Health Care Reform: Fitting into the Puzzle

Not sure how you fit into the Health Care Reform puzzle? Navigating Health Care Reform can be tricky, but luckily, you have Sweeney & Sweeney Insurance to help you along the way! Contact one of our certified, friendly, and knowledgeable agents today with your questions and concerns. We’re always ready and willing to help!

Q: What is the household income eligibility requirement?

A: Americans with household income of 100% to 400% of the Federal Poverty Level (FPL) are eligible. For example:

100% FPL- individual $11,490, family of four $23,550
400% FPL- individual $45,960, family of four $94,200.

Q: Do the credit amounts vary by income?

A: It is a sliding scale that comes into effect here. If you fall on the lower end of the FPL percentage spectrum, you can expect more help from the government than someone closer to 400% FPL.

Q: What is the exchange?

A: You can think of the exchange as a marketplace to purchase insurance. Exchanges are new organizations that are being created to provide a more organized and competitive way to purchase health insurance. Consumers can view several options and easily compare rates and coverage details.

Q: Will Agents be participating in the Health Care Reform?

A: Agents and Brokers have the choice to become Certified Health Care Reform Agents, to have the opportunity to better serve our community and help them get the best coverage available.

Q: What if I already have an individual health plan?

A: When the new law comes into effect in January 1, 2014, all current plans will no longer exist. Your options are to either be moved to a plan that is closest to your current plan or you may call Sweeney & Sweeney Insurance to go over your options in the Exchange, as you may qualify for a tax credit.

Top 10 ACA Points You Should Know

Are you wondering what the different parts of the ACA really mean? Straight from Blue Shield, here are the top 10 key issues you should know about.

1. Guaranteed Issue – No one will be denied healthcare due to health, age, gender, or other issues including pre-existing conditions.

2. The Individual Mandate – All individuals will be required to have coverage that qualifies as the minimum essential by January 2014, or risk paying a tax penalty.

3. Grandfathered Plans – People who have healthcare plans that were in effect prior to March 23, 2010, can keep their plans if they want. The only caveat is they are not subject to the ACA’s requirements.

4. New Marketplaces – Marketplaces (Exchanges) have been created as a place for people to explore and compare different health plans. You can access this marketplace directly through brokers and individual carriers just as before.

5. Open Enrollment – This Open Enrollment period began on October 1, 2013 and ends March 31, 2014.

6. Essential Health Benefits – All non-grandfathered plans for individuals and small businesses will include the following 10 categories:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioural health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including or and vision care

7. Metal Level Plans – All non-grandfathered health plans offered to individuals and small businesses will be required to provide coverage at a “metal level”—Platinum (90%), Gold (80%), Silver (70%), and Bronze (60%)—based on the actuarial value (E.g. With a gold plan, the Insured pays 20% of health care costs, while the plan covers 80%).

8. Federal Subsidies – Subsidies will be available starting 2014 for those whose annual income is between 134% and 400% of the Federal Poverty Level (FPL) and who meet the guidelines. Subsidies will help lower the costs of both premiums and out-of-pocket costs. Those who fall less than 134% below the poverty level may be eligible for Medi-Cal. Tax credits will also continue to be available to small businesses with 25 or less full-time equivalent employees to help cover the costs of providing coverage.

9. ACA Taxes – Taxes covering the ACA will start January 1, 2014. Click here for a downloadable copy of the ACA tax fact sheet

10. Play-or-Pay – As of January 1, 2014, the ACA requires companies over a certain size to offer affordable health coverage to full-time employees and their dependents or face paying a penalty if an employee receives federally-subsidized coverage through the Exchange.