Blog : Health Insurance by way of the Affordable Care Act

Whenever I discuss health insurance with clients the first misunderstanding is concerning the ACA (Affordable Care Act) Law itself.  The ACA law governs all health insurance throughout America. It outlines what a health insurance policy will cover and who is eligible.  So, there is no escaping the affordable care act.   Even though the law is Federal it is still distributed through private health insurance companies that are for-profit and some non-profit companies.

The intention of the law was to insure all Americans through one of the following Health Insurance Channels:  State Medicaid programs, Medicare Insurance, Company Group Plans, Individual Health plans and finally Federally Subsidized Individual Health Plans.  This would give coverage for every American.

However, that is not exactly what happened.  It is the States responsibility to offer markets and govern their own marketplace.  Every state is a little different.   I am only going to discuss the State in where I reside, Florida.

My approach to this subject will be as if I had a sales appointment with you and only for the scope of eligibility.  Plan descriptions will follow in another blog.  First, let us find out where you can obtain insurance in Florida and who is eligible.

First Question – Do you have Insurance available to you or your spouse at work?

Is your total household income above the Federal Poverty Level?

If your total household income is below the FPL (Federal Poverty Level) then you will be eligible for the state Medicaid Program only.  Unfortunately, the State of Florida did not expand its eligibility rules for Medicaid.  This left many people uninsured.  Mainly, single persons with no children. 

So where does that leave the single person.  They would have to pay the full premium for the marketplace insurance (no subsidies).

For those individuals or families that fall between 100% to 450% of the FPL, they can apply for subsidies to help reduce the cost of insurance.  They do that by filling out a federal marketplace application.  It is based on how you file your taxes.  That is also how they determine the subsidy amount.  The closer you are to the FPL the less you will have to pay for insurance.  Conversely, the closer you are to 450% the more you will pay for insurance and receive the least amount of subsidy.    

What if I earn over 450% of the Federal Poverty Level?

For this group of people, you only have two options.  Insurance through your employer or full pay through the marketplace.  It is always better to purchase it through your employer because your insurance premiums will not be subject to FICA taxes.  For all tax questions you should consult a Certified Public Accountant.

What if I am self-employed and do not own a corporation?

Does where I live make a difference?

Short answer, Yes.   The county you live in will determine which companies are available and how much you will pay.  That is determined mostly by what networks the companies, doctors and hospitals have chosen to work with.  If you live in Okeechobee, Florida you will have to purchase health insurance that server Okeechobee. 

This covers the very basic eligibility rules for individual coverage and is not a complete discussion of the topic.  However, it will help you get started in your search for health insurance coverage.