Affordable Care Act

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  1. 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)
  2. 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
  3. 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
  4. 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)
  5. 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
  6. 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)
  7. Who qualifies for the "Cost-sharing Subsidy"?
    ppl enrolled in a "Silver" plan through the Exchange
  8. What are the out-of-pocket limits?
    • individuals: $5,950
    • families: $11,900
    • cost-sharing subsidies reduce the limits
  9. 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
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Affordable Care Act
Affordable Care Act
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