the ACA is legislation that says almost everyone must have health insurance or potentially pay a tax penalty.
the government will help lower the cost of health insurance by providing savings through Advance Tax Credits to those individuals and families that qualify.
no one can be denied health insurance due to previous or existing health conditions.
Depending on factors like your income and household size, you might qualify for the Advance Tax Credit to help pay for health insurance. These savings can be applied to whatever health plan you choose.
Starting October 1, 2013, you have the power to shop for and choose your own health coverage for 2014 online at the Health Insurance Marketplace. You can access the Health Insurance Marketplace through this website.
By choosing to buy health insurance, you will avoid paying a tax penalty. Generally, the amount of the additional tax would be the larger of the flat-rate penalty or percentage of income penalty calculation. The flat-rate tax penalty in 2014 for an adult individual is $95 and $47.50 for children with a maximum $285 penalty. The percentage of income method uses your household income less your filing threshold and multiplies this by 1% for 2014. (Our Tax Pros can helpth make sense of this during your Tax & Health Care Review.)
The first step to understanding health insurance begins with understanding the language used to describe it. In this section you'll find definitions for terms such as premium, deductible, network, and more.
No two health insurance plans are the same. In order to the find the one that's right for you and your family, you'll need to understand the options that are available to you. In this section we'll explain the four levels of health plans on the Health Insurance Marketplace – Platinum, Gold, Silver, and Bronze.
These are changing times in health care. Good thing we have a way to keep track of important dates. Here you'll find a calendar of events to help you prepare for upcoming health care reform changes.
There's a wealth of more detailed information pertaining to the Affordable Care Act. For those who are looking to learn even more about health insurance and health care reform, we've provided some helpthful links.
A claim is a request by an individual to the health insurance company for the insurance company to pay for medical services obtained from a health care professional.
A fixed dollar amount that you pay each time you receive certain services. For example, if your health care plan includes a $15 copay for doctor visits, you pay $15 every time you visit your doctor, and the health insurance company pays the remaining cost.
A person or persons relying on the policyholder for support, as it pertains to health insurance. Dependents may include the spouse and/or unmarried children (whether natural, adopted or step) of the insured person.
The maximum dollar amount your health insurance will pay for covered expenses for the insured and each covered dependent while covered under the health care plan.
A group of doctors, hospitals and other health care providers contracted to provide services to health insurance companies customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network health care provider.
The highest dollar amount you will ever need to pay during a plan year for covered services before your insurance pays 100% of the costs for any subsequent services.
When your health care plan helps pay for some or all of the costs for prescription medications.
Some health care plans include coinsurance. This is the portion of a medical bill that you pay out-of-pocket once your deductible has been reached. A plan with 10% coinsurance would mean if you receive a medical bill for $100 after your deductible has been reached, you would owe $10 and your health care plan would pay the remaining $90.
The dollar amount you must pay out of your pocket for your health care expenses before your health plan begins to pay.
In-network refers to providers or health care facilities that are part of a health insurance plan's network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the health insurance companies with which they have contracts.
The money paid every month to a health plan by you for health care benefits. This money is paid monthly regardless of whether you use your insurance or not.
This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan. Depending on an individual's health insurance plan, expenses incurred by services provided by out-of-plan health care professionals may not be covered, or covered only in part by an individual's health insurance company.
A preferred provider organization (PPO) is a managed care organization of health care providers who contract with a health insurance company to provide health coverage to policy holders represented by the health insurance company.
A term used for health care professionals and places that provide health care services including physicians, hospitals, nurse practitioners, chiropractors, physical therapists, and urgent care centers just to name a few.
The Affordable Care Act requires that every insurer design their health plans to meet specific requirements and that they must present them in a uniform way. So when you begin shopping, you’ll notice that plans are grouped into four categories – Platinum, Gold, Silver, and Bronze. In the simplest terms, these categories group plans together by the level of coverage they provide. (In other words, what percentage of medical costs they cover.)
You might be wondering, "Why wouldn't everyone choose a Platinum plan?" Well, because Platinum plans have a higher monthly premium than Gold plans. Gold plans have a higher monthly premium than Silver plans. Silver plans have a higher monthly... Well, you get the idea.
So it's important to consider how much you think you will use your health insurance when choosing the level of coverage and premium that's right for you. Generally speaking, if you use your health insurance a lot, you may want to consider a Platinum or Gold plan to control your out-of-pocket costs. If you don't think you'll use your health insurance much, you may want to consider a Silver or Bronze plan to help save on monthly premiums.
Good thing we have a timeline to keep track of important dates. Here you'll find a list of events to help you prepare for upcoming changes.