Have Questions About the Affordable Care Act (ACA)? We Have Some Answers

By Jenifer Lambert

Posted on September 6, 2013

by JoAnn Xydis

There are a lot of questions swirling around as the Affordable Care Act, sometimes referred to as “ObamaCare”, continues to be phased in.  There are important changes coming that will affect most Americans so it’s important to be informed.

The Requirement to Buy Health Insurance, or Pay a Fine.

Beginning in 2014, the Affordable Care Act includes a mandate for most people to buy health insurance or potentially pay a penalty. Individuals will be required to maintain minimum essential coverage for themselves and their dependents. Many people are not aware of this requirement, and are most definitely not prepared for it.  Included in this post are some answers to frequently asked questions about the mandate.

What does the individual mandate require?

This requires that you, your children, and anyone else that you claim as a dependent on your taxes must have health insurance in 2014 or pay a penalty. That coverage can be supplied through your job, public programs such as Medicare or Medicaid, or an individual policy that you purchase.

What type of coverage satisfies the individual mandate?

  • Health coverage provided through an employer-based plan (including COBRA or a retirement plan),
  • Policies that you bought for yourself or your family through the individual market,
  • Medicare (and Medicare Advantage), Medicaid, CHIP, some Veterans Administration health programs or
  • TRICARE coverage for members of the military and their dependents.

For a list of plans that meet the requirements of the mandate, visit www.healthcare.gov.

What does not satisfy the individual mandate?

Insurance programs that do not offer minimum essential coverage will not satisfy the mandate.  Dental-only coverage, supplemental benefit programs, and limited benefit medical plans are examples of plans that will not satisfy the mandate.  TERRA offers a limited benefit medical plan through Benefits in a Card; however, this plan does not satisfy the mandate.

How do I shop for insurance?

Online health insurance marketplaces are being created, to help you shop for plans.  For information on the Washington State Exchange, visit http://www.wahbexchange.org/.  For information on the Oregon State Exchange, visit http://www.coveroregon.com/.  Open enrollment begins October 1st and continues through March 31, 2014.

What is the penalty for not getting insurance?

If you do not have the minimum level of coverage and do not qualify for an exemption (see the next paragraph for a list of those exempted), you must pay a penalty to the IRS at the end of the tax year. The penalty for the first year is up to $95 per adult and $47.50 per child, or one percent of family income, whichever is greater.

The fine, however, increases over time and in 2016 will be as much as $695 per adult and $347 per child (up to $2,085 for a family) or 2.5 percent of family income, whichever is greater.

Who will be exempt from the mandate?

Individuals who have a religious exemption, members of a federally recognized Indian tribe, individuals not lawfully present in the United States, and incarcerated individuals are exempt from the minimum essential coverage requirement.

We know health care reform is complicated and new information is becoming available on a regular basis.  We will keep you informed as we learn more.  In the meantime, more information on the health care reform law and the Insurance Marketplaces is available at www.healthcare.gov.

JoAnn Xydis is TERRA’s Director of Administration

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