What you should know about health care

September 28, 2013 

INDIVIDUALS

What if I have job-based insurance?

If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to marketplace (or exchange) coverage if you want to.

Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. If you'd like to explore marketplace coverage options you can, but there are several important things to consider.

Comparing job-based and marketplace plans

With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums. You should consider this carefully before comparing Marketplace plans.

Qualifying for marketplace savings

If you decide to check out marketplace plans, be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise.

Whether you qualify will depend on what kind of coverage your employer offers. If your job-based coverage is considered affordable and meets minimum value, you won't be able to get lower costs on premiums or out-of-pocket costs in the marketplace. This is true no matter what your income and family size are.

Your employer can tell you whether the insurance plan it offers meets minimum value and can provide you with information to determine if the plan is considered affordable to you.

If you do not qualify for lower costs in the marketplace, and your employer does not pay part of your premiums on the marketplace, be sure you take these things into account before you consider choosing a plan other than your employer's.

Apply online, by mail, or in-person

You can apply for marketplace coverage three ways: online, by mail or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 to help you complete your application. Downloadable and paper applications will be available Oct. 1.

Open enrollment starts Oct. 1. Plans and prices will be available then. Coverage starts as soon as Jan. 1, 2014. Open enrollment ends March 31, 2014.

SMALL BUSINESSES

What do small businesses need to know?

Small businesses may get health coverage in the Small Business Health Options Program (SHOP) Marketplace. Starting in 2014, businesses with 50 or fewer full-time equivalent (FTE) employees can use SHOP to offer coverage to their employees. This applies to nonprofit organizations as well. You control the coverage you offer and how much you pay toward premium costs.

Health coverage through SHOP starts as soon as Jan. 1, 2014. Open enrollment begins Oct. 1. You can sign up and begin offering coverage any time during the year.

You have health coverage rights

Starting in 2014, insurance plans:

• Can't turn you down based on the health status of your employees or their dependents, even if they have pre-existing conditions.

• Can't charge you higher premiums for women, or increase your group's premium for employees with high medical costs.

• These rights do not apply to grandfathered plans.

You may qualify for tax credits if you offer coverage through SHOP

If you have fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less, you may qualify for a small business health care tax credit. Starting in 2014, the tax credit is worth up to 50 percent of your contribution toward employee premium costs (up to 35 percent for tax-exempt employers). This will make the cost of providing health coverage lower.

Beginning in 2014, the small business health care tax credit is available only if you get coverage through SHOP.

Businesses with more than 50 employees could face payments in 2015

The "Employer Shared Responsibility payment" is a new requirement under the health care law for some employers. It will take effect in 2015. It will apply only to employers with 50 or more full-time equivalent (FTE) employees that don't offer coverage or whose coverage doesn't meet certain minimum standards.

Have questions about the SHOP Marketplace for businesses with 50 or fewer employees? Call 1-800-706-7893 (TTY users: 1-800-706-7915). Hours: Monday through Friday, 9 a.m. to 5 p.m. EST. Agents and brokers may also use this number.

* Source: HealthCare.gov

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