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The Affordable Care Act (Obamacare): If You Have Health Insurance


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The Exchanges: offsite linkprovides access to the various state exchanges. ("American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges").

Eligibility: Eligibility to purchase insurance from an Exchange is limited to:

  • U.S. citizens and legal immigrants who are not in prison.
  • Small businesses with less than 100 employees.
  • States will be permitted to allow businesses with more than 100 employees to purchase coverage from an Exchange beginning in 2017.

Policies Offered:

  • The Act creates 4 benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange and in the individual and small group markets. The categories are: Bronze, Silver, Gold, Platinum and Catastrophic. The catastrophic plan is an alternative for:
    • People under 30 years of age
    • People who are exempt from the mandate to purchase coverage. 
  • The act reduced out-of-pocket expenses for people with incomes up to 400% of the Federal Poverty Level (FPL)
  • There must be at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.

Guaranteed Issue and Renewability: The Act requires that policies issued through an Exchange for individuals and the small group market include guarantee issue and renewability. This means that even people with pre-existing health conditions are guaranteed to be able to purchase and renew a policy.

People with a health condition cannot be charged more because of their health condition. Rating variations are only allowed in the indiviudal market, small group market and the Exchanges for the following reasons:

  • Age (with a limitation on the maximum that can be charged)
  • Premium rating area
  • Family composition
  • Tobacco use

State health plans:  States are given the option to create a basic health plan for uninsured individuals with income between 133% and 200% of the Federal Poverty Level (FPL) instead of those individuals receiving premium subsidies to purchase coverage in the exchanges. States which choose to provide this coverage must provide at least the essential health benefits. To find out what is happening in your state, go to offsite link

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