Information About the Affordable Care Act (ACA)

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Everyone Needs Insurance

Per the Affordable Care Act (ACA), everyone, with a few exceptions, must be covered by health insurance that meets the ACA requirement of minimum essential coverage or face a tax penalty.

The ACA has established a yearly Open Enrollment period for individual health insurance. In most cases, you must enroll in an ACA compliant health plan within that period to avoid a penalty. However, if you experience a qualifying event outside of that Open Enrollment window, you may be able to enroll during a Special Enrollment period.

Open Enrollment

Open Enrollment runs November 1, 2016 – January 31, 2017.

Qualifying for a Premium Tax Credit

Many who apply for health insurance coverage on the marketplace qualify for premium tax credits that can help lower the costs of getting coverage. The amount you may receive is based on the size of your family and your annual income. You can learn more about tax credits and other ways you might save at Healthcare.gov.

A Few Health Coverage Exemptions

If you aren’t covered by a health plan that meets or exceeds the ACA’s minimum essential coverage requirements, you must claim a health coverage exemption or pay a penalty with your federal tax return. If you qualify for an exemption, you won’t have to pay the penalty.

There are different kinds of exemptions: income-related, health coverage-related, group-related, hardship-related and more. Some exemptions you can claim on your federal tax return. Others, you apply for with a paper application. If you believe you may be eligible for an exemption, you can learn more at Healthcare.gov about fees and exemptions.

The Cost of No Coverage

If you choose not to buy health insurance that meets minimum essential coverage according to the ACA and don’t qualify for a health coverage exemption, you may have to pay a penalty, or fee, for each full month you or other family members are without coverage during the year. And, without insurance you will also have to pay in full for any health care services you receive.

In 2016, the ACA tax penalty is calculated from whichever is higher of the following: percentage of household income and per person.

Per Person
  • $695 per adult
  • $347.50 per child under 18

Maximum: $2,085

Percentage of Household Income
  • 2.5% of household income

Maximum: The amount equal to a year’s worth of premium for a Marketplace Bronze plan (amount figured by the national average)

You pay the fee when you file your federal tax return. For each month you or your dependents are without health coverage, you pay 1/12 of the annual amount. You won’t be charged a penalty if you are without health insurance for less than three months. In 2017 and beyond, the fee will be adjusted for inflation.

Sources for Buying Health Insurance

  • Your Employer – Some employers offer health insurance to their employees at a reduced rate. 
  • Health Insurance Marketplaces – Marketplaces, or "exchanges," are a way for people to shop for and buy health insurance, which may be referred to as a health plan. Each marketplace is divided between individual (for families and individuals) and SHOP (health plans for small employers) marketplaces.
  • Health Insurance Companies – Insurance companies can offer plans directly to people – just as we have done in the past. We can also offer approved plans through the marketplaces.

Preexisting Conditions

Preexisting condition limitations have been eliminated from ACA health plans. You can’t be denied ACA health insurance coverage on the basis of a health condition, and you can't be charged a higher premium because of your condition.

Coverage for Older Children

If a health insurance plan covers children, they can be added to or kept on the parent's policy until they turn 26 years old.

Health Care Reform and Your Existing Coverage

Over time, we anticipate further regulations to guide in implementing the health care reform law, and there may be new requirements in individual states as well. We can assure you that our health plans comply with applicable state and federal laws today and will continue to do so as changes take effect.

How Will I Know about Changes to My Health Plan?

We are committed to communicating with you directly and in a timely manner when your health insurance plan is affected by specific provisions and/or changes in the ACA law.

You can expect to receive written communications from us that explain what changes or additions will be made to your health insurance plan and what they mean for you and your family.

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