Healthcare Reform 101

WHAT IS THE INDIVIDUAL MANDATE?

The Patient Protection and Affordable Care Act (PPACA) requires all non-exempt Americans to have minimum essential health insurance coverage in 2014. Individual insurance will be sold on "marketplaces" (formerly called Exchanges). Alaska has defaulted to the Federally Facilitated Marketplace (FFM). Policies can also be sold off of the FFM in private marketplaces, but premium assistance will only be available on the FFM. Failure to obtain and maintain coverage results in a tax penalty. For a family of four in 2016, the tax will be the greater of 2.5% of the household''s income over the filing threshold or $2,085. This penalty is set to increase each year.

HOW IS THIS HEALTH INSURANCE COVERAGE DIFFERENT?

Health insurance coverage starting in 2014 will differ in many ways from what ued to be available in the market. These changes will greatly increase the accessibility and quality of coverage for many individuals.

  • Guaranteed acceptance (no denials of coverage due to medical history)
  • No rate adjustments for claims history
  • No pre-existing condition exclusions
  • No annual or lifetime dollar caps on a package of "Essential Health Benefits"
  • New benefits offered in the individual markets (i.e. maternity & mental health coverage and the removal of dollar-based maximums on many services)
DO I QUALIFY FOR A FEDERAL SUBSIDY?

The FFM, besides being a place to window shop and compare plans and pricing, is the only marketplace to see if you are eligible for lower premiums through immediate tax credits (or subsidies). This is where the law''s affordability component comes into play. Individuals with household incomes between 100%-400% of Federal Poverty Level will be eligible for premium assistance via the subsidy. Individuals with household incomes outside of these ranges will not receive a tax credit and will pay the full cost of coverage on the marketplaces. Some individuals will also receive help with their deductibles and copayments. Individuals that may not have been able afford health insurance in the past, may see plans that are affordable in the new marketplace.

If your circumstances make you ineligible for the subsidy, then you could look at options available in the private marketplace, as well. For coverage in the private marketplace, you will have access to a wider range of insurance carriers and plans.Individuals will pay the full cost of the plan premiums.

WHERE CAN I FIND COVERAGE?

Enroll Alaska is staffed year-round with licensed professionals waiting to assist you in-peron at our Anchorage location or via phone statewide. Appointments are encouraged,but walk-ins are welcome during normal business hours. Clients without an appointment will be helped on a first come first serve basis. Online enrollment options are available by clicking here or by calling us to speak with an agent directly.

Phone: 907-770-5100 | Toll Free: 855-385-5550

WHAT IF MY EMPLOYER OFFERS COVERAGE?

If your employer offers coverage, and the cost to you for employee only enrollment is more than 9.5% of your total annual household income, this coverage is not considered affordable. This calculation does not include the cost to add a spouse and/or children. If your employer's plan is considered unaffordable, then you would qualify to shop in the Marketplace for health insurance coverage and potentially qualify for a subsidy based on your household size and income.

All employer health plans must meet the minimum value requiring the total cost of covered services to be at least 60%. If your employer sponsored health plan does not meet this requirement, you will be able to shop in the Marketplace for coverage and potentially qualify for a subsidy based on your household size and income. All plans offered in the Marketplace will meet the minimum value requirement.

WHAT IF I DON'T GET HEALTH INSURANCE COVERAGE DURING OPEN ENROLLMENT?

Individuals that do not apply for coverage during the designated enrollment period will need a qualifying life event to enroll in coverage at another time throughout the year, although some exceptions may apply. Open Enrollment for 2016 is scheduled to begin on November 1, 2015 and end January 31, 2016.

Examples of a qualifying event to enroll in the Marketplace outside of open enrollment may include but aren't limited to:

  • Getting married
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Losing other health coverage. Examples of losing coverage:
    • Losing job-based coverage for any reason, including resigning, getting laid off, or getting fired
    • Losing coverage through a divorce
    • COBRA coverage ending (but not cancelling it yourself before it expires)
    • Aging off a parent’s plan when you turn 26
    • Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
    • Note: Losing coverage that doesn’t qualify as minimum essential coverage doesn’t qualify you for a Special Enrollment Period.
  • Permanently moving outside your plan’s coverage area
  • Gaining citizenship or lawful presence in the U.S.
  • Gaining or continuing status as a member of an Indian tribe or an Alaska Native shareholder. Members of federally recognized Indian tribes and Alaska native shareholders can sign up for or change plans once per month throughout the year.
  • Leaving incarceration
  • For people already enrolled in Marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

Changes or additions cannot be made at any other times during the year, except during the open enrollment period or with a qualifying life event.