Health Care Reform

The Affordable Care Act has brought big changes to the health care industry. We’re here to help you understand those changes so you can make the best decisions for your health care.

Individual

If you buy health coverage on your own

Uninsured

If you are uninsured

Small Business Employee

If you work for a business with up to 100 full-time employees

Large Business Employee

If you work for a business with more than 100 full-time employees

Small Business Employer

If you own a small business with up to 100 full-time employees

Large Business Employer

If you own a large business with more than 100 full-time employees

What’s the Affordable Care Act?

The Affordable Care Act (ACA) is a federal law that changes how you receive health care. It was passed by Congress and signed into law by President Barack Obama in March 2010.

Why was it created?

Health care reform was created to:

  • Help more people get health care
  • Improve people’s health
  • Slow rising health care costs

Who’s affected?

Health care reform affects almost all Americans:

  • Insured. People with insurance can get more preventive coverage at no charge to them. They may also have more options to get insurance.
  • Uninsured. Almost everyone is required to have insurance or pay a fine. People with major health problems can’t be turned down for coverage.

What’s changed?

  • People up to age 26 can be covered under their parent’s family health plan if the plan offers dependent coverage.
  • Adults can get more preventive screenings and immunizations at no charge to them.
  • Women can get certain health care services at no charge to them.
  • Most people must have health insurance coverage or pay a fine.
  • You won’t be denied coverage even if you have a serious health condition.
  • Most insurance premiums won't be based on your health status anymore. Premiums for ACA plans will be based on your age and rates may be adjusted based on tobacco use. (For people who get coverage through a small business with up to 100 employees or an individual plan.)
  • ACA plans must cover 10 essential health benefits (For people who get coverage through a small business with up to 100 full-time employees or through an individual plan.)
  • We’ll cover services from chiropractors, acupuncturists, naturopaths, and other complementary and alternative medicine practitioners if their services are within the scope of their Hawaii license, are deemed medically necessary, and are a benefit of your plan. Complementary and alternative services for Health Plan Hawaii members will need preauthorization by your primary care provider. Small business or individual health plans that were in place on October 2013 won’t cover this benefit. Neither will HMSA QUEST or HMSA Akamai Advantage.

How does the ACA affect my health plan?

That depends on whether your plan is “grandfathered” or “non-grandfathered” under the law:

  • Non-grandfathered plans must comply with all ACA mandates. Your plan is non-grandfathered if it’s either a new plan or an existing plan that changed significantly since the law was signed.
  • Grandfathered plans must comply with some ACA mandates. Your plan is grandfathered if it existed on or before the date the law became effective, and it hasn’t changed since that date.

This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.