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
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
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
-Maternity and newborn care
-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
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
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.
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.
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.