Questions about the Wilds of the Affordable Care Act

With another provision of the Affordable Care Act being implemented - new healthcare marketplaces, or “exchanges” are set to come online October 1st - we’ve been hearing many questions. For example...


Are families who can’t afford the employer provided health insurance eligible for subsidies through the new health insurance marketplace?

If your employer offers a health insurance plan, first look at what it covers. It must be a comprehensive plan that meets the essential benefit package.

If it's a comprehensive plan, look at what you're required to pay.  If the annual premium is more than 9.5% of what you report on tax forms as your income, the plan is considered “unaffordable.” If you are between 100-400% of the federal poverty level, you’ll be eligible for a premium subsidy if you buy a plan on your state's health insurance marketplace. Anyone can purchase insurance in the marketplace, but not everyone will qualify for a subsidy.


I got a check from my insurance company recently. Why?

Another way the Affordable Care Act seeks to lower costs is by making sure insurers aren’t padding their pockets or using a majority of your premium dollars for things that aren’t medical care. At least 80% of your premium dollar goes to actual medical care. It may not be your medical care, but that’s the nature of insurance. If the insurer charges too much and doesn’t meet this threshold, they are required to give every customer a rebate until they meet the rule.

Questions?  Email