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About the Affordable Care Act (ACA)
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA). The provisions contained within the ACA reforms the entire healthcare industry. By January 1, 2014, the healthcare industry will be entirely reshaped and the healthcare system as we know it today will no longer exist.
Key ACA Provisions Taking Effect in 2014
- Individual mandate that all U.S. legal residents get health insurance
- Elimination of pre-existing condition restrictions for all
- Premium subsidies for people between the 133% and 400% of the federal poverty level
- Operation of health benefit exchanges in each state
About Health Insurance Exchanges
Each state will have a health insurance exchange by January 2014 where individuals and small businesses can buy health insurance. Health plan designs will be standardized, as well as plan description terminology, to make it possible for apples-to-apples comparisons. The state health insurance exchange will be the only place that health insurance applicants can qualify for federal premium subsidies, called advanced tax credits, but paid directly from the feds to the insurance carriers. Because of these subsidies, the state exchange will become the primary marketplace for individual health insurance.
HealthcareShopper Adds Value
HealthcareShopper provides guidance in selecting health care coverage through the exchange with the help of a licensed health insurance agent. We will make it easy for consumers to check their eligibility for premium subsidies conduct health insurance comparisons among the qualified health plans offered through the Exchange or in the open marketplace.
Premium Subsidies
The premium subsidy reduces the amount that an individual or family pays for health insurance coverage by providing an advance tax credit. These subsidies are only available through your state Exchange. Subsidies are determined on a sliding scale, based on income, so that individuals at the lower end of the income scale get the most help.
Standardized Benefit Plans
Standardization lets consumers shop from one insurance company to the next knowing the benefits are the same and there will be no surprises or tricks. Exchanges are leading the way for consumers to make “apples to apples” comparisons when choosing health coverage.
Enrollment Begins October 1, 2013
Covered California will be the primary individual health insurance marketplace in California starting October 1st. Consumers will have new online tools to compare affordable coverage. Low-income individuals and families will be able to qualify for free health insurance through Medi-Cal and moderate-income families will qualify for premium subsidies to help make private health coverage affordable.
Applying for Coverage
A consumer may begin the initial contact to their state exchange through any one of many doors: online, by phone, or with an licensed agent (such as ourselves). While some applicants will complete an online application, most consumers will need help. Please call one of our call center representatives. The CCR will conduct a “quick sort” interview to establish family size and income level. If the consumer’s income makes them eligible for free public health care through Medicaid, we can get them started on the process of applying.
Verifying Income
Income information can be complex and this part of the Exchange application process is important. The Exchange incorporates electronic verification direct from the federal hub. The income data from the customer’s last federal income tax return is available to the online applicant or the CCR. The CCR can use this IRS data to help determine the customer’s estimated income for the year, but the customer can override the income tax data if there have been significant changes in his or her income for the current year. The system will accept the self-reported income and if it qualifies the applicant for a subsidy, the applicant will have 90 days to verify the self-reported income.
Getting Subsidies
If the consumer is eligible for advanced tax-credits to help pay their premiums, they will next be asked whether they receive or could receive “affordable” employer-sponsored group health insurance through their employment. If not, the customer is on the path to receive advance payments of the premium subsidy, Once the customer’s application is submitted, they receive congratulations, a list of programs for which they qualify and what the next steps are. With the application process complete, customers can enroll in a exchange qualified health plan and apply their tax credit right away.
Selecting a Benefit Plan
Shopping for health insurance coverage will also be esier for consumers because standardized benefit plans will make it easier to make side-by-side comparisons of plans. Health insurance companies will have to accept all applicants regardless of preexisting health conditions, opening access to many new applicants.