frequently asked questions

No!  Although the Affordable Care Act (ACA) mandated individuals have qualified health insurance coverage beginning in 2014, the mandate was lifted in 2019.  As of 2019 tax filing, individuals are no longer subject to a tax penalty (Individual Shared Responsibility Payment) for not having qualified health insurance coverage.

Qualifying for the Advanced Premium Tax Credit (APTC) is based upon your household size and household income.  Under the 2014 Affordable Care Act (ACA) calculations, households whose Modified Adjusted Group Income (MAGI) was lower than 400%, but higher than 158%, would qualify for some level of APTC.  Additionally, household income between 158%-250% would qualify for Cost Share Reduction (CSR) - which would provide for lower deductibles, out-of-pocket maximums, copay, etc.

Generally speaking, employers are not obligated to offer any "fringe benefit" to their employees; including health insurance.  However, beginning 2014, the Affordable Care Act (ACA) does impose a tax penalty (Employer Shared Responsibility Payment) if an employer has more than fifty (50) employees and does not offer a group health plan that provides Minimum Essential Coverage (MEC).

Employees are not required to enroll in the group health plan(s) that may be offered by their employer.  However, if the cost for the employee (only) to enroll on the group health plan is less than 9.86% of their household taxable income, the employer plan would be considered "affordable" and neither the employee nor his/her family will qualify for the subsidy in the Marketplace.

That depends...  If you or your spouse continue working past age 65 and remain eligible for coverage through a group health plan, you may be able to delay your enrollment in Medicare.  Generally speaking, if the employer sponsor has twenty (20) or more employees on payroll, the group health plan would be Primary to Medicare.  In this case, and as long as the coverage is deemed "creditable" - an individual may delay enrollment in Medicare without penalty.

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Since 2014, the Marketplace has had limited enrollment periods that allow individuals to enroll in new coverage, change existing coverage, or simply add dependent(s) to their plan.  These are include:

• OPEN ENROLLMENT - November 1 - December 15 / coverage begin January 1st
• SPECIAL ENROLLMENT - Varies based upon the type of event, but generally within sixty (60) days of the event that permits a Special Enrollment / coverage begins 1st of the month following enrollment OR 1st of the second month following if received after the 15th of the month

For more information on Special Enrollments, give our office a call or visit this website.

There are a few different enrollment dates for Medicare Part A&B, as well as Medicare Advantage / Prescription Drug Plans.  These include:

• INTIAL ENROLLMENT PERIOD - The three (3) months prior to your entitlement date; the month of your entitlement; the three (3) months following your entitlement month. 3+1+3= 7 month window. / coverage begins 1st of the month following but no earlier than the 1st of the entitlement month
• GENERAL ENROLLMENT PERIOD - January 1 - March 31 / coverage begins July 1st
• ANNUAL ENROLLMENT PERIOD - October 15 - December 7 / coverage begins January 1st
• OPEN ENROLLMENT PERIOD - January 1 - March 31 / coverage begins 1st of the month following enrollment
• SPECIAL ENROLLMENT PERIOD - Varies / coverage begins 1st of the month following enrollment

For more information on Medicare enrollment dates, give our office a call!