The Affordable Care Act, often referred to as, “The ACA”, “Obama Care”, PPACA, or Healthcare Reform, was enacted and signed into law by President Obama on March 23, 2010. Beginning in 2014, the Affordable Care Act included a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. It also reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense.
For Americans with insurance coverage who like what they have, they can keep it as long as it is still available. Nothing in this act or anywhere in the bill forces anyone to change the insurance they have. Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market known as the Health Insurance Marketplace – the same insurance market that every member of Congress will be required to use for their insurance. It keeps insurance companies honest by setting clear rules that rein in the worst insurance industry abuses. And it bans insurance companies from denying insurance coverage because of a person’s pre-existing medical conditions.
Important Dates
Helpful Links
Affordable Care Act FAQs
A cancer policy provides your family or your employees with peace of mind that will pay cash benefits to help cover expenses that aren’t covered by major medical insurance.
Your APTC, or subsidy is based upon your household size and income. The income that you list on your Marketplace Application is verified with the income on your tax return. This information in reconciled to ensure your received the accurate amount of subsidy. If you over estimate your income, you could receive a higher tax return, however if you under estimate your income, you could receive a lower income tax return and possibly have to pay back some of the APTC you were given. The Marketplace REQUIRES you to update your information as needed throughout the year by reporting a life change. Your agent can help you report a life change or a Marketplace Representative can assist you with reporting a life change.
A Certified Healthcare Reform Specialist®, CHRS, is a professional designation that is earned and confirms that a professional has an educational and competitive edge in staying on top of the rules, regulations and interpretations of the Affordable Care Act. The designation is earned by extensive training and knowledge of the Affordable Care Act, along with mandatory testing requirements. A Certified Health Care Reform Specialist has an in-depth knowledge of health insurance, benefit designs and the Affordable Care Act. A CHRS can help you with determining your subsidy eligibility, comparing plans, benefits and premiums.
Yes. Plan Premiums will more than likely will change every year, therefore you must update your Marketplace Application every year during Open Enrollment so that you can get your new Subsidy amount, also known as the Advanced Premium Tax Credit, APTC.
After Open Enrollment ends, an individual can enroll in a individual health insurance plan only if you have a qualifying event that will grant a Special Election Period. Normally, you will have 60 days from the date of the qualifying event to enroll in a new plan. If you miss the 60-day deadline, you will have to wait until Open Enrollment for 2017 to enroll in a plan. Types of qualifying events can be: Marriage, Divorce, Birth or Adoption, Leaving Incarceration, Losing job-based coverage, Loss of COBRA,Medicaid or CHIP.
No. It’s against the law for someone who knows that you have Medicare to enroll you in a Marketplace plan. This is true even if you have Medicare Part A or B only or Medicare Parts A and B. You should look into a Medicare Supplement or Medicare Advantage Plan. I can also help you with exploring your Medicare options.
Yes. After 2013, you will be required to prove health care coverage on your tax return each year. Your health insurance provider and/or employer will also have to submit information to the IRS.
The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. This includes individual market policies, job-based coverage, Medicare, Medicaid, CHIP, TRICARE and certain other coverage’s. If you have one of these type coverage’s, you are compliant with the health care law.
Essential Benefits are benefits that ALL plans in the Health Insurance Marketplace must cover as well as employer-sponsored group health plans. They include:
- Doctor visits
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse disorder services
- Prescription drug coverage, (8)rehabilitative services and devices
- Laboratory services
- Preventive and wellness services
- Chronic disease management
- Pediatric services, including oral and vision care
No. There is no cost to you to use a licensed insurance agent to assist you with enrolling in the Health Insurance Marketplace. The premiums are set and are the same whether you use a licensed agent or not. However, there are significant benefits to you in seeking help from a licensed insurance agent and a Certified Healthcare Reform Specialist®, CHRS. I am qualified to explain benefits to you and assist you in choosing a health plan that will best serve you and your family.
