 What Is The Health Insurance Marketplace? | HealthCare.gov What Is The Health Insurance Marketplace? | HealthCare.gov

42% of Americans Unaware of the Act

 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 Bronze60% Silver70% Gold80% Platinum90%

 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.)IndividualFamily of 4 100%$11,850$24, %$47,400$97,800

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 Subsidy Calculator | The Henry J. Kaiser Family Foundation Subsidy Calculator | The Henry J. Kaiser Family Foundation

State Run Marketplace: State Run CaliforniaColoradoConnecticut District of ColHawaiiIdaho KentuckyMarylandMassachusetts MinnesotaNevadaNew Mexico New YorkOregonRhode Island UtahVermontWashington

 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

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