Changes in Health Insurance: What Does It Mean For You?

The passage of the Affordable Care Act, or ACA, marked a significant milestone in this country’s approach to healthcare – many are calling this a new era in healthcare. And like many new frontiers, there is much uncertainty and confusion along with excitement and possibility. To help relieve some uncertainty for our members, we have put together several questions & answers about what you need to know now to make sure you and your family are compliant with the new laws and have the coverage you need.

What is the Affordable Care Act?

On March 23, 2010, President Obama signed the Affordable Care Act into law. The law enacted large-scale health insurance reforms slated to be complete in 2014.

Important features of the ACA include:

  • Prohibits insurance companies from denying coverage for an individual based on a pre-existing condition.
  • Requires most U.S. citizens to have credible health insurance.
  • Creates tax penalties for many U.S. citizens who do not have credible health insurance.
  • Provides tax credits to individuals and families with incomes that fall between 133% and 400% of the Federal Poverty Level.
  • Provides tax credits for small business owners to help provide health insurance for employees.
  • Expands Medicaid eligibility to 133% of the Federal Poverty Level.
  • Creates health exchanges, or on-line marketplaces, where individuals and small-business employers can apply for financial assistance to cover insurance premiums and can compare and shop for plans.

What is Cover Oregon?

Cover Oregon is Oregon’s health exchange or on-line marketplace.

Important Features of Cover Oregon:

  • Cover Oregon offers access to health insurance plans for those who are uninsured, buy insurance on their own, or own a small business with 50 or fewer eligible employees.
  • Cover Oregon offers a search feature that will let you search for and compare health insurance plans online.
  • Assistance is available in person and over the phone.
  • Cover Oregon is funded by federal grant dollars through 2014; after that, it will be self-sustaining through an administrative fee charged to insurance carriers.

Is the Federal Government Going to Help Me Pay for Health Insurance?

  • If your annual adjusted income falls between 133% and 400% of the Federal Poverty Level, you may qualify for help paying for your health insurance premiums. You must purchase a plan through Cover Oregon to receive financial assistance. (2013 Federal Poverty Level for a family of 3: $19,530 combined annual income).
  • If your income falls below 133% of the Federal Poverty Level, you will be automatically enrolled in the Oregon Health Plan (OHP). Children of families with low income levels will be automatically enrolled in Healthy Kids. You must enroll with Cover Oregon to determine eligibility for either of these programs. (133% of the Federal Poverty Level for family of 3: $25,974 annual income)

Am I Required to Have Health Insurance Now?

  • The ACA has a provision called the “individual shared responsibility provision” that applies to individuals of all ages, including children. It mandates that all individuals must have credible health insurance or face a tax penalty.
  • Individuals can apply for an exemption from the individual shared responsibility provision.
  • The provision goes into effect on January 1, 2014 and applies to each month in the calendar year.
  • Individuals and families can only enroll in a qualified health plan during the open enrollment period, unless they experience a qualifying event. For 2014, the open enrollment period is October 2013 through March 2014. In future years, the open enrollment period will occur between October 15 and December 7.
  • Those applying for coverage offered by their workplace will need to do so within the time frame set by their employer.

Are There Penalties For Not Having Health Insurance?

The ACA’s individual “shared responsibility provision” mandates that all individuals must have credible health insurance or face a tax penalty.

  • The amount of any payment owed takes into account the number of months in a given year an individual is without minimal essential coverage or has an exemption.
  • In 2014 the tax begins at $95 per adult and $47.50 per child (up to $285 for a family) or 1 percent of annual income, whichever is greater. (1% of $50,000 is $500).
  • In 2015, the penalty goes to $325 per adult and $162.50 per child (up to $975 for a family) or 2 percent of annual income, whichever is greater.
  • In 2016, the tax is $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5 percent of annual income, whichever is greater.
  • The tax will be adjusted for inflation beginning 2017.

If I’m on Medicare Do I Need New Insurance to Be Compliant With the ACA?

Medicare is not affected by the ACA. If you have Medicare you do not need to purchase any additional insurance.

Helpful links:

For more detailed information about any of the topics covered here, we recommend speaking to a one of our partner agents, Molly McWaters. Molly is a licensed health insurance agent and Certified with Cover Oregon. She can help you understand the new changes in health insurance and help you find a plan that’s right for you through Cover Oregon or in the private market.

Molly McWaters
Insurance Associates NW, LLC
[email protected]