If you buy health insurance though the Health Insurance Marketplace at www.healthcare.gov the amount you pay will depend on several factors, including your income, family size and subsidy eligibility. Find an insurance agent you can trust to help guide you through the process. There is no cost to you to get the help.
An Advanced Premium Tax Credit, APTC, is an assistance payment to your health care coverage provided by the government based on your income and household status. It is often referred to as a “Subsidy”. The amount of your APTC, will depend on your income and the size of your family. If you qualify for an APTC, you will have the option to enroll in health insurance coverage through a government-sponsored Health Insurance Marketplace. If you are married and you receive an APTC, you will be required to file a joint tax return with your spouse. You cannot be married and receive an APTC and file taxes separately from your spouse. If married, the ACA requires that you file taxes together in order to receive a subsidy.
Yes. This began in 2014. If you are a U.S. citizen or lawfully present resident, you are required to buy health care coverage for yourself and your dependents. There are just a few exceptions to this requirement such as members of certain religious sects,prisoners, undocumented immigrants, and Indian tribal members. Depending on your income and household status, you may qualify for a subsidy that can lower your insurance costs. If you decide not to get health insurance, you may be subject to a tax penalty.
Yes, in some ways. Healthcare Reform includes polices that affect all health insurance plans, but you will not need to switch plans if you are happy with your existing coverage and it is still available to you.
If you don’t have health insurance, your penalty will be calculated based on your income and the number of people in your household. For 2014, the penalty amount was $95 or 1% of your annual income per person in your household, (whichever was greater), the penalty increased to $325 or 2% in 2015, and the penalty for not having coverage in 2016 will be $695 or 2.5% of your household income. After 2016, the dollar amount will be adjusted for inflation each year. Penalties for dependents under age 18 will be calculated as a half. The penalty will include each month that you do not have coverage for yourself and your dependents.
The requirement to have health insurance went into effect on January 1, 2014. Most citizens and lawful residents of the U.S. were required to have health insurance from this date or face a tax penalty. The 2016 Open enrollment Period for the Health Insurance Marketplace plans will begin November 1, 2015 and continues through January 31, 2016.
A Health Insurance Marketplace, often referred to as an Exchange, is a new way to find quality health coverage. It is set up as a marketplace where you will have the ability to shop and compare many plans in one central location. You can learn if you can get lower costs based on your income and compare your coverage options side-by-side, and enroll. Private companies offer insurance plans in the Marketplace. They cover the same core set of benefits. No plan can turn you away or charge you more because you have an illness or medical condition. Plans can’t charge women more than men for the same plan and many preventative services are covered at no cost to you.
- I can help you navigate through the Health Insurance Marketplace enrollment process the correct way. With experience as a licensed Life, Health and Accident Insurance Agent, I have an extensive knowledge as it relates to the overall insurance industry. I am qualified and certified to ensure you are getting exactly what you’d hoped for when buying through the Health Insurance Marketplace.
- I have attended many meetings and conferences, extensive training workshops and webinars and I have studied the Affordable Care Act since it was enacted in 2010. Over the past years I have studied and earned the designation, CHRS, Certified HealthCare Reform Specialist. This designation sets me and my agency apart from others. I continue to learn and stay updated on all changes to the Affordable Care Act. There have been many changes and there are many more to come.
- Let me, a licensed, qualified, experienced Insurance Agent and Certified Healthcare Reform Specialist, help you with the entire process from beginning to end. The price is the same whether you buy with me or you buy directly through the Exchange. With me by your side, you will know and understand your plan; you will have taken advantage of any premium subsidies and can have the peace of mind and comfort in knowing you have made the very best possible decision for you and your family.
There are many factors and variables to consider before buying through the Health InsuranceMarketplace. I can make the enrollment process easy and simple and I will make sure you clearly understand the entire process as well as the product you purchase on the Health InsuranceMarketplace. I can explain what happens after you’ve enrolled and what you should expect going forward. I have the knowledge, the experience, the certifications, the software, the privacy requirements and I know all the factors you should consider before purchasing a plan for you or your loved ones.