Northville District Library

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Phone: 248-349-3020

Affordable Care Act (ACA) Quick Facts

 

October 1, 2013   -   March 31, 2014    Open enrollment period at healthcaredotgov

January 1, 2014  Health care coverage can start

 


caduceusCoverage Requirements

Anyone who currently receives health insurance through an employer can decide whether to keep it or change to Marketplace coverage. Otherwise you may need to get insurance through the Marketplace or another source for 2014. Those with Medicaid are already covered.

American citizens without minimum essential coverage in 2014 may face penalties. This flowchart can help you determine if you are required to obtain medical insurance and also view the penalties.

 


 

Health Insurance Marketplace

healthinsurancemarketplaceThe Health Insurance Marketplace is mandated by the federal government and offers plans through multiple carriers/networks. In the Marketplace you can fill out an application and compare coverage options. At the time of enrollment decide how to pay your premiums or sign up for Medicaid or CHIP (Children’s Health Insurance Program) if you are eligible. Several health plans are offered differing in benefits, protections and cost.

 

What You Will Need

Individuals:

  • Social Security numbers (or document numbers for legal immigrants)
  • Employer and Income information (W-2 or paystub)
  • A completed Employer Coverage Tool

Families

  • Social Security numbers (or document numbers for legal immigrants) for all dependents
  • Employer and Income information (W-2 or paystub) for every member of household that needs coverage under the age of 26
  • Policy numbers for any current health insurance plans covering members of your household
  • Information about any health insurance you or your family could get from your jobs
  • A completed Employer Coverage Tool

healthinsuranceform

 

Four Ways To Apply

 

Printable Fact Sheets From HealthCare.gov

 


 

Insurance Benefit Levels

doctorsThere are four levels of health insurance coverage. At each coverage level the benefit coverage increases, premium increases, and cost-sharing reduces. The levels of coverage in the ACA are specified using an Actuarial Value (AV). For the Bronze plan the plan will pay 60% of health care expenses and the enrollee will pay 30% through a combination of deductibles, co pays, and coinsurance. The percentage a plan pays for an enrollee with likely be different from the Actuarial Value depending on health care services used and the total cost of the services.

  • Bronze – Actuarial Value of 60%
  • Silver - 70%
  • Gold - 80%
  • Platinum - 90%

Find out more about what the actuarial values in the ACA mean

 

Core Benefits

Each level of coverage provides core benefits including:

  • Outpatient care
  • Emergency room
  • Inpatient care in a hospital
  • Care before and after a baby is born
  • Mental health and substance use disorder services including behavior health treatment, counseling, psychotherapy
  • Prescription drugs
  • Services and devices that help in recovery if you are injured or have a disability or chronic condition
  • Lab tests
  • Preventive services including counseling, screening, and vaccines to keep you healthy and care for chronic conditions
  • Pediatric services including dental care and vision for kids

 


 

Subsidy Eligibility

Individuals and families may be eligible to receive subsidies if not eligible for Medicare, Medicaid or the Children’s Health Insurance Program (CHIP). Subsidies are based on MAGI (Modified Adjusted Gross Income) on your tax return. Use this calculator to get an estimate of your eligibility for subsidies.

Find out more about the new rules for determining income

 


 

Medicaid And Children’s Health Insurance Program (CHIP)

babyMedicaid provides individuals under 65 years of age with income levels below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid.

CHIP provides health coverage to more than 43 million children, including half of all low-income children in the United States. The ACA extends eligibility and is expected to provide numerous improvements to this program.

Find out more about eligibility for these programs

 


 

Young Adults

Dependent coverage is extended to age 26 regardless of any access the dependent may have to other employer-sponsored health coverage.

Catastrophic Plans are available for individuals under the age 30. These policies have lower premiums but require you to pay all medical costs up to certain amount. 

 


 

Need Assistance?

Department of Insurance and Financial Services (DIFS)

Michigan's Department of Insurance and Financial Services (DIFS) are providing free ACA Workshops at many libraries throughout the state. The workshop is titled The New Health Care Law: What it Means for Everyone. Contact the individual library to register for this event.

 

Navigators

Certified health insurance Navigators will provide in-person assistance to individuals. Navigators, trained by the federal government, are groups of people from organizations that received federal grants to provide this service.

prescriptionThe Navigator recipients in Michigan:

 

Certified Application Counselors

Certified application counselors will provide assistance in completing the application for coverage. Groups include community health centers or other health care providers, hospitals, or social service agencies.

 

Agents and Brokers

Professional advice from agents and brokers to educate individuals and help determine eligibility, compare plans, and select and enroll in coverage. Agents and brokers can also assist qualified employers and employers to enroll in coverage through the Small Business Health Options Programs (SHOPs).

More information about assistance roles

 


 

Small Business Health Options Programs (SHOPs)

SHOP simplifies the process of buying health insurance for small businesses, those with less than 50 FTE’s (Full-time Equivalent Employees). A full-time employee is one which is expected and scheduled to work a minimum of 30 hours per week. Employers can control the coverage they offer and how much they will pay toward an employees’ premium. Health plans available through SHOP are run by private health insurance companies. All plans will offer the same set of essential health benefits, like doctor visits, preventive care, hospitalization, and prescriptions.

Small businesses do not have to purchase health insurance from the SHOP but rather continue purchasing insurance through another insurance provider. By purchasing insurance through the SHOP employers may be eligible for the Small Business Healthcare Tax Credit if the employer has fewer than 25 FTEs  making an average of about $50,000 a year or less. To receive the credit employers must also pay at least 50% of full-time employees’ premium costs.

The Health Insurance Marketplace Small Employer call center provide a customer service representative to answer questions Monday through Friday, 9 a.m. to 5 p.m. EST. at 1-800-706-7893 or (TTY: 1-800-706-7915).

 

Printable Fact Sheets From HealthCare.gov

 


 

ACA Glossary

For a glossary of terms you will encounter when applying and selecting health care coverage check out these sites:

Kaiser Family Foundation

Kaiser Permanente

 


 

Helpful Websites

help

Getting help in a language other than English

Healthcare.gov YouTube channel

Health Law fact sheet at AARP

Tax Provisions at the IRS

Healthcare Reform Basics at Blue Cross Blue Shield of Michigan and Blue Care Network

Four step quick start guide at WebMD

Health Reform: 7 things you need to know now at Consumer Reports

Medicare: 6 things you need to know now at Consumer Reports

ACA Fact Sheets at U.S. Department of Health & Human Services

Health Insurance Consumer Assistance Program (HICAP)

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