Health Insurance Shop Inc. FAQ
The Individual Mandate portion of the Affordable Care Act (commonly referred to as “Obamacare”) requires most legal US citizens and resident aliens be covered by a qualified health insurance plan that provides coverage for minimum essential benefits, beginning Jan. 1, 2014.
Individuals not covered by a qualified health plan for more than three consecutive months will be subject to the Individual Shared Responsibility Payment* – unless they qualify for an exemption. Examples of exemptions are:
- Individual’s whose income is too low to require filing an income tax return, or when the lowest cost plan available exceeds 8 percent of your household income
- Members of a federally recognized Indian tribe
- Members of a recognized health care sharing ministry
- Members of a recognized religious sect with religious objections to social health systems
- Incarcerated individuals
- Individuals not lawfully present in the US
- Individuals who qualify for a hardship exemption
* Coverage for individuals who apply between March 15th these individuals will be uninsured in excess of three (3) consecutive months in 2014, they will not be assessed the Individual Shared Responsibility Payment. thru March 31st will not begin until May 1, 2014.
Beginning Jan. 1, 2014, individuals not covered by a qualified health insurance plan in excess of three consecutive months (and without an approved exemption) will be required to pay a “fee” known as the Individual Shared Responsibility Payment.
In 2014, the Individual Shared Responsibility Payment will be the greater of – 1% of your household income over the filing threshold
$95 per person ($47.50 per child and up to $285 per household)
The fee increases each year. 2015 will be the greater of 2% of income or $325 per person. 2015 will be the greater of 2.5% of income or $695 per person. It is expected to increase annually thereafter with inflation.
Everything in the Affordable Care Act (including the name itself) would lead us all to believe that health insurance would be affordable. The reality is that whether health insurance is now “affordable” depends upon a few variables – with household income being No. 1.
The Affordable Care Act mandates that all fully-insured individual and small group health insurance plans not only be guaranteed issue, but must also be “community rated.” This simply means that rates can only be based upon the following criteria.
- Zip code
- Where an individual resides
- Where an employer’s corporate office is located
- Age of individual(s) to be insured
- Enrollment status
- Tobacco use status of individual(s) to be insured
What does household income have to do with any of that?
Individuals and families whose household income is between 100-400% of the Federal Poverty Level (FPL) could be eligible for help in paying for health insurance premiums in the form of Advanced Premium Tax Credits (APTC). As an example, a family of four with a 2014 household income between $23,850 and $95,400 would qualify for help. The exact amount will vary depending upon the community rating criteria mentioned above, as well as the affordability of any available employer-sponsored group health plan.
If you are eligible for an employer-sponsored group plan, and the cost for single coverage (does not include spouse or dependent child premium) does not exceed 9.5% of your household income – you and your family will not qualify for the APTC. Even if your household income is otherwise between 100-400% of FPL.
For a detailed quote, contact one our CMS Certified agents today!
It’s as simple as clicking the link below if you know your household income is above 400% of Federal Poverty Level (FPL), or contacting one of our CMS Certified* agents to schedule a face-to-face enrollment. Click here to look up your estimated 2014 household income to see where you may fall.
*In order to enroll/assist/sell Marketplace plans, agents are required to go through a certification process to ensure that all practices and procedures established by the Centers for Medicare and Medicaid Services (CMS) are adhered to. Agents who do not possess a certification from CMS are prohibited from enrolling/assisting/selling Marketplace plans.