ACA Healthcare Reform

We can help you understand the laws of ACA Healthcare Reform and how they affect you.

The Affordable Care Act (the ACA) was passed and made the law of the land in 2010.  Although extensive, this bill was intended to better our healthcare system.  However, with nearly 2,700 original pages of healthcare bill and over 41 amendments, the law is complex and many need help interpreting the ACA correctly.  We can help.

Highlights of ACA Healthcare Reform (the Affordable Care Act)

Our experts have listed some of the highlights of the ACA.  While this list explains how the law may affect you, we suggest you call our office at 402-659-5960, or fill out the contact form directly to the right for more assistance.

The Individual Mandate

Individuals must now obtain health insurance.  Failure to comply could result in a tax penalty.  Accordingly, coverage can either be obtained through an individual policy or through their an employer sponsored policy.  In either case, the coverage must contain the “essential benefits” as required by the ACA.

The penalty:  The penalty for non-compliance is $695 for each adult family member and is $347.50 for each child, or 2.5% of household income, whichever is greater.

Following are new guidelines for insurance companies.
  • There is no pre-existing clause. Insurance companies can not increase rates, or deny coverage, because of a preexisting condition.
  • The age for dependents has increased to 26.  In other words, your children are considered dependents until they turn 26.
  • Gender is no longer considered when setting insurance premiums.
What is qualifying coverage?

To be in good standing with healthcare reform laws and avoid costly penalties, you must have qualifying health insurance.  A qualifying policy pays for 60% or more of the costs of the following “essential benefits:”

-Ambulatory patient services
-Emergency services
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management

Individuals who purchase their health insurance through the Federal Health Insurance Marketplace may be eligible for tax subsidy (credit) which is applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please use the Subsidy Calculator below.

Individuals must purchase their insurance during the open enrollment period, or pay a tax penalty.  Accordingly, open enrollment for the individual market is from November 1st through December 15th of each year.

Did you miss this date?  You can still sign up for health insurance after the deadline, if you meet any of the following qualifying events:

  • change in legal marital status
  • a change in the number of dependants
  • a change in place of residence and the current carrier is not available
  • significant cost or coverage change
  • a change in coverage of a spouse or dependant
  • a COBRA qualifying event
  • legal judgements, decrees and orders
  • entitlement to Medicare or Medicaid
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