Health insurance today has made significant changes since the introduction of the 2010 Patient Protection and Affordable Care Act, commonly referred to as "ACA", or "Obamacare". The most significant change is insurance must meet a minimum set of requirements, offer 10 essential health benefits to be considered creditable coverage, and be purchased during the open enrollment period (OEP) Nov 1st. - Dec. 15th for a Jan.1st effective date, with some exceptions. Prior to 2019 plan year, If an individual or family didn't have creditable coverage then they maybe subject to paying a shared responsibility tax payment unless the current plan their on is grandfathered, or they've been exempt from the insurance requirement, but beginning in 2019 there's no requirement to have health insurance, nor a tax penalty.
For an employer with 100 or more employee's affordable insurance must be provided otherwise they will be subject to an excise tax for each employee who purchases through an exchange and receive subsidies.
Kevin Oliver Insurance Agency, LLC
Small businesses with 50 or fewer full-time equivalent employee's can purchase health insurance through the Small Business Health Options (SHOP) marketplace. A tax credit is available for those small businesses that qualify and can receive the credit for up to two years. As with the individual marketplace, insurance companies plans offered must meet the minimum set of requirements, and offer the 10 essential health benefits to be considered creditable. An employer that offers health insurance and applies for a tax credit the company must meet the participation rules of 25 or fewer full time equivalent employee's, average wage's paid of $50,000 per FTE or less, and contribute at least 50% of the premiums. See Small Business Health Insurance Premium Tax Calculator.
Limited Medical Plans or "Gap" insurance are hospital indemnity plans for sickness or accident or a combination of both that pays you a lump sum for services like hospitalization, doctor's visits, or outpatient care, and be performed by a licensed doctor, practitioner, or hospital. These types of plans works well with high deductible health plans (HDHP), they will pay you directly, has simplified underwriting , and usually works with any other insurance.
To purchase creditable health insurance there's different options that can be taken, purchase on or off an exchange, an employer who offers it, government sponsored insurance, a union, or group. To purchase on an exchange there's state-based exchanges, or the federally facilitated exchange referred to as the Health Insurance Marketplace. The health insurance companies offering insurance through an exchange competes for your business. The categories of plans to choose are the same among companies, and have the same actuarial value among each category and that is, bronze (60/40), silver (70/30), gold (80/20), and platinum (90/10), in addition catastrophic plans are available for people under 30, have a hardship exemption, or fall below the federal poverty level (FPL), and usually pays after a very high deductible is met. Depending on your particular needs an on exchange plan maybe the best option, reason being you may qualify for an advanced premium tax credit (APTC) and cost sharing reduction (CSR) if your income falls between 100% - 400% of the federal poverty level (FPL), and to receive this benefit you must purchase an on exchange health plan. To see if you may qualify for these subsidies and the premium you'll pay click here. The Health Insurance Marketplace or state exchange will provide any final eligibility determinations in regards to subsidies. For off exchange health insurance contact us, for employer sponsored health insurance, unions, government sponsored, or groups check with their benefit administrator.
Short Term Medical insurance is also health insurance that is widely used for people that are in need of insurance for short periods of time usually 1 to 12 months. Starting 2019 your short term medical can be renewed for up to 3 years. Short term medical insurance doesn't meet the minimum requirements, nor the 10 essential health benefits. The benefits of short term medical are you can enroll anytime throughout the year, they're fairly inexpensive, if you're in between jobs and only need insurance for a short time, or a recent college grad and not on your parents insurance and looking for a job. I must say that in some cases a Special Enrollment Period maybe available to purchase via the Health Insurance Marketplace. Travel insurance is another type of short term medical, these plans are for people travelling outside of their home country for a few days to a few years.
Our agency offers on-exchange and off-exchange health insurance, as well as limited medical plans, small business health insurance, short term and travel insurance. To get more information about plans, rates, and availability contact us.