Health Insurance Marketplace

The Affordable Care Act is a new federal law that requires all Americans to have health insurance.

The Marketplace is an internet-based system established by the ACA. It’s a new way to shop for quality health coverage and the only way to apply for health tax credits that can help reduce the monthly cost of premiums for qualified health plans.

Open Enrollment begins November 1, 2016 and ends January 31, 2017.

The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.

• U.S. Citizens
• Legal Immigrants lawfully present in the U.S.
• People not incarcerated
• People with pre-existing health conditions

If you already have coverage under one of the following, you do not need to apply: Medicare, Medicaid, CHIP, COBRA, TRICARE, Veterans Health Programs, job-based insurance, student health plans or private insurance. If you have insurance through your job, you may only qualify for a tax credit, if the plan costs more than 9.5% of your yearly salary or the plan doesn’t cover the 10 Essential Health Benefits.

Others that don’t need to apply are people without legal status, some Americans living abroad and non-tax filers. People on CareLink or other medical discount programs must get health insurance or get an exemption because these programs do not meet the federal requirement to have health insurance.

10 Essential Health Benefits

1. Outpatient services
2. Emergency services
3. Hospitalization
4. Maternity & New Born Care
5. Mental Health and Substance Abuse Services & Treatment for Behavioral Health
6. Prescription drugs
7. Rehabilitative Services & Devices
8. Lab tests
9. Preventive and wellness services & Chronic Disease Management
10. Pediatric Services (including dental & eye care for children)

Health Insurance companies can offer four types of plans that cover the same benefits at different percentages (Bronze-60%, Silver-70%, Gold-80% & Platinum-90%). Premium rates will vary based on income and family size, as well as the type of plan you choose.

People with incomes between 100% to 250% of the Federal Poverty Level will qualify for lower out-of-pocket costs but must select a Silver-level plan to receive these benefits.

You need to provide the following information for all the people reported in your income tax return:

• Names, birth dates & Social Security numbers
• Your family’s income information (tax return, W2, pay stubs, net income from self-employment, unemployment, Social Security benefits, retirement, pensions and any other taxable income)
• Proof of Legal Status (Permanent Resident card, Work or Student Visa, Citizenship Certificate, etc.)
• Employer name, address & phone number
• If job-based coverage is available, must provide cost of premiums & types of health benefits covered
• Email address that can be accessed via cell phone or computer

People who do not have health insurance in 2015 must pay a penalty when they file their tax return in 2016. The penalty fee will be 2% of their annual income or $325 per adult, $162.50 per child with a family maximum of $975 (whichever is higher).

There will be NO PENALTY for not having health coverage IF YOUR INCOME is below 100% of the Federal Poverty Level or if you receive an exemption.