Healthcare Reform

When to purchase and/or change your plan

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

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
-Hospitalization
-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

-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.

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 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.

Individuals click here to determine your eligibility.

Employers click here to determine your eligibility.