what is the health insurance marketplace? | healthcare.gov what is the health insurance marketplace?...
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What Is The Health Insurance Marketplace? | HealthCare.gov
ACA – An Overview
Key Features in Place: 2010 – 2013
◦ Prohibit denying coverage of children based on pre-existing conditions up to age 19
◦ Eliminate Annual Lifetime Limits on coverage◦ Seniors who hit the Medicare Prescription Donut
Hole - $250 Rebate check◦ Free Preventive Check-ups◦ Extended coverage for young adults up to age 26.◦ 85% of every health insurance dollar must be
spent on health care and improving quality
Upcoming Key Features:
◦ Prohibit discrimination due to pre-existing conditions or gender
◦ Ensure coverage for individuals participating in clinical trials
◦ Affordability: Tax credits for people with income between 100% and 400% of the poverty line
Upcoming Key Features (Cont’d):
◦ Minimum Essential Coverage (MEC)◦ Affordability: Employee’s cost cannot exceed 9.5%
of his/her annual household income (W-2 income)
Coverage:
◦ *AV is the share of health care expenses a “qualified health plan” covers for a typical group of enrollees.
Coverage Level *Actuarial Value
Bronze 60%
Silver 70%
Gold 80%
Platinum 90%
Premium Tax Credit (PTC):
◦ Individuals with household income between 100% of FPL and 400% FPL receive a PTC to purchase Marketplace coverage.
Housing Allowance Excluded
FPL 2014 (est.)
Individual Family of 4
100% $11,850 $24,450
400% $47,400 $97,800
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RCA Ministers DistributionActual Data
Percentage of Poverty
100% 133.01% 150% 200% 250% 300%Above 400%
below 100%
Total headcount
Total Average
basePersons in
Family headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base1 1 17,241 5 31,992 11 40,679 4 56,839 1 7,513 22 39,0702 1 15,699 2 21,655 5 28,000 8 36,053 37 42,686 37 51,380 13 68,438 3 9,693 106 46,1003 3 21,545 1 27,397 8 36,343 16 44,120 4 51,984 5 65,500 2 15,645 39 42,4474 4 26,102 3 34,416 22 41,105 10 51,536 7 63,627 1 88,306 1 166,464 5 14,211 53 45,2555 4 34,679 10 40,139 20 47,204 6 62,248 6 16,625 46 42,5536 7 39,440 7 44,977 8 51,013 3 24,349 25 42,8837 1 46,957 1 46,9578 1 45,106 1 55,000 2 50,053
Grand Total 21 32,933 24 39,383 64 42,257 40 47,080 53 45,145 54 51,191 18 71,306 20 15,587 294 44,138
9
RCA Ministers DistributionActual Data
Percentage of Poverty
100% 133.01% 150% 200% 250% 300%Above 400%
below 100%
Total headcount
Total Average
basePersons in
Family headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base headcountAverage
base1 1 17,241 5 31,992 11 40,679 4 56,839 1 7,513 22 39,0702 1 15,699 2 21,655 5 28,000 8 36,053 37 42,686 37 51,380 13 68,438 3 9,693 106 46,1003 3 21,545 1 27,397 8 36,343 16 44,120 4 51,984 5 65,500 2 15,645 39 42,4474 4 26,102 3 34,416 22 41,105 10 51,536 7 63,627 1 88,306 1 166,464 5 14,211 53 45,2555 4 34,679 10 40,139 20 47,204 6 62,248 6 16,625 46 42,5536 7 39,440 7 44,977 8 51,013 3 24,349 25 42,8837 1 46,957 1 46,9578 1 45,106 1 55,000 2 50,053
Grand Total 21 32,933 24 39,383 64 42,257 40 47,080 53 45,145 54 51,191 18 71,306 20 15,587 294 44,138
Subsidy Calculator | The Henry J. Kaiser Family Foundation
ACA2014 Federal Poverty Guidelines
State Run Marketplace:
State Run
California Colorado Connecticut
District of Col Hawaii Idaho
Kentucky Maryland Massachusetts
Minnesota Nevada New Mexico
New York Oregon Rhode Island
Utah Vermont Washington
Individual Mandate:
◦ Beginning in 2014, penalty applies to individuals: Who have income above amount required for filing tax
return Who do not maintain Minimum Essential Coverage
◦ Penalty 2014: greater of $95 or 1% of income 2015: greater of $395 or 2% of income 2016: greater of $695 or 2.5% of income
For family, penalty capped at 300% of individual rate
Enrollment:
◦ October 1, 2013 – March 31, 2014◦ Enroll individually or through a Navigator◦ Benefits are effective January 1, 2014