If you're familiar with the Affordable Care Act (ACA or Obamacare), you know it faced significant opposition and a challenging rollout.
Here are things to keep in mind for the coming year regarding health insurance and the ACA.
The ACA remains in effect, but legislative and administrative changes are possible; employers should be prepared for policy shifts that could affect coverage and requirements.
Expect telehealth and virtual visits to continue expanding as insurers look for ways to increase convenience and control costs, though rising overall health care spending can still push premiums higher.
Insurers and employers may add more utilization controls for high-cost brand drugs to encourage generic options; however, some patients respond only to specific brand medications and will need medically justified exceptions.
Some employers consider higher-deductible plans to lower premiums and free budget for other business needs, but this can shift more out-of-pocket cost to employees and create unexpected expenses.
If you plan changes to plan design, discuss them with employees and review potential hidden costs before making a switch.
Knowing what other companies are doing — both competitors and insurers — helps you put choices in context.
You can compare offerings and requirements by reviewing related topics such as Hospital and Medical Service Plans and Miscellaneous Health Care Services Insurance.
Frequently Asked Questions
Is the Affordable Care Act still law?
Yes; the ACA remains law, though specific provisions can change through legislation or regulatory action.
Will telehealth reduce my company's insurance costs?
Telehealth can lower some costs and improve access, but it may not stop premium increases driven by overall health care spending.
Should my company switch to a higher-deductible plan?
It depends—higher deductibles can reduce premiums but increase employee out-of-pocket exposure, so weigh plan costs, employee needs, and operational priorities.