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Pathway Health Insurance Experts, Inc. | Copyright 2017
The Patient Protection and Affordable Care Act (PPACA) is a new law intended to ensure that everyone in America has access to affordable quality healthcare coverage. It requires that everyone purchase qualified coverage or pay a tax penalty. As a result, you will be able to purchase standardized insurance
plans either off or on the Marketplace Exchange. Either way, the coverage will be the same, there will be no pre-existing exclusions imposed (& guaranteed issue), & the prices will be similar.
The main difference is that in order to qualify for a tax subsidy (price reduction), you must purchase coverage through the Marketplace Exchange to receive the credit.
How does it work?
Individuals & families can purchase affordable health insurance either through their state or federally run insurance Marketplace Exchange or through normal insurance carrier channels. Either way, everyone will be guaranteed coverage, regardless of pre-existing conditions. And, for those who qualify for a subsidy (discounted policies), the Marketplace Exchange will be the only place to obtain this subsidy.
What kind of qualified coverage is available both on & off the Marketplace Exchange?
Consumers will have four tiers of coverage to select from. Known as the Metallic Plans, the Bronze (50/50%), Silver (70/30%), Gold (80/20%) & Platinum (90/10%) plans will be standardized, regardless of which insurance carrier you select. And, all must contain the same essential benefits. The difference between the plans will be price, copays & coinsurance. But, the maximum out of pocket limits will be the same for all.
Also, the tax subsidy (reduction in price) will be based on the Silver plan, as a benchmark.
A New Option for Affordable Healthcare Insurance
INDIVIDUALS AND FAMILIES
How much is the penalty?
Grandfathered plans are exempt
from some rules of the law.
In 2014, the penalty for individuals (for each family member) is $95 for adults ($47.50 for a child) or 1% of household income, whichever is greater.
In 2015, penalty rises to $325 per adult and $162.50 per child (up to $975 for a family) or 2% of family income, whichever is greater.
In 2016 it jumps to the greater of $695 for adults ($347.50 for a child) or 2.5% of income.
Currently, the maximum family penalty in 2016 is the greater of 2.5% of income or three times the per-adult penalty ($2,085).