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Open Enrollment: November 1st - December 15th

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Obamacare/ The Affordable care Act (ACA) 

 

What is Obamacare? 

Obamacare is a term used to describe the Affordable Care Act (ACA). This law was put into place to make it easier for people to purchase the health insurance they need. The Affordable Care Act mandates that health insurance companies are required to provide certain levels of coverage with every plan. In 2010, President Barack Obama passed the Affordable Care Act (ACA) or Obamacare to help reduce healthcare costs for families and ensure more people were able to access health insurance. Originally, it required everyone to have qualifying insurance or they would face a tax penalty. However, it has evolved over the years. The Affordable Care Act also established marketplaces where people can review and compare healthcare plans to find the one that is right for them. 

What is the Marketplace? 

The federal Health Insurance Marketplace, which is also called the "Marketplace" is the website where individuals can browse various health care plans available under the Affordable Care Act, commonly known as "Obamacare," as well as compare them, and purchase health insurance. The Health Insurance Marketplace helps you find health coverage that fits your needs and budget. Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more.

Affordable Care Act Requirements 

The ACA includes multiple requirements for health insurance companies, including: 

  • Prohibits lifetime monetary caps on coverage 

  • Sets annual in-network out-of-pocket maximums 

  •  Requires that insurers in the ACA marketplace cover at least the 10 essential health benefits, including hospitalizations, outpatient care, emergency services and maternity and newborn care 

  •  Doesn’t allow health insurers to cancel health insurance unless there’s fraud 

  • Forbids insurance companies from denying coverage based on preexisting conditions 

  • Demands that insurers use a minimum percentage of premiums to pay for member medical services 

Eligibility for the Affordable Care Act (ACA) 

  • To be eligible to enroll in a Marketplace plan, you must: 

  • Live in the United States. 

  • Be a U.S. citizen, national or lawfully present. 

  • Not be incarcerated. 

  • Have income above 100% of the federal poverty level. 

However, even if you meet the above eligibility criteria, you’re not eligible to get a Marketplace plan if you’re eligible for Medicare or Medicaid coverage. 

In addition to U.S. citizens, here are a few categories of immigrants who can enroll in Marketplace coverage: 

  • Lawful Permanent Resident (LPR) or Lawful Temporary Resident (LTR) 

  • Cuban/Haitian entrant 

  • Asylee and Refugee (eligible if they’ve been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days) 

  • Temporary Protected Status (TPS) 

  • Work or student visa

 

Which Health Insurance Carriers offer coverage in the Florida Marketplace  

As of 2023, there are 14 insurers offering plans in Florida’s marketplace, including one new insurer (AmeriHealth Caritas) and one exit (Bright Health is no longer offering plans after 2022). As is the case in most states, insurer participation varies from one area of the state to another, but most Florida counties have at least five insurers offering plans for 2023. The following insurers offer 2023 coverage through Florida’s exchange: 

  • AvMed 

  • AmeriHealth Caritas (new for 2023) 

  • Blue Cross Blue Shield of Florida (Florida Blue) 

  • Capital Health Plan  

  • Ambetter/Celtic 

  • Cigna 

  • Aetna CVS Health/Coventry Health Plan of Florida  

  • Florida Health Care Plan Inc 

  • Health First Health Plans 

  • Molina 
     

Oscar Health (Enrollment in 2023 coverage is no longer available after December 12, 2022, although people who enrolled by that deadline can keep their Oscar coverage for 2023, and existing Oscar plans will renew for 2023 unless the enrollee selects a different plan. Oscar experienced very strong enrollment in the early weeks of open enrollment, including enrollees switching from Bright to Oscar. In an effort to maintain a sustainable level of enrollment, Oscar paused new enrollments for 2023. In Minnesota, Medica took a similar approach in the fall of 2017.) 

  • Florida Blue HMO (Health Options) 

  • Sunshine State Health Plan (also affiliated with Ambetter) 

  • UnitedHealthcare
     

COST 

Obamacare costs are based on multiple factors, including age, whether you smoke, how many people are covered on your plan, the health insurance company, your location, the plan’s metal tier, the benefit design and your household income. A health insurance company can’t use your overall health or gender when setting your rates.
 

