The Affordable Care Act and what it means for you!

What is the Affordable Care Act?

The Patient Protection and Affordable Care Act (PPACA) 2010 HR3590, or Affordable Care Act (ACA) for short, is the new health care reform law in America and is often called by its nick-name Obamacare. The Patient Protection and Affordable Care Act is made up of the Affordable Health Care for America Act, the Patient Protection Act, and the health care related sections of the the Health Care and Education Reconciliation Act and the Student Aid and Fiscal Responsibility Act. It also includes amendments to other laws like the Food, Drug and Cosmetics Act and the Health and Public Services Act. Since being singed into law additional rules and regulations have expanded upon the law, we have attempted to update our summaries with those changes.

What Does the Affordable Care Act Do?

The Affordable Care Act is a long, complex piece of legislation that attempts to reform the healthcare system by providing more Americans with affordable quality health insurance and by curbing the growth in healthcare spending in the U.S. Reforms include new benefits, rights and protections, rules for insurance companies, taxes, tax breaks, funding, spending, the creation of committees, education, new job creation and more. Please note that the law, in many cases, gives power to ongoing efforts by Health and Human Services and other Government programs to reform health care. So healthcare reform doesn't start and end with the Act itself. Make sure to check out the official HHS site for more information on healthcare reform outside of the ACA.

The penalty in 2014 and beyond if you do not buy health Insurance......

The penalty in 2014 is calculated one of 2 ways. You will pay whichever of these amounts is higher:
  • 1% of your yearly household income. The maximum penalty is the national average yearly premium for a bronze plan.
  • $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.
The fee increases every year. In 2015 is 2% of income or $325 per person. In 2016 and later years it's 2.5% of income or $695 per person. After that it is adjusted for inflation. If you're uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you're uninsured. If you're uninsured for less than 3 months, you don't have to make a payment. How do I qualify for an exemption from the fee for not having health coverage?

Exemptions from the payment

Under certain circumstances, you won't have to make the individual responsibility payment. This is called an 'exemption.'

You may qualify for an exemption if:
  • You're uninsured for less than 3 months of the year
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You don't have to file a tax return because your income is too low (Learn about the filing limit.)
  • You're a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You're a member of a recognized health care sharing ministry
  • You're a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You're incarcerated, and not awaiting the disposition of charges against you
  • You're not lawfully present in the U.S.

Hardship exemptions

If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a 'hardship' exemption:
  1. You were homeless.
  2. You were evicted in the past 6 months or were facing eviction or foreclosure.
  3. You received a shut-off notice from a utility company.
  4. You recently experienced domestic violence.
  5. You recently experienced the death of a close family member.
  6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
  7. You filed for bankruptcy in the last 6 months.
  8. You had medical expenses you couldn't pay in the last 24 months.
  9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
  10. You expect to claim a child as a tax dependent who's been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
  11. As a result of an eligibility appeals decision, you're eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren't enrolled in a QHP through the Marketplace.
  12. You were determined ineligible for Medicaid because your state didn't expand eligibility for Medicaid under the Affordable Care Act.
  13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.

How to apply for an exemption

If you are applying for an exemption based on: coverage being unaffordable; membership in a health care sharing ministry; membership in a federally-recognized tribe; or being incarcerated: You have two options--
  • You can claim these exemptions when you fill out your 2014 federal tax return, which is due in April 2015
  • You can apply for the exemptions using the appropriate form:
    • Form to apply for exemption based on coverage being unaffordable (if you live in a state using Healthcare.gov)
    • Form to apply for exemption based on coverage being unaffordable (if you live in a state using its own health exchange)
    • Form to apply for exemption based on membership in a health care sharing ministry
    • Form to apply for exemption for American Indians and Alaska Natives and others who are eligible for services from an Indian health care provider
    • Form to apply for exemption based on being incarcerated
Call Rod Dunlap Insurance for health insurance assistance today at 541-744-0556.

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