FREQUENTLY ASKED QUESTIONS, (FAQ's)
1. What is the Health Insurance Marketplace? 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.
2. When did the major changes of health care reform come into effect? 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.
3. When can I enroll? The 2016 Open Enrollment Period for the Health Insurance Marketplace begins November 1, 2015 and continues through January 31, 2016. However, to have a January 1, 2016 effective date, you must be enrolled in a plan by December 15, 2015.
4. What are the penalties for not having health coverage? 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.
5. I already have health insurance. Will Healthcare Reform affect me? 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.
6. If I am not covered by an employer or government-sponsored plan, will I have to buy my own health insurance? 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.
7. What is an Advanced Premium Tax Credit, APTC? 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.
8. How much will health insurance cost me through the Health Insurance Marketplace? 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.
9. Does it cost me anything to use a licensed insurance agent to help with enrolling in the Health Insurance Marketplace and what are the advantages? 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.
10. Are my dependents required to have coverage under health care reform? Yes. Your dependents must have minimum essential insurance coverage unless they are exempt. The exceptions are (1) not a U.S. Citizen or lawfully present alien, (2) incarcerated, or (3) qualifies for a religious exemption. You will pay a penalty for every month that your dependent does not have minimum essential coverage. If you file taxes jointly with a spouse, both of you would be responsible for the penalty. If your children have LA. Medicaid/CHIP, they are considered as having coverage and should not be accessed a penalty.
11. What are Essential Benefits? Essential Benefits are benefits that ALL plans in the Health Insurance Marketplace must cover as well as employer-sponsored group health plans. They include: (1)doctor visits, (2)outpatient services, (3)emergency services, (4)hospitalization, (5)maternity and newborn care, (6)mental health and substance abuse disorder services, (7)prescription drug coverage, (8)rehabilitative services and devices, (9)laboratory services, (10) preventive and wellness services, (11) chronic disease management, and (12)pediatric services, including oral and vision care.
12. What is Minimum Essential Coverage? 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.
13. Does the information on my tax return change because of health care reform? 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.
14. Can I get a Marketplace Plan in addition to Medicare? 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.
15. What is a special Election Period(SEP)? After Open Enrollment Ends January 31, 2016, 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.
16. Do I have to update my Marketplace Application every year? 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.
17. What is a Certified Healthcare Reform Specialist®? 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.
18. How does receiving An APTC or subsidy affect my income tax return? 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.