Health Care Reform-State Health Insurance Exchanges

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State Health Insurance Exchanges

The Health Insurance Marketplace helps uninsured people find health coverage. When you fill out the Marketplace application online the website will tell you if you qualify for:

Private health insurance plans. The site will tell you whether you qualify for lower costs based on your household size and income. Plans cover essential health benefits, pre-existing conditions, and preventive care. If you don’t qualify for lower costs, you can still use the Marketplace to buy insurance at the standard price.
Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide coverage to millions of families with limited income. If it looks like you qualify, the exchange will share information with your state agency and they’ll contact you. Many but not all states have expanded Medicaid in 2014 to cover more people.

Click and Read 2016 Health Care Reform State Health Insurance Exchanges Here

No Matter What State You Live in, You Can Use the Marketplace
Some states operate their own Marketplace. In some states, the Marketplace is run by the federal government.

Most people must have health coverage in 2015 or pay a fee. If you don’t have coverage in 2015, you’ll have to pay a penalty of $325 per adult, $162.50 per child, or 2% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee. If you enrolled by March 31, 2015, you won’t have to pay the fee for any month before your coverage began.

You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.

If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums.

If you have Medicare, you’re considered covered and don’t have to make any changes. You can’t use the Marketplace o buy a supplemental or dental plan.

Click and Read 2016 Health Care Reform State Health Insurance Exchanges Here

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Health Care Reform-Individual Insurance Requirement

ACA June 6

Requirement to Have Health Insurance

Beginning January 2014, nonexempt U.S. citizens and legal residents are required to maintain minimum essential coverage. Minimum essential coverage can include
government-sponsored programs, eligible employer-sponsored plans, plans in the individual market, grandfathered group health plans, and other coverage as recognized by the Secretary of Health and Human Services (HHS), in coordination with the Secretary of the Treasury.

Government-sponsored programs include Medicare, Medicaid, Children’s Health Insurance Program, coverage for members of the U.S. military, veteran’s health care, and health care for Peace Corps volunteers. Eligible employer-sponsored plans include governmental plans, church plans, grandfathered plans, COBRA coverage, retiree coverage, and other group health plans offered in the small or large group market within a state.

Click and Read 2016 Health Care Reform Individual Insurance Requirement Here

Health Insurance Portability and Accountability Act (HIPAA)

Excepted Benefits
Minimum essential coverage does not include coverage that consists of certain HIPAA excepted benefits. HIPAA excepted benefits include:
1) Coverage only for accident or disability income insurance,
2) Coverage issued as a supplement to liability insurance,
3) Liability insurance, including general liability insurance and automobile liability insurance,
4) Workers’ compensation or similar insurance,
5) Automobile medical payment insurance,
6) Credit-only insurance,
7) Coverage for on-site medical clinics, and
8) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. Other HIPAA excepted benefits that do not constitute minimum essential coverage if offered under a
separate policy, certificate, or contract of insurance include long-term care, limited scope dental and vision benefits, coverage for a disease or specified illness, hospital indemnity or other fixed indemnity insurance, or Medicare supplemental health insurance.

Click and Read 2016 Health Care Reform Individual Insurance Requirement Here

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Health Care Reform-Premium Assistance Credit

2016 Health Care Reform

Premium Assistance Credit

Health Care Reform created a refundable premium assistance credit for eligible individuals and families to subsidize the purchase of health insurance through an exchange.

Eligible individuals enrolled in the plan report their income to the exchange. Based on the income reported, the individual receives a premium assistance credit. The credit is paid directly to the insurance plan. The individual then pays the insurance plan the difference between the credit amount and the total premium charged.

2016 Health Care Reform Premium Assistance Credit

Eligibility
Initial eligibility for the premium assistance credit is based on the individual’s income for the tax year ending two years prior to the enrollment period. Individuals (or couples) who experience a change in marital status or other household circumstance, experience a decrease in income of more than 20%, or receive unemployment insurance, may update eligibility information or request a redetermination of their credit eligibility.

The premium assistance credit is available for individuals (single or joint filers) with household incomes between 100% and 400% of the federal poverty level (FPL) for the family size involved who do not receive health insurance through an employer or a spouse’s employer.

Note: Individuals below 133% of FPL are generally eligible 2016 Health Care Reform Premium Assistance Credit for Medicaid coverage under the new law.

2016 Health Care Reform Premium Assistance Credit

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Health Care Reform Cost Sharing Subsidy for Individuals with High-Deductible Plans

2016 ACA

Cost Sharing Subsidy for Individuals with High-Deductible Plans

Out-Of-Pocket Expense Limits
The health care reform law provides for a cost-sharing subsidy to reduce the maximum annual deductible and out-of-pocket expense limits for high-deductible health
plans for individuals and households between 100% and 400% of the federal poverty level (FPL). A high deductible health plan is currently $6,450 for self-only coverage in 2015 and $12,900 for family coverage in 2015. High-deductible health plans are those plans that
qualify the taxpayer to contribute to a health savings account (HSA) (or allow an employer to contribute to the HSA of an employee).

2016 Health Care Reform Cost Sharing Subsidy for Individuals with High-Deductible Plans

Note: The individual does not have to contribute to an HSA to qualify for the subsidy. The individual merely has to have a high-deductible health plan and fall within the FPL income range.

Note: Individuals below 133% of FPL are generally eligible for Medicaid coverage under the health care reform law.

2016 Health Care Reform Cost Sharing Subsidy for Individuals with High-Deductible Plans

Calculation of Subsidy
For individuals with household income of more than 100%, but not more than 200% of FPL, the out-of-pocket limit is reduced by two-thirds. For those between 201%
and 300% of FPL, the out-of-pocket limit is reduced by one-half, and for those between 301% and 400% of FPL, the out-of-pocket limit is reduced by one-third.

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State Health Insurance Exchanges

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