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ACA INFORMATION

Are There ACA/Obamacare Subsidies?

It is possible to qualify for premium tax credits, or subsidies, which help pay for your health insurance if your total Modified Adjusted Gross Income (or MAGI) is between 100% and 400% of the Federal Poverty Level (or FPL) and you meet these requirements:

  • You live in the U.S.
  • You are a U.S. citizen, U.S. national, or lawfully present in the U.S.
  • You are not currently incarcerated.
  • You are not eligible for other minimum essential coverage.

These subsidies are set on a sliding scale so that what you spend each month is limited to a defined percentage of your income, adjusted to the second least-expensive silver-level plan available in your area. In most cases, people who earn 400% or below the federal poverty level for their household size, are eligible for subsidies. Government subsidies can only be determined by the governing body in your area. The dollar value of your subsidies will depend in part on the cost of the benchmark Obamacare plan in your area.  If the benchmark plan costs more than a certain percentage of your estimated annual income, you can get a subsidy in the amount of the difference. You may then use that subsidy when you buy a qualified Obamacare health insurance plan. In order to calculate your Obamacare subsidy amount, the following variables are considered:

  • Your estimated household income for the year
  • The cost of plans in your area. ACA considers health insurance unaffordable when annual premiums for the lowest priced plan costs more than 8.16% of your modified adjusted gross income (MAGI).  

How Do the Subsidies Work?

Under the Affordable Care Act rules, to be eligible for a subsidy your income needs to fall within 100% and 400% of the federal poverty level – that’s approximately $12,000-$48,00 for an individual or $24,000-$98,000 for a family of four (Alaska and Hawaii have different thresholds). If you fall below these guidelines it’s possible you may qualify for Medicaid. Otherwise, it’s important to know there are other more affordable and limited coverage alternatives to the ACA; such options include short-term health insurance, accident, or what we at eHealth call medical insurance packages (these combine a number of different non-ACA products into one). These alternatives to the ACA aren’t eligible for government subsidies, don’t meet the coverage requirements for ACA plans, and don’t count as qualified health insurance if you’re subject to the ACA tax penalty, but these alternatives are also generally less expensive and may be a good fit for your budget and needs. We recommend speaking with a licensed agent to review the options available in your area, and help you in choosing the coverage that best meets your needs.

What About Pre-Existing Conditions?

Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

These rules went into effect for plan years beginning on or after January 1, 2014.

What This Means for You

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

One Exception: Grandfathered Plans

The pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies. A grandfathered individual health insurance policy is a policy that you bought for yourself or your family on or before March 23, 2010 that has not been changed in certain specific ways that reduce benefits or increase costs to consumers.

Pre-Existing Condition Insurance Plan (PCIP) Coverage

The Pre-existing Condition Insurance Plan (PCIP) ended on April 30, 2014.  The PCIP program provided health coverage options to individuals who were uninsured for at least six months, had a pre-existing condition, and had been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private insurance company. Now, thanks to the Affordable Care Act, health insurance plans can no longer deny anyone coverage for their pre-existing condition, and so PCIP enrollees can transition to a new plan outside of the PCIP program.  Learn more about your health insurance options at HealthCare.gov.

Can I Keep My Doctor?

To know if you can still see your doctor, you need to make sure if your doctor is covered by your Obamacare health plan.

In most cases, access to doctors will work much like it does today. Health insurance plans will contract with networks of doctors, specialists, and hospitals. As long as your doctor is contracted with your plan, there is no reason to believe that doctor will stop taking appointments.

However, it could take longer to see a doctor in person. In some areas, the number of people who have health insurance will increase significantly, but there may not be a correlative increase in the number of physicians and other care providers.

DISCLAIMER

HEALTH INSURANCE HELPERS IS SITE THAT CONNECTS YOU WITH LICENSED PHONE AGENTS WHO WILL SHARE EVERY TYPE OF HEALTH INSURANCE AVAILABLE TO YOU IN YOUR AREA, INCLUDING ACA/OBAMACARE, SHORT TERM HEALTH INSURANCE, AND HEALTH BENEFIT INDEMNITY INSURANCE (HBI). THE LATTER TWO ARE INSURANCE OUTSIDE OF THE AFFORDABLE CARE ACT (OBAMACARE). SHORT TERM HEALTH INSURANCE AND HBI DO NOT COVER PRE-EXISTING CONDITIONS AND DO NOT INCLUDE ALL TEN OF THE MINIMUM ESSENTIAL BENEFITS OF OBAMACARE. HBI INSURANCE IS DESIGNED TO PROVIDE ADDITIONAL BENEFITS TO SUPPLEMENT MAJOR MEDICAL INSURANCE. YOU MAY BE SUBJECT TO THE AFFORDABLE CARE ACT UNINSURED TAX (ELIMINATED BY THE CONGRESSIONAL TAX REFORM ACT STARTING IN 2019). IF THESE PRODUCTS ARE OF INTEREST TO YOU, PAY ATTENTION TO ALL OF THE DISCLAIMERS READ TO YOU BY THE AGENT PRIOR TO PURCHASE. YOU CAN LEARN MORE HERE.