The Affordable Care Act health insurance
On March 23, of 2010 President Obama signed the the Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare. The law has been through many changes over the last few years and now allows over 35 million people the chance the have “affordable” health insurance coverage, either though Marketplace plans or Medicare expansion.
ACA explained
New changes for 2023.
In 2023, a job-based health plan is considered “affordable” if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.12% of your household income.
- The lowest-cost plan must also meet the minimum value standard.
- If you’re the employee, affordability is based on only the premium you’d pay for self-only (individual) coverage.
- For coverage starting January 1, 2023, if you’re offered job-based coverage through a household member’s job, affordability is based on the premium amount to cover everyone in the household.
- Total household income includes incomes from everybody in the household who’s required to file a tax return.
If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings.
Example:
- Household’s monthly income = $4,083 (about $49,000 per year).
- 9.12% of the household’s monthly household income = $372
For the employee:
- Monthly premium the employee would have to pay for the lowest-priced plan that covers just the employee = $300
- Is the plan affordable for the employee? YES. The premium the employee would have to pay to cover just themselves ($300) is less than 9.12% of the household’s income ($372). Because the job-based coverage is affordable for the employee, the employee won’t qualify for savings in the Marketplace.
For other household members:
- Monthly premium the employee would have to pay for the lowest-priced plan that covers other members of their household = $450
- Is the plan affordable for other household members? NO. The premium the employee would have to pay to cover others in the household ($450) is more than 9.12% of the household’s income ($372). Because the job-based coverage isn’t affordable for the employee’s household members, the employee’s household members may qualify for savings in the Marketplace.
Employer Coverage Tool
Use this worksheet to help you gather information about employers that offer traditional health coverage to anyone on your Marketplace application. Complete one form for each employer that offers coverage. You’ll need this information to complete the application, even if no one enrolls in coverage through their job (or the job of another person, like a spouse or parent). Don’t use this form if someone works for a business that offers help paying for a health plan or health care expenses through a Health Reimbursement Arrangement (HRA).
Did you know?…It does not cost YOU one cent more to have your very own licensed agent explain to you your options, help you enroll, and be there for you throughout the year when needed. Located in Lafayette Indiana, we are also licensed in Illinois and Michigan. Contact us for a free insurance quotes and enrollments.
Helpful Links
Get a Quote or Enroll
Use our convenient online quote and enrollment link and avoid the marketplace website all together!
Qualifying Life Events
Did you miss the annual open enrollment period? Check to see if you have a “Special Life Qualifying Event” to buy outside the enrollment period.
Marketplace Appeal
Did you get a decision you do not agree with? It’s easy to appeal, get the forms online.
Have good RX Coverage?
Here is a link for a free program to reduce the cost of medications.
Indiana Hip 2.0 Program
Do you make too much for Medicaid, but not enough for a marketplace plan? Indiana HIP 2.0 is for you.
Calculate your subsidy
Curious about how much of a subsidy you may qualify for before filling out an application?
Short Term Medical
An affordable option?
If you missed the annual enrollment period on the Marketplace for your health insurance, or you just don’t want to pay the high prices for the ACA, short term medical plans can be an option for you. Keep in mind they do not cover pre-existing health conditions and have none or limited prescription coverage.
AllState Health Solutions
Allstate Health Solutions understands that how
you live and work is constantly changing. That’s
why short term medical insurance gives you
flexibility to choose the amount of coverage
you need, for amount of time you need it.
With options from top insurance providers like
Aetna and Cigna, you can customize a plan that protects you from everyday health care costs, and
unexpected health emergencies:
- Doctor visits and preventive care
- Emergency room and hospital stays
- Pharmacy benefits and discounts
Pivot Health
Plans offer coverage for a variety of medical services like doctor office visits, emergency room care, hospital stays, surgery and more after a deductible is met.
Some plans offer doctor office copays for primary care and Urgent Care. Each plan also includes coinsurance, which is the portion an insured is required to pay after the deductible is met.
It is important to review the Plan Details and understand full services provided, coinsurance out-of-pocket maximums, exclusions and limitations.
UnitedHealthcare
Not having health insurance coverage for even a short amount of time can be expensive. What if you have an accident? What if you fall ill?
- Coverage for doctor office visits, urgent care visits, emergency room, hospitalization, outpatient spine and back visits, limited preventititve care and more
- Prescription coverage available on most plans
- Network access to quality care from 1.3 million physicians and health care professionals and 6,000 hospitals and medicals facilities
- Use any doctor in the Choice network across the nation, no Primary Care Physician(PCP required.
Everest
Your FlexTerm policy does not confine you to a specific network, but it can be advantageous to see doctors and obtain other ancillary services in the PHCS Practitioner Plus Ancillary Network (PHCS Network). When you see doctors in the PHCS Network, you can avoid balance billing for services that are covered by your policy.
Telemedicine
24/7 accessibility to doctors with the convenience of not leaving your home. Want to know more? Quote and enroll online.
Metal Gap Coverage
The ACA plans can leave you with high deductibles and co-pays. These plans fill the gaps. Quote and enroll online.
We are a full service Life/Health/Retirment Planning agency located in Lafayette Indiana, although we are licensed to do business in Illinios, Michigan, and Texas as well. We strive to have one of the largest portfolios available to independant agencies like ours so that we can always offer our clients the best value for thier hard earned money.