Understanding The Affordable Care Act #ACA2me

7:16 PM, Sep 30, 2013   |    comments
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At 12:01am Tuesday, health exchanges for the Affordable Care Act will begin. That means you'll be able to shop for an insurance plan online.

You may be wondering how the Affordable Care Act - also known as Obamacare - will affect you.

To start, if you already have insurance through your employer, if your on Medicare, Medicaid, COBRA or your child is covered by CHIP, you don't need to do anything.

If you don't have insurance, go to healthcare.gov to shop for a plan. Your rate will be based on three things: your age, where you live and how many people are in your family. You'll also find out whether you're eligible for insurance and if you can enroll in Medicaid or use other tax credits to pay for it.

At this point, you need to decide whether buying insurance makes sense for you financially. For some people, paying an annual penalty may be the cheaper move.

One big change is insurance companies are not allowed to ask about a pre-existing condition. "Previously if a person had been diagnosed with asthma or maybe they've had a bout with cancer, they may actually be ineligible, or insurance may be able to disqualify them or policies may be unaffordable for them," said Miriam Heard, a certified Navigator trained in the Affordable Care Act. "This is something that's new.  Now people with pre-existing conditions, those things don't matter."

The biggest misconception about the act is that it is government-based health insurance, but it is not.

If you're a senior and on Medicare, you won't have to do anything.
For people 65 or older, the health care law closes Medicare's Part D "doughnut hole," which is a temporary limit on what the drug plan covers for drugs.

For small business owners with 50 or fewer full-time employees, you can enroll in the Small Business Health Options Program, or SHOP.

SHOP will allow for the comparison of health plans online by components such as price, coverage and quality.

If you plan to use SHOP, coverage must be offered to all full-time employees, generally defined as those working at least 30 or more hours per week on average.

In many states, at least 70% of full-time employees must enroll in your SHOP plan.

You may qualify for employer health care tax credits if you have fewer than 25 full-time equivalent employees.

The law does not mandate that businesses with fewer than 50 full-time employees -- defined as 30 hours per week -- provide health insurance. If your business employs more than 50 full-time employees, penalties could arise if you do not provide insurance.

If you are not insured on Jan. 1, 2014 you may face a penalty.

The penalties start off relatively lax in 2014, but by 2016 there will be large increases in penalty fines.

2014 annual penalty $95/person with up to a family maximum of $285 or 1% of family income (whichever is greater)

2015 annual penalty $325/person with up to a family maximum of $975 or 2% of family income (whichever is greater).

2016 annual penalty $695/person with up to a family maximum of $2,085 or 2.5% of family income (whichever is greater).

When filling out your 2014 federal income tax return, there will be a requirement to provide information regarding health insurance. Those who did not have health insurance will be fined, and fines could be withdrawn from income tax returns. Insurers will be required to provide everyone that they cover with information each year that will demonstrate they had coverage for that year.

Penalties for children are half the amount for adults.

The above numbers are annual penalties, but people will get monthly penalties, too, for the time they are not covered.

If you still have more questions, log onto healthcare.gov or call 1-800-318-2596.

Also, starting October 14th, you can call 855-733-3711 to set up an appointment with a certified Navigator in the Triad.

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