Affordable Care Act: What Individuals and Families Need To Know

Regardless of the efforts of some misguided Tea Party members in Congress that have lead to our current government shutdown, the Patient Protection and Affordable Care Act continued its implementation process on October 1, 2013. Now, I don’t want this post to be negative, so I won’t let my personal political views get in the way:

Most of the information below comes directly from the website, so be sure to check the site for more detailed information.

Here’s what you need to know:

Individuals & Families –

If you have job-based health insurance you like, you can keep it. You’re considered covered. You may be able to change to Marketplace coverage if you want to.
Any job-based health plan you currently have qualifies as minimum essential coverage. You don’t need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. If you’d like to explore Marketplace coverage options you can, but there are several important things to consider.
Comparing job-based and Marketplace plans
With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

Qualifying for Marketplace savings

If you decide to check out Marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.
Whether you qualify will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won’t be able to get lower costs on premiums or out-of-pocket costs in the Marketplace. This is true no matter what your income and family size are.
Your employer can tell you whether the insurance plan it offers meets minimum value and can provide you with information to determine if the plan is considered affordable to you.
If you do not qualify for lower costs in the Marketplace, and your employer does not pay part of your premiums on the Marketplace, be sure you take these things into account before you consider choosing a plan other than your employer’s.
When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size.

Pay lower costs for premiums each month

In the Health Insurance Marketplace you may be able to lower the costs of your health insurance coverage by paying lower monthly premiums. You’ll see the amount of savings you’re eligible for when you fill out your Marketplace application. Prices shown for insurance plans will reflect the lower costs.
These lower costs are handled with a tax credit called the Advance Premium Tax Credit. But these tax credits can be applied directly to your monthly premiums, so you get the lower costs immediately.

Savings depends on income and family size

The amount you save depends on your family size and how much money your family earns. In general, if your income falls within the following ranges you’ll qualify to save money on your premiums in 2014. The lower your income within these ranges, the more you’ll save. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)
• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8
If your income falls below the amounts shown, you may qualify for coverage under your state’s Medicaid program. But if your state is not expanding Medicaid in 2014–and you don’t qualify for Medicaid under your state’s rules–you can’t get lower costs on Marketplace coverage based on your income. You’d have to pay the entire cost of a Marketplace insurance plan.

When you get coverage through the Marketplace, the Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care. This savings is based on your income and family size.

Out-of-pocket costs savings depend on your income

Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. (Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014. Amounts are different for each family size, up to 8.)
• Up to $28,725 for individuals
• Up to $38,775 for a family of 2
• Up to $48,825 for a family of 3
• Up to $58,875 for a family of 4
• Up to $68,925 for a family of 5
• Up to $78,975 for a family of 6
• Up to $89,025 for a family of 7
• Up to $99,075 for a family of 8
When you apply for coverage in the Marketplace, you’ll learn if you’re eligible for these savings on out-of-pocket costs.

Out-of-pocket savings apply only to Silver plans

Plans in the Marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much of your medical costs you pay and how much the plan pays when you get medical care. They are not based on plan quality.

If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. If you qualify for these savings, you’ll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you’ll get the out-of-pocket savings only if you enroll in a Silver plan.
You’ll be able to choose your plan category when you fill out your Marketplace application.

Your rights, protections, and benefits

The health care law provides important new rights, strong consumer protections, and key benefits that apply to most job-based insurance plans. You can learn more about your rights and protections, free preventative benefits, and more directly on the website.


Categories: Workplace Legislation


1 reply


  1. Affordable Care Act: What Employers Need To Know | Ernie's HR Project

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