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. The Trump Tax plan did not eliminate the Individual Mandate penalty, however, it made the penalty amount $0 beginning with the 2019 plan year.
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 for assistance. Generally, a subsidy is available up to 400% of the Federal Poverty Level based on the Tax Filing status of the Household. ‘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 Medicaid 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, whether you participate in the plan or not. There are other rules which should be reviewed in full by those that feel they qualify.
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. Residents of states that elected not to set up exchanges default to the Federal Exchange at www.healthcare.gov
Residents of the DC Metro area could be located in Maryland, the District of Columbia, or Virginia. The State of Maryland and the District of Columbia did set up Exchanges – however, Virginia did not.
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 DC Health Link (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 we work with that purchase Individual Health insurance 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 your 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, billing, and administrative issues and questions. Please contact our office today in order to get the information you need for you and your family in order to make the best decision for your health insurance.
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 health insurance understandable and easy to shop for – select and enroll in the health insurance plan of your choice.