The Affordable Care Act

by Katherine A. Taylor, Esq.

You have undoubtedly heard about the new Affordable Care Act (ACA) and the Health Insurance Marketplace that opened on October 1, 2013.  But many of us are still trying to understand the new health insurance options available through the Marketplace, and, more importantly, how the ACA will affect us and our loved ones.  Whether you are exploring your health insurance options as an individual or for your small business, the following information will help get you started.

Affordable Care Act and Individuals

If you have job-based health insurance you like, then you will be able to keep your current plan, so long as the plan meets certain requirements imposed by the ACA.  If your employer does not provide health insurance, then you may need to obtain insurance through the Marketplace or from other sources, such as private health insurance plans, TriCare, Medicare, Medicaid, or the United States Department of Veterans Affairs.  If you don’t have coverage in 2014, then you may have to pay a financial penalty in the form of a tax.

Virginia is using the Federal Marketplace, available at HealthCare.gov.  In the Marketplace, you may compare your options and enroll in coverage.

It is important to note that if you have Medicare, then you’re already covered and don’t need to make any changes.

Affordable Care Act Offers New Insurance Options for Small Business Employers

The Marketplace offers new coverage options and, in many cases, savings on premium costs not only for individuals, but for small employers as well.  The Small Business Health Options Program—SHOP—gives small employers a choice of quality, brand name insurance plans.  In addition, it gives employers the ability to compare plans side-by-side so that they can choose and enroll in the one that works best for their budget, their business, and their employees.

There is no requirement under the new health care law for employers with fewer than 50 employees to offer health insurance, nor is there any penalty for those small employers who do not offer employee health insurance.  Instead, the law offers small employers a range of new options, tools, and protections, and for many, tax credits to help those who would like to or already offer employee health coverage.  These new options, tools, and protections address many of the obstacles that have traditionally made it difficult for these employers to offer employee health benefits.  Small employers have historically had to contend with few choices, high administrative costs, and premiums that skyrocket when an employee has a pre-existing health condition, or gets sick or injured.

Starting in 2014, insurance companies can no longer sell coverage that charges higher rates or limits benefits to individuals based on a pre-existing health condition or the individual’s health status.  For small employers, this means that insurers can’t sell coverage to the business that comes with higher premiums just because an employee has a pre-existing condition, or because an employee gets sick or injured.

Small employers who buy insurance through the SHOP Marketplace may also qualify for a tax credit worth up to 50 percent of the employer’s premium costs (up to 35 percent for tax-exempt employers).  More information on the SHOP Marketplace is available at HealthCare.gov.

Questions?

Enroll Virginia is a nonpartisan, community-based effort to educate Virginians about the new health insurance marketplace and provide free, unbiased assistance with the new application and enrollment process.  For assistance with the Individual Marketplace or SHOP Marketplace in Southside Hampton Roads, please contact:

Katherine Taylor, Esq.
Certified Navigator with Enroll Virginia
125 St. Paul’s Boulevard, Suite 400
Norfolk, VA 23510
757-627-3362
katherinet@enroll-virginia.com
www.enroll-virginia.com