Under the Affordable Care Act, you may be able to get help paying for your monthly premium depending on your family size and income. The amount of premium credit will depend on your family size and family income. If your family makes less than the yearly income below, you may qualify.
2016 - Medicaid Kicks in at 100% BELOW the Federal Poverty Level (FPL)
Coverage Limits of the ACA
The Out Of Pocket (OOP) Maximum which includes the deductible for an individual is $6850 and for a family is $13,700. All co-payments such as doctor’s office visits now go toward the OOP.
During the 2016 enrollment, the maximum allowable payments to a HSA are $3350 for an individual and $6750 for a family. The family contribution has increased by $100 from 2015 to 2016 enrollment period.
The Ten Essential Health Benefits (EHBs) of the ACA
- Mental Health, Substance Abuse and Behavioral Health Treatment
Other Mandates of the ACA
- No annual or lifetime dollar limits on EHBs.
- Adult children may remain on a parents plan until age 26.
- Plans obtained before March 23rd, 2010 may be “Grandfathered Plans”.
Excluded Benefits
- Non-pediatric dental services.
- Routine non-pediatric eye exam services.
- Long term custodial nursing home care.
- Non-medically necessary orthodontia.
- A plan is NOT required to cover abortion services.
Open enrollment for individual health insurance is between November 1st through January 31st of each year. If one of these "Qualifying Life Events" occurs between during the year, you or your dependent(s) will be eligible to enroll in a health plan, with your effective date no more than 60 days from the date of your "Qualifying Event". This means if you wait until the 59th day to enroll after your "Qualifying Event", you will be able to recieve health insurance on the 1st of a month with a waitning period not to exceed 45 days.
Qualifying Life Events
- I gained a dependent due to marriage.
- I gained a dependent due to birth, adoption, or placement for adoption.
- I am no longer eligible as a dependent under my prior health insurance due to reaching the maximum age, legal separation, divorce or death of policyholder.
- I am no longer eligible for my prior health insurance plan due to termination of employment, reduction in number of hours of employment, loss of employer contribution toward my premiums, or I have exhausted my COBRA benefits.
- I gained access to new health plan option because of a permanent move.
- I am newly ineligible for payments of the advance premium tax credit.
- I am no longer residing or living in my prior health insurance plan’s HMO service area.
- I have adequately demonstrated that my previous health plan or issuer substantially violated a material provision of its contract with me.
- I and/or my dependent(s) lost minimum essential coverage (Due to reasons other than non-payment of premiums or rescission.
- Other qualifying events (as required or permitted by applicable laws).
