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Affordable Care Health Insurance FAQs

What is the Affordable Care Act (ACA)?

The ACA was signed into law on March 23, 2010. Making up the ACA are two separate pieces of legislation: The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). The PPACA is a health care law aimed at improving the health care system of the United States by widening health coverage to more Americans and protecting existing health insurance policy holders. The HCERA was then signed into law on March 30, 2010 to amend the PPACA.

What is a Consumer Assistance Program (CAP)?

A Consumer Assistance Program is a program to help all families or individuals with any health insurance questions or problems they may encounter. The program can also assist with any appeals to be made to the health insurance provider.

What is a Health Insurance Marketplace?

Marketplaces are new organizations that will be set up to create a more organized and competitive market for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options.

Beginning in 2014, Marketplaces will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future.

Can I still get ACA-compliant coverage after the enrollment period?

Most of the nation is now outside of the annual open enrollment period, that doesn't mean that ACA-compliant coverage is necessarily out of reach.

Even if you didn't make the open enrollment deadline for 2016 coverage, you may be able to buy an ACA-compliant major medical policy right now if you've had a qualifying event - a major life change that makes you eligible for a special enrollment period. By purchasing coverage, you can avoid or minimize an Obamacare penalty.

How can the nation afford health care reform?

Americans currently spends more than $2 trillion dollars a year on health care. The majority of the cost of paying for health care reform will come from cutting waste, fraud, and abuse within existing government health programs and increasing efficiency with steps such as coordinating care and streamlining paperwork.

The nation also cannot afford to bypass health care reform. The cost of inaction is too high. One out of every six dollars in this country is spent on health care. Soon it will be one in five. If nothing is done, in 30 years, one third of this country's economic output will be tied up in the health care system.

What factors will help to determine premium cost for each enrollee?

There are three cost factors in health care reform: the area a person is located, a family's composition or size, and if an individual uses tobacco.

Who will be eligible for subsidies to make health insurance more affordable?

Beginning in 2014, advanced premium tax credit subsidies will be available to individuals who are lawfully present in the United States and who purchase coverage in the new health insurance Marketplace and who have income up to 400% of the federal poverty level ($43,320 for an individual or $88,200 for a family of four in 2009).

Will business owners have to buy insurance for their employees?

It depends on the size of the business. Beginning January 1, 2015, companies with fewer than 50 full-time employees and full-time equivalents won't be penalized if they don't offer health insurance. But effective now, businesses can get tax credits for providing health insurance coverage if they have 25 or fewer full time equivalent employees and a workforce with an average annual wage of up to $50,000. Tax credits of 35 percent of the premium costs are available for tax years 2010 through 2013 and will increase up to 50 percent starting in 2014.

Also beginning in 2015, businesses with more than 50 employees that do not offer health insurance must pay a penalty if any of their employees get government-subsidized coverage through the exchange. The first 30 employees will be excluded from the assessment.


For more information about the Affordable Care Act and Health Insurance, call (312) 600-7084 to contact our health insurance specialist.

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