Health Reform For Individuals

There is a lot to know with health reform. We have offered some Frequently Asked Questions below. If you have more questions , please contact a broker. 303.425.4466

December 20, 2017 -The GOP's new tax bill passes Congress

The tax bill states- "The individual mandate penalty, which requires most Americans to carry a minimum level of health coverage, is still in effect for 2018. The elimination of the penalty will take effect in 2019, however, individual insurance markets, federal subsidies to help Americans pay monthly insurance premiums, and Medicaid expansion in the dozens of states that implemented it will all still be in effect barring further Congressional action.

What are the basic changes under Health Care Reform? 

    

  • The elimination of pre-existing medical conditions to qualify for individual health insurance.

  • All medical plans purchased after 2014 are required to meet minimum essential health benefits.

  • Children may remain on a parents plan up to age 26.

  • The elimination of Lifetime Limits.

  • Requirement to obtain minimum health insurance coverage or pay a penalty. (Repealed for 2019)

When can I purchase an insurance plan?

  • Open Enrollment :  For 2019 from November 1, 2018 to January 15, 2019.

  • Special Enrollment:  Exception to enroll off open enrollment through a "Qualified Event"                                                  

While each situation is unique, if a Coloradoan has a life change event such as birth, marriage or moving could open up a Special Enrollment where you will have 60 days to make application for new health coverage.

                                                                                                                                        

         Special Enrollment Guidance                                           More Qualifying Events                                           

Where can I purchase health insurance?

  

  • Direct from carrier, Colorado’s exchange/marketplace, and a broker can assist with both.

  • Health plans are required by law to be the same price whether purchased on the exchange or direct from the carrier.

  • If you qualify for a tax credit, you must purchase a plan on the exchange to receive it.

  • You may still utilize the services of a broker at no extra cost.

                                                                                                           

 

How do I know if I qualify for financial assistance?

  • Income and financial assistance verification will be completed online at Connectforhealth.com

  • When completing information for financial assistance on the marketplace:

    • Keep in mind this is an estimate of your annual income for 2019.

    • Include income from all family members that will be listed as dependents on your 2019 tax return.

    • It’s important to update changes in income or dependent status for potential for tax liabilities.

If you qualify for a tax credit, you must purchase your plan on the exchange. The tax credit  is based on a sliding scale so that the individual's premium contribution will be limited to a percentage of income for specified income levels. If an individual does qualify for a tax credit you must be diligent to update any changes in income or you may have an unexpected tax consequence when reconciled at the end of the tax year.

                                                                                                                     

How are rates calculated?

Beginning January 1, 2014 all individual and family medical premiums will be calculated for each person, including dependents. Plan rates will be rated by each member's age, tobacco use and zip code. For families, children are rated individually (Up to 3 children.)

 

What are the penalties if I don't purchase health insurance?

2016 - 2017 Individuals who do not obtain minimal essential coverage will be penalized the greater of $695.00 per Adult, $347.50 per child ($2085.00 Maximum for family) or 2.5% of taxable household income.

If you lack coverage for only part of the year, the fee is prorated. For example, if an individual is without health insurance for six months you will be assessed 50 percent of the fee.

2019 The individual penalties for not purchasing minimal essential health coverage has been repealed, therefore there will be no penalty for tax year 2019.

Are there exemptions from the penalty?

  • Religious Conscience;

  • Income Restraints- Tax penalty exemptions may be granted for people when the lowest cost plan option exceeds 8% of annual income;

  • Hardships- If the US Department of Health and Human Services determines someone has suffered a qualified hardship, they may be exempt;

  • Taxpayers with income below the filing threshold;

  • Members of Indian tribes;

  • Individuals who experience short coverage gaps;

  • Incarcerated individuals; 

  • Individuals who are not lawfully present;

DO YOU HAVE A SMALL BUSINESS?

 

IF YOUR BUSINESS QUALIFIES FOR A GROUP HEALTH PLAN, YOU MAY BE ABLE TO SAVE ON PREMIUMS WITH RICHER BENEFITS...

 

Subsidy Guidelines

  

Federal assistance is based on (1) Size of Household and (2) Household Income. The tax credits are only eligible for plans purchased on the exchange, Connect for Health Colorado.

 

If you qualify for a subsidy, you may be able to save up to 80% on your monthly premium if you are unable to receive coverage through an employer or other sources.

An Individual making up to $48,560,

A Family of 2 making up to $65,840,

A Family of 3 making up to $83,120, 

A Family of 4 making up to $100,400 per year, you may be eligible for financial help if employer sponsored coverage is unavailable. Learn more about 

Things to Know: 

  •  Advance Premium Tax Credits (APTC) help people to pay for monthly health coverage.

  • Cost-sharing Subsidies (CSR) reduce deductibles, copays, and out of pocket maximums.

  • Federal tax credits are not available to people on Medicaid, Medicare or who are offered affordable coverage through an employer.

  • Husband and spouse must file jointly to receive APTC's.

  • Remember: Tax credits are based on your estimated household adjusted gross income for the current year. Credits will be reconciled when filing your annual federal tax return, try to be as accurate as possible!

  • If you have a household change or income change, ie: loss of job, bonus, salary increase, make sure to inform Connect for Health Colorado so the tax credit can be adjusted. If you do not report changes you may end up with a refund or unexpectedly owe money on your annual tax return.

 

Determine Household Size:   Include:

  • You, your spouse, unmarried partner who needs coverage.    

  • Children who live with you, whether they file their own tax return or not.

  • Anyone you list as a dependent on your tax return, whether they live with you or not.

  • Anyone under 21 who lives with you and you take care of.

                                                                                                         

Determine Household Income:   Include Income from You, your spouse, and dependents filing a tax return. Remember this is "estimated" income for the current tax year,

 

  • Include:  Salaries, wages,tips, net income from self employed business,Social Security including disability, Unemployment, Investment income,pensions, rental income, gambling, awards.

  • Do Not Include:  Veterans disability, Workers Compensation,Child Support, Gifts.

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