Act (ACA), often known as health care reform, mean this year’s open enrollment may be even more complicated than those in years past. A few key aspects of benefits enrollment are changing as a result of market reforms. Understanding these changes can help businesses better adjust to the shifting benefits landscape:

  • Workers can shop for insurance on the individual market – even if their companies offer insurance: Starting this fall (Oct 1), open enrollment begins for the Health Insurance Marketplace. Managed by each state and/or the U.S. Department of Health and Human Services, this public marketplace is where people can access coverage information; compare insurance plans; and buy health insurance online, through the mail, by phone or with the help of an agent, broker, or navigator.
  • Actuarial value standards make comparison shopping simpler: Health care reform introduces a new way to understand the value of major medical coverage. Coverage levels are based upon the actuarial value (AV) of each plan and are represented by metal levels: Bronze (60% AV), Silver (70% AV), Gold (80% AV) or Platinum (90% AV). These values represent the amount a plan is expected to pay, on average, for the essential health benefits (EHBs) it provides. The remaining amount is paid by covered individual(s) in the form of the co-payments, deductibles and co-insurance.
  • Workers are more puzzled about benefits than ever before: If open enrollment was confusing for workers in the past, it is now even more complicated. The majority of workers (74 percent) say they sometimes or never understand everything covered in their current policies, and 90 percent elect the same benefits coverage year after year.1 More than half (54 percent) admit to wasting up to $750 annually due to enrollment mistakes. Since the majority of workers say they are confused about health care reform,2 it’s not surprising that they might not be prepared to handle the numerous and complex details of managing their health care insurance options and are wary of taking more control over their benefits decisions.
  • The workforce is looking to employers for answers: With so many changes, workers are looking to their employers to help explain possible shifts to their benefits plans, and how they can best prepare for those shifts. In 2013, three-quarters of employees (74 percent) said they believe their employers will educate them about changes to their health care coverage as a result of health care reform.2 Yet just 13 percent of employers said educating employees about health care reform is an important issue for their companies right now, and only 9 percent indicated that they are very prepared to implement changes to their businesses based on the health care reform law.