Who’s eligible for the health exchange? How to enroll?

September 24, 2013 

This is the second column on the new health care reforms under the Affordable Care Act. In the first column, I discussed the basic outline of the marketplace plans that will be available. In this column, I will review eligibility and enrollment.

The individual coverage portion of the Affordable Care Act begins in January of 2014. The initial enrollment period for individual coverage begins on Oct. 1 and ends March 15, 2014. If your initial application is completed by Dec. 15, your coverage is scheduled to begin on Jan. 1, 2014. To qualify, you must live in the United States; must be a U.S. citizen or national (or be lawfully present); and can’t be currently incarcerated.

The enrollment beginning in October is for individual and family coverage. The federal Health Insurance Marketplace plans offered by qualified health plan providers will offer premium, deductible and/or out of pocket subsidies to those who qualify. The amount of subsidy will depend upon several factors including age, household income and family composition.

Age: Individuals below age 26 can remain on their parent’s plan. This includes young married individuals. If you are age 65 or older, you are eligible for Medicare.

Household Income: The program will rely upon you providing the modified adjusted gross income for your household. Kaiser Family Foundation’s health insurance costs and savings calculator ( http://kff.org/interactive/subsidy-calculator) is linked through the healthcare.gov website. Using this tool, you can see an estimate of the amount of subsidy you may be eligible for in 2014. If you are below the minimum income level, you may qualify for Medicaid. If you are above the threshold, you can still apply for coverage but will not be eligible for any cost reduction.

Family Composition: The amount of subsidy will also depend upon the number of individuals in your family. An individual’s subsidy qualifying income levels will be lower than a family of six.

If you will not have health insurance coverage effective Jan. 1, 2014, or if your health care costs exceed the federal marketplace guidelines under your employer plan, you should review the options available on the Federal facilitated marketplace portal: www.healthcare.gov. It is important to understand that you are able to access the www.healthcare.gov site directly and complete your enrollment in order to determine if any subsidy.

If you would prefer assistance, the government plan allows for brokers/agents (properly licensed and appointed), navigators, application assistors, certified application counselors, and the federally facilitated marketplace toll-free call center (150 languages) to assist you. Assistance will not change your costs and may be helpful in determining the plan best suited to your needs.

Reach Bob Condron, ChFC, MSFS at 803-548-8875 or mbcondron@bridgefp.com or go to BridgeFP.com.

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