Individuals
Individuals are required to project their income for 2014 to determine the maximum subsidy that may be available to them through a public exchange to help reduce their insurance premiums.
If it turns out that an individual projected their income incorrectly, and the premium subsidy they received was too much, then the individual will have to pay back a portion or the entire subsidy amount when they file their federal income tax return.
By this time most of us are starting to become familiar with the subsidies that are available to eligible individuals that enroll in coverage through the Health Insurance Marketplace, also known as the Exchange. Many of us have also heard the phrase:
“If your household income is within 400% of the Federal Poverty Level you may qualify for a subsidy in the Exchange.”
This seems simple to understand on the surface, but this statement is packed with terms that require further definition. We’ve put together a summary to help you understand some of the key pieces of information within this statement.
The InsureXSolutions® private insurance exchange, operated by Flexible Benefit Service LLC (Flex), has launched new resources which can be found at insurexsolutions.com.
There is no need to wait.
The Center for Medicare & Medicaid Services (CMS) released proposed regulations about a new Basic Health Program that will be available starting in 2015. The Basic Health Program will be a lower cost alternative for people that cannot afford health plans in the insurance exchanges, such as those people that fall just outside of Medicaid eligibility.
New guidance was released on September 13, 2013 that applies to Health Reimbursement Arrangements (HRAs) and other employer healthcare arrangements. Much of the guidance impacts employers that want to provide reimbursements to employees to help pay for individual health insurance policy premiums. Many employers have given this idea some consideration instead of offering a traditional group health plan to reduce their costs.
Leadership, resources cap decades of achievements and milestones
Earlier this week, Flexible Benefit Service LLC (Flex) celebrated its 25th anniversary in the health insurance industry. A marketplace leader since 1988, Flex is a trusted general agency and account-based benefits administrator, who also operates the InsureXSolutions® private health insurance exchange.
Last week, the U.S. Department of Treasury published final guidance on the Individual Shared Responsibility requirements, also known as the Individual Mandate. The Affordable Care Act (ACA) mandates that most U.S. citizens and permanent residents have a qualified health plan starting in 2014 or face financial penalties.
The Affordable Care Act (ACA) requires non-grandfathered plans to impose limitations on out-of-pocket expenses for essential health benefits starting in 2014. The out-of-pocket limitations will be capped next year at $6,350 for single coverage and $12,700 for family coverage.
However, some self-funded plans will be exempt from this requirement until 2015. The guidance indicates that self-funded plans contracting with multiple service providers can delay this requirement for one year.
On Monday, July 22nd, 2013, Governor Pat Quinn signed legislation that will expand the Medicaid program for residents of Illinois starting in 2014. Illinois is now the 23rd state that has decided to move forward with the expansion of its Medicaid program.
The Affordable Care Act (ACA) provides federal funds for states opting to expand its Medicaid program. Federal funds will pay for all of the costs to cover newly eligible people from 2014 to 2016. The federal funds will then start to gradually drop from 2017 until 2020 where it will level off at a 90% payment rate from that year and moving forward.
The public insurance exchanges are expected to introduce a new way for individuals to obtain health insurance coverage next year. However, with the introduction of these exchanges comes a number of complexities and nuances. That includes the topic of premium payment processing and late payments.
Individuals that qualify for Advanced Premium Tax Credits (APTC) through the exchanges will have a portion of their premium subsidized by the federal government, but the balance of the premium will be their responsibility.
Join Our Mailing List
Benefits Buzz RSS Feed