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The Affordable Care Act and What You Need to Know

For a more detailed analysis of your Medicare or Social Security benefits please click here to be redirected to our Financial Services Department website.

Here is a short list of things that everyone needs to understand about the Affordable Care Act.  Because of the problems with the government website we have summarized some of the material for our clients below:

1.     Everyone will be required to have health insurance in 2014.

2.     You buy health insurance from an Agent, on or via phone call 800-318-2596

3.     Open Enrollment is from October 1, 2013 until March 31, 2014. 

4.     You can only buy coverage during open enrollment.   Unless you have a qualified event, like lose coverage you had, lose your job etc..

5.     Penalty in 2014 for no coverage is $95 or 1% of your income whichever is greater.  It will be deducted from any tax return or added to any federal tax bill.   The penalty grows each year; max penalty will be $650 in 2014.

6.     Individuals and Families can qualify for subsidies.  If you qualify the Federal government will pay a part of your premium directly to the insurance carrier, thus lowering the premiums you pay.  Individuals can go to or to see what subsidies they qualify for

7.  If you
have health insurance now it will change at renewal to an ACA compliant product.   About 60 days from your policies renewal your health insurance carrier will send you a letter telling what your options and the related costs will be.

8.      To get quotes on the new ACA compliant health insurance rates you can speak to your agent or goto

9.      If you have group coverage through your employer, you do not have to do anything.  The product and price will change when the group policy renews in 2014.  Your employer will tell you more.

10.  You can apply for Medicaid and CHIP any time  The Marketplace will tell you whether you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). If you qualify for Medicaid or CHIP, your coverage can begin immediately. You can also apply for either of these programs right now. Follow the the links above to learn more.

            Small employers can start SHOP coverage any time  Small employers generally may start offering health insurance coverage to their employees through the       
                     SHOP Marketplace
at any time during the year.

Health Insurance Plan Basics:

1.       5 categories of Marketplace insurance plans


When you compare Marketplace insurance plans, they're put into 5 categories based on how you and the plan can expect to share the costs of care:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic

All Marketplace insurance plan categories offer the same set of essential health benefits. The categories do not reflect the quality or amount of care the plans provide.

Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.  Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace. States expanding their Medicaid programs must provide these benefits to people newly eligible for Medicaid.

The category you choose affects how much your premium costs each month and what portion of the bill you pay for things like hospital visits or prescription medications. It also affects your total out-of-pocket costs —the total amount you’ll spend for the year if you need lots of care.

The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Note: Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness -- are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay. Learn more about catastrophic plans.

If you buy a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or out-of-pocket costs based on your income. Regardless of your income, you pay the standard price for the catastrophic plan.


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