Health Insurance Basics

Tax Information Regarding the Affordable Care Act

Click here to find licensed agents and brokers affiliated with a professional organization, the National Association of Health Underwriters (NAHU), that have certification to sell insurance available on the federally facilitated marketplace
(as designated by: PPACA or Exchange Broker Certification OK)

Federal Resources

• www.HealthCare.gov Consumer site for eligibility, plan comparisons, subsidy and cost sharing reductions, enrollment and Q&A.
  • Individuals, employees, agents/brokers: Toll-free FFM Call Center available 24/7 @ 1-800-318-2596 or TTY 1-877-871-6594.
  • Employers, agents/brokers: Toll-free FF-SHOP Call Center M-F 8-4PM CDT @ 1-800-706-7893 or TTY 1-800-706-7915
• Missed Open Enrollment? https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=1
• Am I eligible for Special Enrollment Periods? https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2
• Timeline: Beginning in 2010 – What’s Changed and When: http://kff.org/interactive/implementation-timeline/ provides a year by year summary of PPACA provisions.
• Taxes: Internal Revenue Service (IRS) http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions provides a summary of tax-related provisions.
• Regulations: Center for Consumer Information and Insurance Oversight (CCIIO) http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html is a source for federal regulations and guidance.
• Compilation of Patient Protection and Affordable Care Act: http://housedocs.house.gov/energycommerce/ppacacon.pdf the full text of the law.

Federal Reform Insurance Provisions

• A federally-created marketplace opened for individuals and small employers on October 1st, 2013. During Open Enrollment all Oklahomans can shop and enroll for coverage. Outside of Open Enrollment, you may apply for coverage if you fall into a category of eligibility called Special Enrollment. People with incomes between 100 and 400 percent of federal poverty level may be eligible for premium and cost sharing reductions. https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/
• Find more information on www.healthcare.gov.

Essential Health Benefits

• The health care reform law requires individual and small employer group plans to cover a minimum package of essential health benefits beginning in 2014. https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/
• The essential health benefits package is based on the coverage offered in the most popular plan in the Oklahoma small group market, called the benchmark plan, which is BCBSOK Blue Options Plan. For the Oklahoma Plan Summary and more information http://www.cms.gov/cciio/resources/data-resources/ehb.html#oklahoma
• Preventive Care: Individual and small and large employer plans are required to provide certain preventive care service without cost sharing. https://www.healthcare.gov/preventive-care-benefits

Pre-existing Conditions

• In 2014, health insurers must offer coverage to all individuals and employer groups in or out of the exchange who purchase an ACA compliant comprehensive medical plan, regardless of health status. More information on pre-existing conditions. https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/

Individual Mandate

• Beginning January 1, 2014, most consumers will be required to have qualifying health insurance coverage. More information on the Individual Mandate can be found here: https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/
• The Tax Cuts and Jobs Act eliminated the penalty for not having ACA coverage starting in 2019.  The mandate was not repealed but penalty was zeroed out.

Employer Mandate

• Beginning January 1, 2015, employers with 100 or more full time equivalent employees and beginning January 1, 2016, employers with 50-99 or more full time equivalent employees will be required to pay tax assessments if their employees receive subsidized coverage through the marketplace because the employer doesn’t offer minimum essential coverage or because the coverage offered is unaffordable. For more information on employer responsibilities.  https://www.irs.gov/affordable-care-act/employers/employer-shared-responsibility-provisions
• Employers with 25 or fewer full time equivalent employees may be eligible for tax credits if they provide health coverage.
• General Information for Employers with less than 50 full-time equivalent employees – FF-SHOP. https://www.healthcare.gov/small-businesses/

Grandfathered Plans

• Plans issued before March 23, 2010 are not subject to many of the requirements of the federal reforms and will not include many of the required coverage. For more information on grandfathered plans. https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/