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Top 5 FAQ's about Health Insurance Reform Answered

1. What is the health insurance market place?

Health insurance marketplaces are exchanges and organizations within each state to assist in making health coverage affordable for everyone. Plans purchased through the marketplace are qualified as minimum essential coverage. In order to make coverage affordable for everyone, the marketplace offers financial assistance programs to those with lower income. Medicaid, CHIP (children’s health insurance program), and tax credits. Marketplace plans are utilized by those who want to pay the minimum for their coverage, by those who can’t afford to purchase private healthcare, or by those who aren’t covered through their employer.

2. What is the difference between on-exchange and off-exchange?

On-exchange plans are the health insurance plans purchased through the federal marketplace by those who qualify for financial assistance. Off-exchange plans are those purchased through private health insurance carriers. People choose to purchase an off exchange plan for 3 main reasons:

- There tend to be more options off of the exchange. Off-exchange providers must offer every plan that is on the exchange, and then some. There are more providers in the network to choose from, and more leverage with deductibles and drug coverage. - When you apply for coverage through the marketplace, you must provide the federal government with personal information, including your income and tax returns. This information must be provided constantly. Some feel uncomfortable handing over this information, and sometimes, applying for an on-exchange plan can be a lengthy process (but not always). - When you purchase an off-exchange plan, you are able to utilize an insurance broker or an agent. These resources are available to you to ensure you’re getting the right plan that fits your personal needs. Brokers and agents are knowledgeable of all plan specifics, and will be able to compare your cost vs coverage needs when narrowing down plan options.

3. What is the Federal Premium Assistance tax credit?

The PTC is a refundable credit that helps eligible individuals and families with low or moderate incomes afford health insurance purchased through the marketplace. You must meet certain requirements, and file a tax return to qualify. Your household income must fall within a certain range, you cannot be claimed as a dependent by another person, and you must pay the share of premiums not covered by the tax credit.

4. What is the penalty for not having health coverage, and how do I get caught?

There is a penalty for not having health insurance which is either a flat rate, or a percentage of household income. In 2015, the penalty is the greater of $325 for each adult, or 2% of household income above the federal tax filing threshold, which is $10,300 for a single filer. In 2016, the penalty will be $695 for each adult, or 2.5% of household income. 8 million people are projected to pay the tax penality this year. Not having health coverage often becomes visible when filing your tax returns at the end of the year.

5. What is the annual open enrollment period?

Open enrollment is the yearly period when you can enroll in a health insurance plan. This is also an opportunity to make changes to your current plan, or change your plan all together. Reasons for changing your plan can be due to increased rates in the following year, your medications no longer being covered under your plan, or your doctor no longer being in your network to name a few. The open enrollment period for health insurance is November 1st – January 31st. The enrollment period for Medicare is October 15th- December 7th. These dates may be extended depending on high demand. Some are able to change their plans outside of this enrollment period if they have a qualifying life event. Qualifying life events include:

• Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity. • Gaining a dependent (for example, if you get married or give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity. • Loss of coverage due to divorce or legal separation. • Loss of dependent status (for example, “aging off” a parents’ plan when you turn 26) • Moving to another state or within a state if you move outside of your health plan service area. • Exhaustion of COBRA coverage. • Losing eligibility for Medicaid or the Children’s Health Insurance Program. • For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies. • Change in immigration status. • Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.

If you have any other specific or personal questions that aren’t answered on this list, we will be able to answer them for you. You can call us anytime, or leave a message through our contact forum. Our phone number is 770-945-5261. More detailed information can be found at or

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