What You Need To Know

Highlights of the Affordable Care Act (ACA)

The Affordable Care Act (the ACA) is extensive healthcare reform originally passed and first implemented in 2010.  Since then, the law has had 40+ amendments, making the law complex and hard to interpret correctly.  We have provided you with the basic highlights of the law, however urge you to call us for more information and to insure you are in compliance.

Enrollment & Underwriting

Annual Open Enrollment

Individual Health Market
NOV. 1st to DEC 15th

When to purchase and/or change your plan

Special Enrollment Period

Requirements for Special Enrollment

You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

-Change in legal marital status
-Change in the number of dependants
-Change in place of residence and the current carrier is not available
-A significant cost or coverage change
-Change in coverage of a spouse or dependant
-A COBRA qualifying event
-Legal judgements, decrees and orders
-Entitlement to Medicare or Medicaid

Qualifying Coverage

The ACA Essential Benefits

To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase insurance coverage that pays at least 60% of the costs of the following “essential benefits.”

-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management

Underwriting Guidelines

New Rules for Health Insurance

-No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.
-Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.
-Gender is no longer a factor in determining rates.

Tax Credits and Tax Penalties

The Individual Mandate

Tax Penalty for Noncompliance

The individual mandate requires all individuals to have health insurance, either through their employer or an individual policy, or face potential penalties.

The mandate:  Starting in 2016 the penalty for non-compliance will be $695 for each adult family member, and $347.50 for each child, or 2.5% of household income, whichever is greater.

The Employer Mandate

Tax Penalty for Noncompliance
for those with incomes below $85,000 if single, $170,000 if married**

The employer mandate requires employers who have 50 or more full-time employees to provide health coverage to their employees or face potential penalties.

The mandate:  Beginning in 2015, if you have 50 or more full-time equivalent employees who are not offered health coverage, and at least one employee receives a premium tax credit/cost sharing subsidy in the exchange, your tax penalty is $2,000 annually multiplied by the number of full-time employees (excluding the first 30 employees).   The penalty is increased each year by the growth in insurance premiums.

Tax Credits

Premium Discounts

Individuals and Businesses who purchase their health insurance through the Federal Health Insurance Marketplace may be eligible for tax credits which are applied as a discount on your monthly insurance premium.

Individuals click here to determine your eligibility.

Employers click here to determine your eligibility.

The information contained on this website is not intended to be legal or financial advice.  Please consult your tax or legal professional for more information.