Information About the Affordable Care Act (ACA)

Get a Quote

It’s hard to turn on the news these days without seeing stories about the Affordable Care Act (ACA), often referred to as “health care reform” or “Obamacare.” But do you know what the law really means for you and your family?

While the health care landscape is still evolving, there are some things we do know. We’re on top of it, and we’re here to make sure you’re in the know, too.

Everyone Needs Insurance

In 2015 and beyond, everyone, with a few exceptions, must be covered by comprehensive health insurance or face a tax penalty.

The ACA has established a yearly Open Enrollment  period of time 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 , you may be able to enroll during Special Enrollment.

Next Open Enrollment

The next Open Enrollment period is November 1, 2015 – January 31, 2016.

Qualifying for a Premium Tax Credit

Most people 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. Get a free, online quote and find out if you qualify for a tax-credit.

A Few Health Coverage Exemptions

If you aren’t covered by a health plan that meets or exceeds the ACA’s essential health benefits 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 about fees and exemptions.

The Cost of No Coverage

If you choose not to buy health insurance with the ACA’s essential health benefits and don’t qualify for a health coverage exemption, you may have to pay a penalty, or fee, each year you’re not covered. And, you will also have to pay in full for any health care services you receive.

For example, if you don’t have coverage in 2015, your penalty fee for the year would be the higher of these two options:

  • 2% of your annual household income above the tax filing threshold
  • $325 per adult for the year and $162.50 per child under 18 with a family maximum of $975.

In 2016, these options will increase to 2.5% of your household income or $695 per adult and $347.5 per child.

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, like our own, 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. Now, 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

Implementation of the Affordable Care Act (ACA) will be phased in over the next decade. We anticipate further regulations to guide in implementing the law and there may be new requirements in individual states as well. We can assure you that our health plans comply with all 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.