The Affordable Care Act (ACA) FAQ

The Affordable Care Act
Frequently Asked Questions

What is the difference between the Affordable Care Act (ACA) and ‘Obamacare”?

The official name for “ObamaCare” is the Patient Protection and Affordable Care Act (PPACA). It is also commonly referred to as ObamaCare, health care reform and the Affordable Care Act (ACA).

When does my coverage begin?

Individuals who have enrolled and paid their first premium by December 15, 20-13 will have coverage starting on January 1, 2014. After December 15, 2013, coverage purchased before the 15th of each month will begin on the 1st of the next month. Coverage purchased after the 15th of each month will start the 1st on the following month.

What is the Marketplace?

The Marketplace is way to find apply for and get health coverage that best fits consumers’ needs and budgets. Depending on consumers’ income level, health coverage through the Marketplace may be available at a reduced cost.

When can I enroll in insurance in the Marketplace?

Open Enrollment in Your State’s marketplace is from Oct 1st, 2013 and closes March 31st, 2014. Coverage purchased through the marketplace before December 15th start January 1st, 2014.

What if I can not afford insurance?

Americans making less than $45,960 as an individual or $94,200 as a family of 4 may be eligible for free or low-cost health insurance due to cost assistance subsidies for reduced premiums, co-pays, coinsurance and deductibles in 2014.

What are some of the benefits of The ACA?

The Affordable Care Act offers a number of new benefits, rights and protections. These include provisions that let young adults stay on their plan until 26. The ACA also eliminates exclusion from the ability to acquire insurance due to a preexisting condition. Insurance providers cannot drop a person if you make an honest mistake on your application. There are measures to prevent against gender discrimination and it does away with life-time and annual limits. The ACA also gives you the right to a rapid appeal of insurance company decisions. The ACA also requires essential health benefits be included in all plans available in the Marketplace including preventive services such as yearly check-ups, immunizations, counseling, and screenings must be included on all non-grandfathered plans at no out-of-pocket costs.

Who can buy coverage in the Marketplace?

Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated. Not everybody who is eligible to purchase coverage in the Marketplace will be eligible for subsidies, however. To qualify for subsidies people will have to meet additional requirements having to do with their income and their eligibility for other coverage.

What employers are eligible for the Small Business Health Options Program (SHOP)?

The Small Business Health Options Program (SHOP) Marketplace helps small businesses provide Health insurance for their employees. Enrollment in the SHOP marketplace is available to employers with 50 or less FTEs who offer insurance to all FTEs and contribute at least 50% to single coverage cost. Some employers are eligible to receive small business tax credits to help make offering cove3rage to their employees more affordable.

What is a Qualified Health Plan (QHP)?

A Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace and must meet certain requirements. These include that the insurance provider be licensed and in good standing with the state in which they are providing the insurance coverage. The plans offer must provide Essential Health Benefits. The insurance providers agree to charge the same premium rate for plans through the Marketplace as those on the open market. The insurance providers must also follow established limits on cost-sharing (like deductibles, co-payments, and out-of-pocket maximum amounts)

What are Essential Health Benefits (EHBs)?

Qualified Health Plans cover Essential Health Benefits which include at least these 10 categories:

1. Ambulatory patient services
2. Prescription drugs
3. Emergency services
4. Rehabilitative services
5. Hospitalizations
6. Laboratory services
7. Maternity and newborn care
8. Preventative and wellness services and chronic disease management
9. Mental health substance use disorder services including behavioral health treatment
10. Pediatric services, including oral and vision care (pediatric oral services may be provided by a standalone plan.

How many plans are available to those in South Carolina?

There are 52 plans, from four different Insurance Providers available to the individuals and families of South Carolina that can be purchased through the Marketplace. There are 12 plans available through the SHOP for small businesses to acquire for their employees.

How are the plans structured?

Plans are offered in four tiers of coverage.
 The levels of coverage base on Actuarial Values (AV) are as follows:
 Bronze level ‐is a health plan that has an AV of 60%.
 Silver level ‐is a health plan that has an AV of 70%. The second lowest cost silver plan is used for figuring the reductions in cost sharing and premium tax credits for eligible individuals.*
 Gold level ‐is a health plan that has an AV of 80%.
 Platinum level ‐is a health plan that has an AV of 90%.
 You must enroll in at least a silver plan to be eligible for tax credits and cost sharing

What is the Premium Tax Credit?

With most tax credits, you have to wait until you file your tax returns. The new health care tax credit is DIFFERENT. It can be credited immediately to your insurance premium and paid by the federal government to the insurance company so you pay less each month. Your eligibility for premium tax credits will be determined immediately by the Marketplace during the online application process. For those who mail in applications they will receive their eligibility back to them via mail in approximately two weeks. You can accept all, or part, of tax credit.

Who is eligible for a Premium Tax Credit?

Eligibility for premium tax credits is based on household income and family size for the year. Families with income between $23,550 and $94,200 for a family of 4 in 2013 or 100-400% of the Federal Poverty Level (FPL) will most likely be eligible for the premium tax credit. The tax credit amount depends on income as a percentage of the FPL and is based on a sliding scale. Having the premium tax credit offered in this manner limits the cost of premium payments for families and individuals, basing them on a percent of household income.

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