Plan’s metal tier 

The Obamacare marketplace divides health plans into metal tiers solely based on health insurance premiums and out-of-pocket costs. The metal tiers include Bronze, Silver, Gold and Platinum. 

Bronze and Silver plans have the lowest premiums and highest out-of-pocket costs. That means you pay less to have those plans initially, but you pick up more of the cost when you need care. Gold and Platinum plans have higher premiums and lower out-of-pocket costs, so you pay more for coverage but less when you need care. 

Bronze and Silver plans are the most common ACA plans, while few health insurers offer Platinum plans. 

Which health plan category is right for you? 

Bronze 

  • Lowest monthly premium 

  • Highest costs when you need care 

  • Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year. 

  • Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself. 

Silver 

  • Moderate monthly premium 

  • Moderate costs when you need care 

  • Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than those of bronze plans. 

  • Good choice if: You qualify for “extra savings” — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered. 
     

Gold 

  • High monthly premium 

  • Low costs when you need care 

  • Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low. 

  • Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a gold plan could be a good value. 
     

Platinum 

  • Highest monthly premium 

  • Lowest costs when you get care 

  • Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans. 

  • Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered. 
     

How you and your insurance plan split costs 

Estimated averages for a typical population. Your costs will vary. 

 

 

The Affordable Care Act (ACA) And the self Employed 

If you’re one of the 15 million self-employed workers in America, then you probably already know that buying health insurance hasn’t always been easy or affordable. From finding a plan that covers pre-existing conditions to simply buying insurance to cover basic preventive care, you may have struggled in the past to protect yourself or your family during medical crises. Fortunately for you, the Affordable Care Act changes the rules when it comes to health insurance. 

Entrepreneurs straddle the line between individual and business, and the new healthcare law can be confusing for both groups of workers. Do you qualify as a business for health insurance purposes, or can you use the individual marketplace to buy a plan? You’re not alone in the confusion. Though the ACA was signed into law in 2010, millions of people continue to ask questions about how the new law affects them and their business. We’re here to clear up some of the confusion. The following article discusses the impact of Obamacare on self-employed workers. 

Entrepreneur vs. Employer 

Some people have trouble identifying as self-employed workers due to the nature of their work. For example, you might assume that Realtors who associate with national realty companies are considered employees of those companies. Actually, real estate agents are typically self-employed. Just over 10 percent of the American workforce is made up of self-employed people. How do you distinguish between a sole proprietor and an employer? 

According to the HealthCare.gov website, a self-employed person is someone who works independently of any employees. In other words, if you work as a graphic designer and don’t pay someone to work for you, then you’re considered self-employed. Even self-employed people who hire occasional contract workers to complete certain tasks are still considered self-employed for tax purposes. 

On the flip side, sole proprietors who hire someone to work part-time or full-time on a regular basis are considered small business owners for tax and health insurance purposes. If you pay someone a salary and report their wages to the government using a W-2 form at the end of the year, then you’ve crossed the line into employer territory. We’ll discuss your health insurance responsibilities as an employer in a later section. 

 

Individual Responsibilities 

It’s important to note the distinction between entrepreneurs and employers because the rules on buying health insurance differ substantially for each group. For all intents and purposes, self-employed workers are treated as individuals on the health insurance exchange sites. Whether you walk dogs, write web content, style hair or sell houses, you’re expected to meet certain obligations as a self-employed worker in the United States. Under the Affordable Care Act, every eligible American citizen must purchase some type of health insurance or face a penalty fee known as the “shared responsibility fee” or “non-compliance fee.”

This fee is a tax, and the IRS will collect the tax when you file your return each year. 
 

As an individual, keep in mind that the marketplace, or health insurance exchange site, is only open once per year for open enrollment. The next enrollment period begins on November 1, 2017 and runs through December 15, 2017. If you don’t purchase a health insurance plan during this period, then you may have to pay a fee when you file taxes the following year. Note that the fee only applies to the months that you lack insurance. 

