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What You Need To Know About The Affordable Care Act

The primary goal of the Affordable Care Act (ACA)  is to help millions of Americans obtain health insurance coverage.  To achieve that goal, the Affordable Care Act provides new coverage options, gives consumers the tools they need to make informed choices about their health care coverage, and puts in place strong consumer protections.

The Insurance Marketplace will play an integral role in helping COBRA Participants understand and act on the coverage choices that the Affordable Care Act offers through public and private Marketplaces. also provides participants with exclusive products which compliment health insurance; such as Core Health Insurance, Core Dental Insurance, and more.

You have to have Health Insurance in 2014 and forward

If you do not have health insurance (specifically a Qualified Health Plan – QHP) you will pay a tax penalty.  The penalty for 2014 is the greater of $95 or 1% of the household income reported on last year’s tax statement.  We encourage you to contact a representative to help you understand ACA, see if your existing plan qualifies, or access a new QHP.  The ACA also provides subsidies for many families and you may qualify.

Affordable Care Act Marketplace

A Marketplace (exchange) is a mechanism for organizing health insurance options to help consumers shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality.

The Affordable Care Act includes many provisions to make health insurance coverage more accessible and affordable. Key components of the Affordable Care Act that will affect you:

  • Health law changes
  • Major consumer protections

Health Law Changes in the Affordable Care Act

The health law changes include:

  • Creation of Public Marketplaces, through which individuals who do not have access to public assistance programs or affordable employer-sponsored coverage may compare and purchase plans. Some individuals will be eligible for financial assistance through premium tax credits (subsidies) and/or cost-sharing reductions
  • Expansion of Medicaid in some states to cover individuals under age 65 whose household incomes are less than 138% of the Federal Poverty Level (FPL)
  • Penalty Mandate: a requirement that requires individuals to maintain minimum essential coverage, qualify for an exemption from coverage, or make a payment when filing their federal income tax returns

Major Consumer Protections in the Affordable Care Act

The Affordable Care Act included many provisions designed to help ensure that consumers have access to effective health care coverage, and to limit their costs. Key provisions to understand include:

  • Extension of health insurance coverage to children up to age 26
  • Expansion of the “guaranteed issue” requirement to ensure that health insurance issuers offer group and individual market policies to any eligible individual in a state, regardless of health status
  • Prohibition on charging consumers a higher premium based on health status or gender
  • Elimination of annual and lifetime coverage limits
  • Prohibition on coverage limitations or exclusions based on pre-existing conditions
  • Prohibition on precluding a qualified individual’s participation in an approved clinical trial, or discriminating against that individual based on such participation
  • Introduction of an 80/20 MLR rule to ensure that at least 80 percent of the premium dollars paid to a health insurance issuer are spent on providing healthcare

Young Adult Coverage

Under the Affordable Care Act, health plans that cover children must make coverage available to children up to age 26. Young adults can join or remain on a parent’s plan even if they are:

  • Married (coverage does not extend to married child’s spouse)
  • Not living with a parent
  • Not attending school
  • Not financially dependent on a parent
  • Eligible to enroll in their employer’s plan (starting in 2014)

Guaranteed Issue and Guaranteed Renewability

The Affordable Care Act requires health insurance issuers to offer all of their individual market and group market plans to any applicant in the state. It also requires health insurance issuers to accept any individual who applies for those policies, as long as the applicant agrees to the terms and conditions of the policy, including the payment of premiums. This provision is called “guaranteed issue.”

Coverage offered through and outside the Marketplaces may restrict guaranteed issue coverage to certain enrollment periods.

Additionally, the Affordable Care Act requires health insurance issuers to offer to renew or continue in force coverage at the option of the policyholder. This is called “guaranteed renewability.”

Coverage of Pre-existing Health Conditions Regardless of Age

Effective for all health plans with plan years beginning on or after January 1, 2014, the Affordable Care Act prohibits health insurance issuers from limiting or excluding coverage related to pre-existing health conditions, regardless of the age of the covered individual. For persons under age 19, this provision became effective for policy years beginning on or after September 23, 2010.

Generally, a pre-existing condition is any health condition or illness that was present before the coverage effective date, regardless of whether medical advice or treatment was actually received or recommended.

Nondiscrimination Regarding Clinical Trial Participation

The Affordable Care Act prohibits health insurance issuers from:

  • Precluding participation of qualified individuals in an approved clinical trial
  • Denying, limiting, or placing additional conditions on the coverage of routine patient costs for items and services furnished in connection with participation in an approved clinical trial
  • Discriminating against qualified individuals on the basis of their participation in an approved clinical trial

We can help you understand and enroll in a health plan of your choice can aid in your purchase of health insurance in 2014 and beyond.   We are looking forward to helping you with your insurance needs.  You should contact for advice and/or direction navigating their options.  Products and insurance companies may be different per exchange.  We can provide options through private and/or public marketplaces (exchanges).

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