What Is The Health Insurance Marketplace? | HealthCare.gov

ACA – An Overview

42% of Americans Unaware of the Act

Key Features in Place: 2010 – 2013

◦ Prohibit denying coverage of children based on pre-existing conditions up to age 19

◦ Eliminate Annual Lifetime Limits on coverage◦ Seniors who hit the Medicare Prescription Donut

Hole - $250 Rebate check◦ Free Preventive Check-ups◦ Extended coverage for young adults up to age 26.◦ 85% of every health insurance dollar must be

spent on health care and improving quality

Upcoming Key Features:

◦ Prohibit discrimination due to pre-existing conditions or gender

◦ Ensure coverage for individuals participating in clinical trials

◦ Affordability: Tax credits for people with income between 100% and 400% of the poverty line

Upcoming Key Features (Cont’d):

◦ Minimum Essential Coverage (MEC)◦ Affordability: Employee’s cost cannot exceed 9.5%

of his/her annual household income (W-2 income)

Coverage:

◦ *AV is the share of health care expenses a “qualified health plan” covers for a typical group of enrollees.

Coverage Level *Actuarial Value

Bronze 60%

Silver 70%

Gold 80%

Platinum 90%

Premium Tax Credit (PTC):

◦ Individuals with household income between 100% of FPL and 400% FPL receive a PTC to purchase Marketplace coverage.

Housing Allowance Excluded

FPL 2014 (est.)

Individual Family of 4

100% $11,850 $24,450

400% $47,400 $97,800

8

RCA Ministers DistributionActual Data

Percentage of Poverty

100% 133.01% 150% 200% 250% 300%Above 400%

below 100%

Total headcount

Total Average

basePersons in

Family headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base1 1 17,241 5 31,992 11 40,679 4 56,839 1 7,513 22 39,0702 1 15,699 2 21,655 5 28,000 8 36,053 37 42,686 37 51,380 13 68,438 3 9,693 106 46,1003 3 21,545 1 27,397 8 36,343 16 44,120 4 51,984 5 65,500 2 15,645 39 42,4474 4 26,102 3 34,416 22 41,105 10 51,536 7 63,627 1 88,306 1 166,464 5 14,211 53 45,2555 4 34,679 10 40,139 20 47,204 6 62,248 6 16,625 46 42,5536 7 39,440 7 44,977 8 51,013 3 24,349 25 42,8837 1 46,957 1 46,9578 1 45,106 1 55,000 2 50,053

Grand Total 21 32,933 24 39,383 64 42,257 40 47,080 53 45,145 54 51,191 18 71,306 20 15,587 294 44,138

9

RCA Ministers DistributionActual Data

Percentage of Poverty

100% 133.01% 150% 200% 250% 300%Above 400%

below 100%

Total headcount

Total Average

basePersons in

Family headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base headcountAverage

base1 1 17,241 5 31,992 11 40,679 4 56,839 1 7,513 22 39,0702 1 15,699 2 21,655 5 28,000 8 36,053 37 42,686 37 51,380 13 68,438 3 9,693 106 46,1003 3 21,545 1 27,397 8 36,343 16 44,120 4 51,984 5 65,500 2 15,645 39 42,4474 4 26,102 3 34,416 22 41,105 10 51,536 7 63,627 1 88,306 1 166,464 5 14,211 53 45,2555 4 34,679 10 40,139 20 47,204 6 62,248 6 16,625 46 42,5536 7 39,440 7 44,977 8 51,013 3 24,349 25 42,8837 1 46,957 1 46,9578 1 45,106 1 55,000 2 50,053

Grand Total 21 32,933 24 39,383 64 42,257 40 47,080 53 45,145 54 51,191 18 71,306 20 15,587 294 44,138

Subsidy Calculator | The Henry J. Kaiser Family Foundation

ACA2014 Federal Poverty Guidelines

State Run Marketplace:

State Run

California Colorado Connecticut

District of Col Hawaii Idaho

Kentucky Maryland Massachusetts

Minnesota Nevada New Mexico

New York Oregon Rhode Island

Utah Vermont Washington

Individual Mandate:

◦ Beginning in 2014, penalty applies to individuals: Who have income above amount required for filing tax

return Who do not maintain Minimum Essential Coverage

◦ Penalty 2014: greater of $95 or 1% of income 2015: greater of $395 or 2% of income 2016: greater of $695 or 2.5% of income

For family, penalty capped at 300% of individual rate

Enrollment:

◦ October 1, 2013 – March 31, 2014◦ Enroll individually or through a Navigator◦ Benefits are effective January 1, 2014

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