 

Insuring the Self-Employed 

One of the perks of Obamacare is that insurance plans that are created after March 23, 2010 have to offer 10 essential benefits. You may not need or use some of these benefits, but they’re available to everyone who purchases a new plan on or off the Marketplace. If you’re enrolled in a plan through your spouse’s employer, then you may fall within the grandfathered clause. This clause allows businesses to continue offering outdated plans as long as they existed before the ACA became law.

Check with your provider to see if your plan covers the following 10 essential benefits: 

• Emergency services 

• Hospitalization and related care 

• Laboratory testing 

• Maternity care before, during and after labor 

• Mental and behavioral healthcare 

• Outpatient services such as walk-in care 

• Pediatric care 

• Prescription medication 

• Preventive care and wellness visits 

• Rehabilitative services including equipment 

Finding comprehensive coverage has traditionally been difficult for self-employed workers because insurance companies tend to take a conservative approach to offering benefits. Now, you have the option to purchase any plan and receive access to at least 10 basic benefits. Coverage doesn’t necessarily preclude payment. Depending on the type of plan you buy, you’ll still have to pay co-pays or meet a deductible to enjoy some of the benefits, but your plan will cover these things regardless of the level of plan you buy.  
 

Tax Breaks and Deductions 

Keeping tabs on your income as a self-employed worker can be tricky, which is part of why the government requires freelancers and other self-employed professionals to submit quarterly estimated taxes. As you probably know, preparing your own taxes can also be a huge headache. How do you know what to pay Uncle Sam when your income fluctuates so widely each month? Each person develops his own system over time to deal with the chore of taxes, but health insurance throws another wrench into the calculations. 
 

As we outlined above, individuals must buy health insurance or pay a penalty fee when they file taxes for the year. In 2017, the fee is $695 per uninsured adult and $347.50 per uninsured child, per household, or 2.5 percent of your household’s total taxable income, whichever is greater. The fee will go up in 2018. On the upside, you can still take the tax deduction for health insurance if you purchase a qualifying plan during the year. 
 

The government offers a number of tax deductions and credits to self-employed people in an effort to help them offset the cost of doing business. For example, you may be able to write off the cost of your home office if you use it solely for work during the year. One of the most important tax deductions is health insurance. This deduction allows self-employed people to write off the cost of their medical, dental or long-term care insurance as long as the following parameters are met: 

  • You earned a net profit from your business. 

  • A partner in your business reported net earnings. 

  • You used an alternate method to report net earnings. 

  • You earned wages as a shareholder.  

  • The insurance policy was in your name, your business partner’s name or the S corporation’s name. 
     

The deduction applies to premiums, and you can only take this deduction if you or your spouse didn’t have the option to enroll in an employer-sponsored healthcare plan during the year. There’s also a limit on how much you can deduct. You can only deduct the cost of insurance and un-reimbursed medical expenses that exceed 10 percent of your adjusted gross income for the year. 

There are other advantages to enrolling in a health insurance plan under Obamacare. Even with the tax deduction, many small business owners and entrepreneurs found it difficult to afford health insurance prior to 2010. Now, you have the option to use government subsidies to buy insurance on the Marketplace. These subsidies help lower monthly premium costs, and millions of people have already taken advantage of the program. Regarding taxes, subsidies are not considered taxable income. You won’t be able to claim them as a credit, but they also don’t count against you for income purposes.
 

There are other advantages to enrolling in a health insurance plan under Obamacare. Even with the tax deduction, many small business owners and entrepreneurs found it difficult to afford health insurance prior to 2010. Now, you have the option to use government subsidies to buy insurance on the Marketplace. These subsidies help lower monthly premium costs, and millions of people have already taken advantage of the program. Regarding taxes, subsidies are not considered taxable income. You won’t be able to claim them as a credit, but they also don’t count against you for income purposes. 

