The Patient Protection and Affordable Care Act (PPACA), which is generally referred to as the ACA with no doubt changed the way Americans access and purchase their health insurance more than any other legislation ever passed by congress. For the first time ever having a ‘Qualified Health Insurance’ policy as defined by the ACA is a requirement or individuals face the ‘Individual Mandate’ penalty. For 2016 the penalty is the greater of a percentage of the tax households income – or a per person penalty. The per person penalty is $695.00 per uninsured Adult and/or $347.50 per uninsured Child up to a tax household maximum of $2,085.00.
So not only does it make sense to have health insurance to have access to quality care for you and your family – it is expensive not to have health insurance.
One of the main features of the Affordable Care Act is Subsidies or ‘Advance Premium Tax Credit’ (APTC) for those who qualify based on their income to assist paying for the coverage. Generally a subsidy is available up to 400% of the Federal Poverty Level based on the Tax Filing Household. In addition ‘Cost Sharing’ arrangements (reduced deductibles, co-pays, etc.) are also available in addition to the subsidy for those that qualify. At lower income levels you may qualify for Medicaide depending on your state of residence and/or your children may qualify for the Children’s Health Insurance Program (CHIP).
Subsidies are not available to those that have ‘Affordable and Essential’ coverage offered through their employer, rather you participate in the plan or not. There are other rules which should be reviewed in full by those that feel they qualify.
The following is a chart showing the income levels that could qualify for a subsidy for the 2016-2017 plan years.
Tax Filing Household Size
Tax Filing Household Annual Income
For each additional person, add
You can also use the subsidy calculator on the Kaiser Foundation website to estimate your Subsidy amount by clicking here
How you buy your individual health insurance will depend on the state you live in. Some states set up Health Insurance Exchanges or Marketplaces – other states did not. Resident’s of states that elected not to set up exchanges default to the Federal Exchange at www.healthcare.gov
Residents of Maryland do NOT have to use the Exchange and can acquire their coverage ‘Off Exchange’. The same plans and pricing are offered on – or off Exchange. However if after using the subsidy estimator above you feel that you qualify for a Subsidy you must use the Exchange to process a subsidy. If you do not qualify for a subsidy many people feel it is easier to purchase their coverage ‘Off Exchange’. Please visit the Maryland Residents page for more information.
Residents of the District of Columbia are required to use the Exchange rather they feel they qualify for a Subsidy or not. Please visit the DC Residents page for more information.
Residents of Virginia like residents of Maryland are not required to use the Exchange unless they want to qualify for a Subsidy and/or cost sharing. Please visit the VA Residents page for more information.
Many of the people that we work with who purchase Individual Health insurance coverage are self-employed. Self-Employed individuals may be able to deduct a portion or all the premiums they pay for tax purposes. Therefore we will work with you to be sure you are getting every possible deduction and paying premiums as efficiently as possible.
In addition so that you do not have to spend your valuable time on hold waiting for a ‘Call Center’ representative after your enrollment – we provide you with professional customer service and support by assisting you with claims issues, billing and administrative questions. Please contact our office today in order to get the information you need for you and your family to make the best decision for your health care in the next plan year.
At Kelley Insurance & Financial we are authorized and credentialed to work with you on or off the Exchanges. We are your premiere source for all your health insurance needs – we make it easy to shop for, select and enroll in the health insurance plan of your choice.
Please contact us or click here for a personalized quote and see how easy the process can be.