Ideal ACA Exchange

Should you buy coverage for yourself and your family?

The Affordable Care Act (ACA) is the law.  You are required to have health insurance beginning in 2014.  If you fail to have coverage for at least nine continuous months in 2014, you will be subject to a tax penalty.  This means you are required to enroll by March 31 for an effective date (when coverage begins) of April 1, and you must continue the policy through the end of 2014 in order to avoid this penalty.

The penalty for not having proper coverage in 2014 is the greater of 1% of your adjusted gross income (AGI) or $95 per person for the year, whichever is higher. The fee for each uninsured child is only 50% of that for an adult ($47.50 in 2014). The most a family would have to pay in 2014 is $285. The fee increases every year.

Regardless of any tax penalty, not having coverage would leave you responsible for 100% of all medical costs, with no limit on your personal liability. If a critical illness or accident occurs, this could cause permanent financial ruin for your family.

Also, you may be exempt from any tax penalty. Households with incomes above 400% of FPL (see the chart above) will be exempt from paying tax penalties if insurance in their area costs more than 8% of their taxable income, after taking into account employer contributions or tax credits.

The penalty for not having proper coverage for at least 9 months in 2015 is the greater of 2% of your AGI or $325 per person ($162.50 per child) for the year, whichever is higher. The most a family would have to pay in 2015 is $975.

The penalty for not having proper coverage for at least 9 months in 2016 is the greater of 2.5% of your AGI or $695 per person ($347.50 per child) for the year, whichever is higher. The most a family would have to pay in 2016 is $2,085.

Because the annual enrollment period will run from October 15 to December 7 of each year, where you will be able to select your coverage effective from January 1 through December 31 of the following year, it is unlikely that you would have coverage in any year after 2014 that did not span the entire year.

March 31, 2014: Open enrollment closes. After this date, you will not be able to shop for and purchase health insurance through the Marketplace until the next open enrollment period, or unless you qualify for a special enrollment period, generally allowing only for significant life changes (births, deaths, marriage, loss of existing coverage, etc.). You cannot be denied health insurance coverage because of a pre-existing condition or disease. However, one exception exists: Individual insurance plans can still deny coverage for a pre-existing condition. In other words, if you already have individually purchased insurance, your insurance company is grandfathered in and can refuse to pay for a procedure or treatment related to a condition you had before you purchased insurance. At any time, you can use the Exchange to purchase insurance that does not exclude your condition.

Similarly, gender can no longer be a factor in health insurance expenses. Health insurance companies will not be able to discriminate against individuals, deny them coverage, or charge them more because of their gender.

Also, companies will no longer be able to limit the amount of coverage they provide in a year. If you have a larger health insurance need in 2014, your insurance company cannot deny payment because of a limit or cap they’ve placed on you or your insurance policy.

If you can buy directly on the Marketplace, why use an agent?

You won't pay any more for your coverage when you use an agent versus enrolling directly through, either online or by requesting assistance with enrolling by phone. Also, since agents are paid commissions by the insurance carrier, we have a vested interest in enrolling you in the best coverage that fits your particular needs and budget.

Michigan has expanded Medicaid, in order to support those who still don't qualify for subsidies because their income falls below a certain threshold. If you feel you may qualify for the newly expanded Medicaid, you can apply here.