So many Americans are struggling to understand how the Affordable Care Act (ACA) works and applies to them. The reason being is that each individual’s situation is different. The family of four with a disabled child is not going to qualify for the same benefits as the unemployed single teacher. Those living above the 400% mark of the poverty line will get no financial assistance while many of those below it could receive some subsidies. Your income, your family size, even where you live must be considered when reviewing how the ACA is applied to you.
Liberty Tax has set up an informational website to answer many of the questions that we have received during our free ACA seminars. The website has example scenarios as well as a subsidy calculator. The calculator is user-friendly and can give you an idea of where you stand.
If you’re unemployed, you may qualify for the new expanded Medicaid program or lower costs for monthly health insurance premiums though the Marketplace. If you have applied for Medicaid before and have been denied, you may want to apply again because new rules take effect in many states beginning January 1, 2014.
You can fill out an application as early as October 1, 2013 at the Health Insurance Marketplace website to see what options will be available to you. You can apply for health insurance through the Marketplace during Open Enrollment, which runs from October 1, 2013, to March 31, 2014. You will not be able to enroll for coverage outside of open enrollment unless you have a qualifying life event such as you move to another state, your family size changes or your income changes. If you miss the open enrollment window you will not be able to gain coverage through the Marketplace until the next open enrollment in October 2014.
Here are a few key benefits of the ACA you need to be aware of:
- No one will be denied insurance based on pre-existing health conditions.
- Young adults can now remain insured through their parents' health insurance plan until the age of 26. The only exception is if the parent has an existing job-based plan (“grandfathered” plan) and the child can obtain their own job-based coverage.
- Insurers must cover preventive care (wellness visits, vision and hearing tests, and development screenings) without requiring co-payments, deductibles or co-insurance.
- Insurance companies cannot limit lifetime expenditures on the health plans they offer. Beginning in 2014, annual limits will no longer be allowed.
- For those in new health plans, individuals will have the right to appeal decisions through the plan’s internal process, and the right to appeal decisions made by their health plan to an outside, independent decision-maker, regardless of which state they live in or what type of health coverage they have.
Here is a breakdown of the insurance tiers the Marketplace will offer:
- Bronze: .......... Provides an essential health benefits package and covers 60% of the benefit costs of the plan with the consumer cost-sharing at 40%.
- Silver: ............. Provides an essential health benefits package and covers 70% of the benefit costs of the plan with the consumer cost-sharing at 30%.
- Gold: .............. Provides an essential health benefits package and covers 80% of the benefit costs of the plan with the consumer cost-sharing at 20%.
- Platinum: ...... Provides an essential health benefits package and covers 90% of the benefit costs of the plan with the consumer cost-sharing at 10%.
- Catastrophic: Provides coverage for those younger than 30 years old or those exempt from the individual mandate because affordable health care is not available or they have a hardship exemption.
If you are still confused, call Liberty Tax Service at 1-866-871-1040 to locate an office near you. Bring last year’s tax return to a local Liberty Tax office and find out how the ACA will impact you.