-
What are the $ amounts for the individual mandate penalties?
- penalties are annual but prorated for months without coverage
- <18yo = 1/2 penalty amount
- family cap = 300% of flat rate penalty
- 2014: $95 or 1% income difference
- 2015: $325 or 2% income difference
- 2016: $695 or 2.5% income difference
- +2016: penalty pegged to inflation
- (income difference = income - tax threshold)
-
Who is excluded from the individual mandate?
- people with religious conscience exemption (certain faiths only)
- incarcerated individuals
- undocumented aliens
- people who cannot afford coverage
- (i.e. required contribution exceeds 8% of household income)
- people with <3mo coverage gap
- hardship situations (defined by Secretary of Dept. of Health and Human Services)
- people with income below the tax filing threshold (<$10,000 in 2014)
- members of Indian tribes
-
What is included under "minimum essential coverage"?
- government programs: Medicaid, Medicare, CHIP, TRICARE, VA coverage, Peace Corp Healthcare
- employer-sponsored plans: governmental plans, grandfathered plans, other plans offered in small or large group market
- individual market plans (including grandfathered plans)
- other plans designated by HHS and/or Dept. of Treasury
-
What are some aspects of the ACA that are intended to assist low income individuals with the cost of healthcare?
- premium credits
- cost-sharing subsidies
- (must be enrolled in a health benefits plan purchased through an Exchange)
-
Who qualifies for the "Premium Credit"?
- (must be enrolled in a health benefits plan purchased through an Exchange)
- people with incomes up to 400% of the Federal Poverty Level
- excluding: illegal immigrants, individuals eligible for employer-sponsored coverage, Medicare pts, Medicaid pts, CHIP pts, TRICARE pts, or VA pts
- *ppl who are eligible for employer-sponsored coverage may apply when their employer coverage is <60% actuarial value or if premiums >9.5% of their income
-
How much is the "Premium Credit"?
- it is equal to the LESSER of:
- total monthly premium for taxpayer and any covered dependents
- OR
- the amount by which the adjusted monthly premium for the second lowest "Silver" plan purchased through the Exchange exceeds a defined percentage of household income (sliding scale based on FPL ranging from 2% to 9.5% of income)
- premium credit is determined in advance based upon taxpayers' last tax return
- (premium is adjusted based on age)
-
Who qualifies for the "Cost-sharing Subsidy"?
ppl enrolled in a "Silver" plan through the Exchange
-
What are the out-of-pocket limits?
- individuals: $5,950
- families: $11,900
- cost-sharing subsidies reduce the limits
-
What is the amount of the cost-sharing subsidy?
- it's based upon a sliding scale depending on Federal Poverty Limit (FPL)
- ranging from 1/3-2/3 out-of-pocket limit
|
|