Healthcare Reform Made Simple

What Does Healthcare Reform Mean To You?

In March of 2010 the Patient Protection and Affordable Care Act (PPACA) was signed into law.  This page will give you some basic information on the law along with answers to frequently asked questions. For additional information or if you just have some questions, please give us a call.

 

Guaranteed Issue Coverage

Individual and Family Health Insurance policies are now guaranteed issue, meaning that everyone can get coverage at the standard rate. You no longer need to fill out a medical questionnaire or go through the hassle of your policy being underwritten. There are no longer pre-existing condition clauses in your medical policy; all medical conditions are covered on day one.

 

Where to Purchase Coverage

To purchase Individual and Family Health Insurance policies you can go through a brokerage like us, you are not required to go through healthcare.gov (AKA The Market Place, also known as the Exchange). The website is for people who qualify for a subsidy. If you do qualify for a subsidy we can go over plans and rates with you prior to entering healthcare.gov. We can also be your broker on these policies after it has been purchased.

 

Market Place / Exchange

The ACA Market Place is where individuals and families can go to purchase health insurance. Depending on your family size and annual income you may qualify for a subsidy through the health insurance Market Place.

 

1 – Less than $47,080 in annual income

2 – Less than $63,720 in annual income

3 – Less than $80,360 in annual income

4 – Less than $97,000 in annual income

5 – Less than $113,640 in annual income

6 – Less than $130,280 in annual income

 

Open Enrollment / Special Enrollment Period

The annual open enrollment period starts on October 1st and runs through January 31st. This is the time for individuals and families to enroll in health insurance or make a plan change. Once the open enrollment period has ended you will have to wait until the next open enrollment period to enroll in coverage. However, if you qualify for a special enrollment period (SEP) you can enroll in coverage outside of the annual open enrollment period. A few example of an SEP would be Marriage, Birth, Divorce, loss of employer coverage, change of residency, etc.

 

Penalty

If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. (The fee is sometimes called the “penalty,” “fine,” or “individual mandate.”) The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.

Percentage of income

  • 5% of household income
  • Maximum:Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
  • In some cases, you may qualify for a health coverage exemption from the requirement to have insurance. If you qualify, you won’t have to pay the fee.

 

Employer Health Insurance

Some employers with 50 or more FTE employees who don’t offer insurance, or whose offer of coverage is not affordable or doesn’t meet certain minimum standards, are subject to Employer Shared Responsibility provisions. They may owe a payment if at least one of their full-time employees enrolls in a plan through the Health Insurance Marketplace and receives a premium tax credit.

 

No employer with fewer than 50 full-time employees, including full-time equivalents (FTEs), is subject to the Employer Shared Responsibility Payment, regardless of whether they offer health insurance to their employees.