We can help you understand your obligations under the complex laws of Healthcare Reform

The Affordable Care Act (the ACA) was passed and first implemented in 2010.  This extensive Healthcare legislation was originally intended to better our healthcare system, however with nearly 2,700 original pages of healthcare bill and over 41 amendments, the law is complex and many need help interpreting the ACA correctly.

Highlights of the Affordable Care Act

For your information, we have listed some (but certainly not all) of the highlights of the new law and how it may impact individuals under 65.  We strongly suggest you call our office at 213-383-4108 or fill out the contact form directly to the right for more assistance.

Our consultants are ACA ( Affordable Care Act) trained and certified, and continually work to stay abreast of industry laws and trends.

Individuals must now obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty.

The mandate:  In 2016 the penalty for non-compliance will be $695 for each adult family member, and $347.50 for each child, or 2.5% of household income, whichever is greater.

Employers who have 50 or more full-time equivalent employees must offer those employees and their families and dependents up to age 26, benefits that pay for 60% of the minimum essential benefits, as established by the ACA, or face a potential penalty.

The mandate:  Beginning in 2015, if you have 50 or more full-time equivalent employees who are not offered health coverage, and at least one employee receives a premium tax credit/cost sharing subsidy in the exchange, your tax penalty is $2,000 annually multiplied by the number of full-time employees (excluding the first 30 employees).   The penalty is increased each year by the growth in insurance premiums.

  • No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.
  • Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.
  • Gender is no longer a factor in determining rates.
  • Renewal rates are the same as new business rates.
  • Waiting period should not exceed 90 days.

To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase Insurance coverage that pays at least 60% of the costs of the following “essential benefits:”
-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management

Individuals and Businesses who purchase their health insurance through the new Health Insurance Marketplace (Covered California) and/or SHOP may be eligible for tax credits which are applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please use the appropriate calculator below.

Individuals under 65 seeking an individual health insurance policy must purchase their insurance during the new annual open enrollment period which runs each year from November 1st through January 31st.  Failure to purchase insurance during open enrollment may result in a tax penalty and having to wait until the next annual open enrollment to obtain health insurance.

However, there are some instances one may qualify to enroll for health insurance outside of the normal open enrollment period.  You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

  • change in legal marital status
  • a change in the number of dependants
  • a change in place of residence and the current carrier is not available
  • significant cost or coverage change
  • a change in coverage of a spouse or dependant
  • a COBRA qualifying event
  • legal judgements, decrees and orders
  • entitlement to Medicare or Medicaid

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