 

The above information is not intended to be taken as tax advice. You may have a completely different tax situation depending on the type of business that you run, so make sure to talk to your accountant or tax adviser about your personal situation and how Obamacare fits in with your business. 
 

Obamacare’s Impact on Growth 

The Affordable Care Act does more than offer insurance to freelancers and self-employed individuals: Over the next few years, experts agree that the new healthcare law should actually stimulate entrepreneurial job growth. In March 2014, Co-Director for the Center for Economic and Policy Research Dean Baker testified that the Affordable Care Act would have a direct and positive impact on job growth for self-employed workers. In his testimony, Baker noted that “it is reasonable to conclude that the ACA will increase self-employment by between 15-25 percent when its effects are fully felt in the next few years.” 


How does a healthcare law stimulate job growth? The ACA impacts job growth by giving entrepreneurs the motive and opportunity they need to branch out on their own. For millions of workers in the United States, working a standard 9-to-5 job is a means to an end. Employers know that they can keep workers on board as long as they offer health insurance. Before 2010, there weren’t many health insurance options for people who wanted to start their own business or work as a freelancer. The Affordable Care Act changed the game. Now, people who want to work for themselves can have their cake and eat it too. 

 

By giving people more options for buying health insurance, the ACA encourages workers who might want to become self-employed to seek new employment opportunities. Businesses will grow and expand, new companies will form, and the self-employment job rate will recover over time. 

Small Business Retention 

Because the ACA requires certain businesses to start providing health insurance for full-time employees, America should see job growth in other areas as well. Competition breeds growth, and competitive businesses will soon start offering health insurance to keep their workforce intact. One of the primary reasons people stay in jobs they dislike is the benefits package. As we mentioned above, this has kept entrepreneurial people from branching out on their own in the past. 

 

In the business world, new benefits options will force business owners to re-evaluate their health insurance plans to make sure that they remain competitive in the marketplace. For people just entering the workforce, health insurance will be all but a guarantee, and companies that want to attract top talent will need to consider supplying appropriate coverage. Even small businesses will need to assess their health insurance policies given new competition. Opponents of the ACA claim that the new healthcare law will stomp out business growth. In reality, the new law may encourage growth across multiple fields. 
 

Using the Individual Marketplace 

Because self-employed workers qualify as individuals for health insurance purposes, you can use the individual marketplace if you’re self-employed. The health insurance exchange site was designed to help people see all of their health insurance options at once so that they could make better decisions about buying healthcare. To sign up for health insurance through the exchange site, visit HealthCare.gov and find your state. You’ll be guided through the process. As mentioned above, the marketplace is only open
during select times, but you can still see your options and get a general idea of your premiums by visiting the site year-round. 

 

Use of Subsidies for the Self-Employed 

One of the best features of Obamacare and the Marketplace is the availability of subsidies to help offset the cost of monthly premiums. If you earn between 100 and 400 percent of the federal poverty level (FPL), then you may qualify for a subsidy. This government credit allows you to purchase insurance for less than you might pay off-marketplace, but there are some restrictions. Most significant, the subsidy allotment is based on your adjusted gross income. Calculating adjusted gross income if you’re self-employed can be not only difficult but seemingly impossible.
 

Income varies widely for people who run their own businesses or work independently as contractors. You might have a great year and earn close to six figures, but you may experience leaner years in which you barely earn a profit at all. When calculating your income for health insurance purposes on the marketplace, it’s easy to see how you might overestimate or underestimate your income.  


The government doesn’t expect perfection when it comes to income calculations for the self-employed, but it does expect you to report changes in your income that could affect the amount of your subsidies. If you earn more money than you initially reported when you received subsidies, then you may owe the excess amount back to the government when you file taxes for the year.

 

Experts recommend that self-employed workers calculate their earnings on a monthly or quarterly basis to make sure they still qualify for their appropriate subsidies. If you notice a substantial change in your income, then contact the exchange you used to enroll and notify officials of the increase. Doing so could help you avoid a surprise bill from the government in April. The subsidy system isn’t perfect, but it’s a good start for helping people afford health insurance. 

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