Navigating the Landscape of Healthcare Reform

by | Mar 27, 2012 | Employee Benefits, Farrell Backlund, Health Insurance

Seeing as there has been a lot of talk recently about healthcare reform—I wanted to take some time to set the record straight and inform you all as to the changes that are fast-approaching in the health insurance market.  The state of Massachusetts has been the frontrunner with regards to healthcare provisions, but the new federal healthcare reform law will impact individuals and businesses in a big way.  Bear in mind that these changes will not take place immediately, nor will the changes be all at once—but being aware of these new provisions will allow you to plan ahead instead of scrambling to keep up with the changes. Today, we’re going to take a look at what has happened recently in healthcare reform as well as look at the future to see what’s on the horizon.

Looking Back on 2010 & 2011

  • First phase of Small Business Tax Credit commences—there is up to a 35% tax credit for the funds put towards acquiring healthcare coverage for their employees.  A 25% credit exists for non-profit organizations
  • Eliminating pre-existing conditions for children—this provision prohibits healthcare providers from excluding children from health coverage due to a pre-existing condition.
  • Extending Dependent Age Coverage—Allows individuals with dependent children to secure coverage up to age 26.  This is opposed to the previous age of 19, unless a full-time student.
  • No Cost-Sharing from well-visits—this essentially allows individuals’ one well-visit per year at no cost.  (Annual Physical is covered by health plan)
  • Standardizing Qualified Medical Expenses—places restrictions on what can be covered by FSA’s. More specifically, over the counter drugs are now excluded from being a qualified medical expense.
  • Reporting W-2 healthcare costs—this motion that would require employers to report all healthcare costs that are incurred in the year on their W-2.  Recently, this reform was deemed as optional in 2011 by the IRS.

A look Ahead (2012-2014)

  • Limiting annual contributions for HSA’s and FSA’s—this provision takes a previously unlimited spending amount and places a 2500 dollar annual limit.  (2013)
  • Reforming Health Insurance Regulation—bars healthcare providers from imposing limitations due to pre-existing conditions for all covered persons.  Factors such as gender or health status are limited.  Premiums can only vary by age, geography and tobacco use. (2014)
  • Eliminating Annual Limits—Healthcare plans can no longer limit the amount of health coverage an individual may receive annually.(2014)
  • Promoting Employer Responsibility—Requires employers with 50 or more employees who don’t provide coverage health insurance to pay $2000 per full-time employee(2014)
  • Establishing Health Exchanges—Much like Mass-Health, states are required to set up exchanges in which individuals and small-group employers can secure healthcare coverage through the healthcare exchange.  (2014)

The next few years will be a very tumultuous time in the world of healthcare/health insurance, but taking the time to look at the upcoming changes will allow you to properly forecast your healthcare expense budget, and ensure that you’re ready for the reform law that is fast-approaching.  If you’re having trouble navigating the health insurance laws and regulations, you can contact your local agent, or find more information at


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