THE AFFORDABLE CARE ACT. (ACA)   WHAT IS IT?

     The Affordable Care Act, often referred to as, “The ACA”, "Obama Care", PPACA, or Healthcare Reform, was enacted and signed into law by President Obama on March 23, 2010.  Beginning in 2014, the Affordable Care Act included a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. It also reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense.

      For Americans with insurance coverage who like what they have, they can keep it as long as it is still available.   Nothing in this act or anywhere in the bill forces anyone to change the insurance they have. Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market known as the Health Insurance Marketplace – the same insurance market that every member of Congress will be required to use for their insurance. It keeps insurance companies honest by setting clear rules that rein in the worst insurance industry abuses. And it bans insurance companies from denying insurance coverage because of a person’s pre-existing medical conditions.

   A few other Affordable Care Act, ACA, facts are:

*The primary goals of the ACA are to decrease the number of uninsured Americans and reduce the overall costs of health care.

*Provides for premium tax credits and cost-sharing reductions to help eligible low-income and middle- Income individuals purchase health insurance through a Marketplace.

*Provides a small business health care tax credit to eligible employers.

*Provides new opportunities for State Medicaid programs to cover additional adults and children with low incomes, and simplifies the eligibility rules for Medicaid and CHIP. (Louisiana did not expand   Medicaid)

*Eliminates Lifetime or Annual Limits.

*No Pre-existing Exclusion for children under age 19.

*Makes cost of prescription drugs more affordable for seniors in the prescription donut hole.  Beginning In 2013, seniors started receiving 50% discount on brand-name drugs when in the donut hole. Before the ACA, seniors were paying 100% of the cost of their brand-name drugs in the donut hole. The donut hole is expected to be completely eliminated by 2020 and will decrease every year until then. In 2014, seniors started receiving a discount of 52.5% of the cost of their brand-name drugs in the donut hole.  Individuals with Medicare CANNOT enroll in a Marketplace plan. 

*The Affordable Care Act Allows for FREE PREVENTATIVE CARE for seniors.

Are you eligible to get help to pay for Health Insurance?

       2015 Federal Poverty Guidelines

*Reminder:  You are not eligible for an Advance Premium Tax Credit, APTC, if you have health insurance coverage or If you have the  offer of coverage for health insurance through your job or a spouse's job.

Federally facilitated marketplaces will use the 2015 Guidelines and possibly the 2016 Guidelines, when released, to determine eligibility for Medicaid and CHIP.

    1. Find your household size on the FPL Chart:  Your household size             should be same as  the number of dependents that will be listed             on your 2017 tax return. This is the tax return that you                         will physically file in 2018 for tax year 2017.

2. Once you have your household size on the chart, scroll over to the right until you find your total gross household income (amount before any deductions are taken out of your paycheck) for 2017.  If you are married, you MUST include your spouse’s income as well.  If your dependents receive income, this income, this also has to be included.  DO NOT INCLUDE SSI INCOME OR CHILD SUPPORT.
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3. If your household size and income are on this chart and you do not have health insurance coverage available to you though your job or someone else’s job, you could possibly qualify for an Advanced Premium Tax Credit, APTC, also known as a  subsidy, which will help in paying your monthly cost for health insurance.

                 THE HEALTH INSURANCE MARKETPLACE

Open Enrollment for 2017 begins November 1, 2016 - January 31, 2017. The ACA requires each to state to have a Health Insurance Marketplace.  Louisiana is using a Federally Facilitated Health Insurance Marketplace (FFE).  Health Insurance Marketplaces will be set up as a Marketplace for Individual policies and as SHOPs (Small Business Health Options Program) for small employer groups.  A small group by Louisiana standards is a group under 50 employees. (See FAQ #3) Beginning in 2016, the ACA defines a small group as having 1- 100 full time employees.

Plans offered through the Health Insurance Marketplace are regulated by the federal government and MUST include Essential Health Benefits.  (See FAQ #11)

THE HEALTH INSURANCE MARKETPLACE PLAN OPTIONS

The 4 levels of coverage available in the Health Insurance Marketplace will be defined as "Metal Plans." Each plan has a co-insurance amount, the amounts the individual and the plans pay.  Some Insurance Companies may have more than 1 plan in the metal coverage levels.

Example:  An individual in the Silver Plan can expect to pay approximately 30% of the healthcare costs and the plan will pay approximately 70% of the cost of the healthcare costs.

ADVANCED PREMIUM TAX CREDITS, APTC  

An Advance Premium Tax Credits, APTC, lowers the monthly premium an individual will pay throughout the year for health insurance coverage.   Tax credits may be available to individuals with a household income between 100% and 400% of the Federal Poverty Level (up to $47,080 for an individual and $97,000 for a family) (See FAQ #7)

COST SHARING REDUCTIONS

Cost Sharing Reductions reduce out-of-pocket expenses for the individual.  Generally this would be available to individuals who enroll in Silver Plans with incomes between 100% ($11,770 for an individual and $24,250 for a family of 4) and 250% ($29,425 for an individual and $60,625 for a family of 4) of the Federal Poverty Level.  Subsidy amounts may vary by income and family size.  Reductions can include reduced monthly premiums, copays, deductibles and Out of Pocket Maximums.

CHANGES that began in 2014 and are continuing through 2016

- No more annual dollar limits on Essential Health Benefits or Lifetime Maximums on benefits

- An employer can no longer have a waiting period for benefits longer than 90 days

- Guaranteed issue and renewability for plans (no eligible person can be denied coverage)

- Insurance Companies will be required to spend at least 80% of each premium dollar on medical expenses.  This is often referred to as the Medical Loss Ratio (MLR).

INDIVIDUAL MANDATE: PENALTIES FOR NOT HAVING COVERAGE

Beginning January 1, 2014, The Affordable Care Act, ACA, included a mandate which required most individuals to have some form of health insurance coverage or face penalties for not having coverage.   The 2016 Open Enrollment Period for the Health Insurance Marketplace is November 1, 2015 – January 31, 2016. (See FAQ #3)

- 2014 Penalty - $95 per adult and $47.50 per child (up to $285 for a family) or 1% of your family income, whichever is greater.

- 2015 Penalty - $325 per adult and $162.50 per child (up to $975 for a family) or 2% of your family   income, whichever is greater.

- 2016 and beyond penalty - $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5%   of your family income, whichever is greater.

WHAT INFORMATION DO YOU NEED TO BRING WITH YOU TO ENROLL?

1. Names, Birthdates and Social Security Cards/Numbers for everyone in your household. (Your household should include everyone you plan to file on your 2017 Tax Return)

2. Know your expected Gross Income (before taxes) for 2017; if married, know your spouse’s Gross Income information as well.  If children receive any income, know their expected income for 2017 as well.  SSI and child support do not have to be included in income calculation.

3. Bring Proof of all Incomes for everyone in your household,  to include income from Social Security Benefits, Retirement Income, Investments, etc. (LAST PAYCHECK STUB  WOULD BE VERY HELPFUL)

4. Have a valid email address; if you do not have one, we can create one for you.  If you have an email address, be sure you know your password as you will need to log into your account at the time of the appointment.

5. Name and Telephone Number of your Employers; both past and present for 2017.