Friday, August 23, 2013

Part 9 Summary and Advice from a Licensed Agent

In the final months of 2013, my advice to individuals, families and employers is to not wait until you are absolutely required to make a decision about your healthcare plan.  Unfortunately, so many people I speak to are sitting on the fence hoping the Affordable Care Act regulations will go away. 

For business owners, the law suggests that small employers who offer a minimum Essential Health Benefit (EHB) group plan in 2014 will prevent employees and their families from qualifying to receive premium tax credits.  If this is the case, then the same benefits that attract quality employees now, will repel them.  Call me for specific recommendations if you are in this situation as a business owner.

If you are an individual, unless you currently have serious medical conditions or have insufficient income to afford obtaining quality health insurance coverage, your best option may be to purchase a short term major medical plan or non Affordable Care Act (ACA) major medical plan for 2014 only. If you take the $95 penalty, this could prove to be far cheaper than opting for a ACA Qualified Health Plan. For more information, visit or call Brian Linkous, GA and TN licensed Agent, USA Benefits Group - 706-889-6925.

Part 8

SHOP additional Information:

  • Premium Tax Credits and Cost Sharing Reductions are not available to employees and families covered through a SHOP

  • Employers meeting certain size and average wage requirement for a SHOP may receive a Small Business Tax Credit on their tax returns of up to 50% of the employer's contribution to the premium

Part 7

Small Business Health Options Program (SHOP).  During the first year, small businesses that qualify for coverage through a SHOP will be able to offer employees a single Qualified Health Plan (QHP) option.  SHOP's will offer qualified small groups access to QHP's in each state. 

To qualify for a SHOP, a business must:

  • Be located in a SHOP's service area (generally a state)

  • Offer coverage to all full time employees (30+ hours)

  • Have at least one eligible employee on payroll

  • Have 50 or fewer full time equivalent employees on payroll in 2014

Part 6

Cost Sharing Reductions in addition to Premium Tax Credits:

  • Offered to people who enroll in a Qualified Health Plan (QHP)

  • Meet eligibility for the Premium Tax Credit

  • Have annual household income at or below 250% of the Federal Poverty Level

  • Be enrolled in a Silver level QHP

Part 5

Premium Tax Credits to offset the cost of the QHPs:

  • Offered to people whose annual household income is between 100 and 400% of the Federal Poverty Level and who are not eligible for minimum essential coverage

  • Not offered to people who are eligible for minimum essential coverage including employer sponsored coverage, Medicaid, CHIP and Medicare

Part 4


The Federal Government will establish in Georgia and Tennessee, Federally-facilitated Marketplaces formally called exchanges.  Marketplaces will only offer health insurance plans that are certified as a Qualified Health Plan (QHP).  Marketplaces must be ready October 1st, 2013 for individuals, employers and employees to enroll in QHP's.

There will be two types of Marketplaces:

  • Individual - for individuals and families

  • SHOP - for small business owners

Part 3

Affordable Care Act (ACA) Qualified Health Plans (QHP) will offer:

  • Four "metallic" levels of coverage consisting of Bronze, Silver, Gold and Platinum

  • One Catastrophic plan for individuals under the age of 30 who do not have an affordable coverage option

  • Maximum out of pocket (OOP) in 2014 is $6,350 for individuals and $12,700 for families spread between deductibles and co-pays

  • Ten categories of essential health benefits (EHB)

  • Premium rate variations will only be based on age, family composition, geographical area and tobacco use