Guide to the Affordable Care Act
Beginning in 2014, “The Affordable Care Act” includes a mandate for most individuals to have health insurance or potentially pay a penalty for noncompliance. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some individuals will be exempt from the mandate or the penalty, while others may be given financial assistance to help them pay for the cost of health insurance.
A Set of New Rules for Health Insurance starting in 2014
Guaranteed Issue: Health plans must sell coverage to everyone, regardless of pre-existing conditions, and can’t change more based on health or gender.
Health Insurance Marketplaces: By Oct. 1, 2013, North Carolina will have an insurance exchange, an organized marketplace where small business owners and individuals can select from among all the qualified private health plans available in their area.
All plans must design their cost-sharing (deductibles, co-pays, and coinsurance) to fit into specific levels of coverage. The levels of coverage are defined as follows:
- Bronze Level-The plan must cover 60% of expected costs for the average individual
- Silver Level- The plan must cover 70% of expected costs for the average individual
- Gold Level- The plan must cover 80% of expected costs for the average individual
- Platinum Level- The plan must cover 90% of expected costs for the average individual
The exchange will group coverage by these “metal” levels, allowing consumers to easily compare comparable options.
Penalty: If you don’t have health insurance you’ll have to pay a tax penalty, from $95 per individual, $285 per family, or 1% of income, which will be greater for 2014 (that rises to $695 per individual, $2,085 per family, or 2.5% of income in 2016.
Individual Subsidies: If you buy on our state marketplace as an individual, you may qualify for a subsidy if your household income is between 100% and 400% of the federal poverty level the subsidy will be a new kind of tax credit that you can use right away to lower your premium costs.
- Modified Adjusted Gross Income under the Affordable Care Act (PDF) from Center for Labor Research and Education, University of California, Berkeley.
Household Income Eligibility Range
(Advanced Premium Tax Credits for Individuals)
|Family Size||100% FPL||400% FPL|
Individual Mandate: Everyone will be required to have health insurance or pay a penalty. Almost any sort of legitimate coverage will satisfy the mandate private insurance obtained on your own or through a job, Medicare, Medicaid, Chip, Veterans, Affairs, the Indian Health Service, or Tricare
Medicaid Expansion: The health care law was intended to expand the government-run health program for low-income Americans to cover up to 16 million more people with household incomes up to 133% of the poverty line. ($14,856 for an individual and $30,657 for a family of four).
Grandfathered Plans: The Affordable Care Act exempts most plans that existed on March 23, 2010, (the day the law was enacted from some of the law’s consumer protections).This preserves consumers’ rights to keep the coverage they already had before health reform.
If you have health coverage from a plan that existed on March 23, 2010, (and that has covered at least one person continuously from that day forward your plan may be considered a “grandfather” plan). A grandfathered health plan isn’t required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered.
However some plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers. If your plan loses its grandfathered status, all of the Affordable Care Act consumer protections would apply to you when your plan begins a new plan year or policy year.