10 Things Employers Should Know About the Affordable Care Act (Obamacare)

The Affordable Care Act, often referred to as “Obamacare”, has changed the healthcare landscape for the uninsured in the US.  Many, even well-versed health insurance buyers, find the law confusing at times.  Here are the top ten facts we think all small businesses and employers with part-time employees should know about the individual exchange ahead of the upcoming Open Enrollment Period:

  1. INDIVIDUAL MANDATE: As of 2014, everyone (with limited exceptions*) in the United States is legally required to sign up for qualifying health insurance

  2. EMPLOYER MANDATE: Businesses with 50 or more full-time equivalent employees (FTE) are required to provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee per employee by 2016.  The mandate does not require employers to cover their part-time employees** or contractors

  3. FINE FOR NO COVERAGE: Individuals who don’t have coverage for 2016 will pay the higher of these two amounts: 2.5% of yearly household income OR $695 per person ($347.50 per child under 18)

  4. SUBSIDY-ELIGIBILITY: Individuals making up to $47,080 or a family of four with a household income up to $97,000 may qualify for subsidies

  5. ENROLLMENT: 11.4 million Americans are estimated to have enrolled in the Marketplace during 2015 open enrollment

  6. SUBSIDY-GRANTED: 87% of people who selected a marketplace plan for 2015 received financial assistance

  7. AVERAGE SUBSIDY: The average premium was $82 on average after assistance. The average Advanced Premium Tax Credit (APTC) for those enrollees who qualified for the financial assistance in 2015 was $270 per month

  8. DIFFERENCES BETWEEN STATES: Plans, premiums, and subsidies vary by state

  9. SHOPPING EACH YEAR: Individuals are encouraged to shop for health insurance each year to ensure they enroll in the most appropriate plan for their current circumstances.  Additionally, not all plans auto-renew

  10. 2016 OPEN ENROLLMENT: The open enrollment period for 2016 coverage will run from November 1, 2015 - January 31, 2016.  For the rest of the year, only individuals with special qualifying circumstances*** will be able to enroll

*ACA Exemptions: http://obamacarefacts.com/obamacare-exemptions-list/ 
**How part-time status is measured for the ACA: http://www.irs.gov/Affordable-Care-Act/Employers/Identifying-Full-time-Employees
***ACA Qualifying Life Event: http://obamacarefacts.com/special-enrollment-period/


Healthcare.gov just released their updated enrollment numbers [1]. 7.75 million people have selected plans. 4.5 million of those were auto-renewals, leaving 3.25 million people who have signed up this year. 

Over 110,000 have come through HealthSherpa, meaning that our 8-person, seed-stage startup has processed more than 3% of total Healthcare.gov new enrollments this year.

That's more enrollments than 13 of the 17 state exchanges completed all of last year [2].

According to Bloomberg, Healthcare.gov itself has cost over $2.1 billion so far [3], and per Kaiser Health News again, there are 14,000 call center agents [4].

Pretty wild, huh?

[Edit]: Some confused visitors in CA & NY have asked why HealthSherpa has limited functionality in their states. CA, NY and about a dozen other states have their own exchanges, which don't support third-party integration. To see HealthSherpa in action, try a Healthcare.gov state like Florida (example zip code 33604) or Texas (e.g. 77001).

7 Dates to Know About Open Enrollment

Open enrollment is in full force!  That means, if you don't have coverage for 2015 yet, you should get it.  Use our easy zipcode health care search to find a plan. 

With so many moving wheels when a large health plan is rolled out, you probably have a few a questions.  Okay, maybe more than a few questions regarding deadlines.  We have come up with seven dates to know about the 2015 open enrollment period.

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What is the difference? Understanding HMO and PPO

HMO, PPO, EPO, POS -- what do these letters mean and what do they mean for your family’s medical care? Before choosing a health insurance plan for yourself or your family, take a moment to explore the different plan types.

There are two main types of plans: HMOs and PPOs. There are also POS plans and EPO plans, options that combine some desirable aspects of HMOs and PPOs.

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The Medicaid Gap Explained

Vea el articulo en español 

The Affordable Care Act (ACA or “Obamacare”) included a rule requiring states to expand Medicaid coverage to low-income adults. That meant that individuals with a gross annual income of less than about $16,000, couples with income less than about $21,000, and families of four with an income less than about $32,000 would be covered for free under their state Medicaid program.

Some states embraced this expansion of Medicaid, while others protested it. After the law passed some states challenged the requirement to expand Medicaid in court and in 2012 the United States Supreme Court ruled that it was not permissible for the federal government to “force” states to expand their Medicaid programs.

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Why Can’t I Buy Insurance Unless I Have a "Qualifying Life Event"?

Vea el articulo en Español 

One of the major changes under the Affordable Care Act (“Obamacare”) is the introduction of open enrollment. Open Enrollment is a special period during the year when you can buy health insurance or change your health insurance plan. The 2014 open enrollment period ran from October 1, 2013 to March 30, 2014. The 2015 open enrollment opens on November 15, 2014 and runs through February 15, 2015. To buy insurance outside open enrollment, you'll need to have a qualifying life event which triggers a special enrollment period. To learn more about qualifying life events and special enrollment periods, read this post.

So why does open enrollment exist?

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The 10 Benefits All Plans Have to Offer

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Before the Affordable Care Act (ACA or "Obamacare"), insurance companies would often cut costs by only covering certain treatments. This was often confusing and expensive for the consumer, as you couldn't be sure that the treatment they needed would be covered by their insurance policy. 

Under the new rules set out by the ACA all new major medical health insurance policies must provide ten essential health benefits ("EHBs"). These are minimum coverage requirements that all insurance plans must meet. The ten EHBs that all plans must cover are:

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Insurance Signup in 3 Minutes [video]

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We are proud to announce the fastest, easiest way to sign up for health insurance from the health exchange. Our process is engineered from the ground up for simplicity and ease of use, and takes minutes, rather than hours.

Check the video below to see how it works. In the time it takes you to create an account on Healthcare.gov, you'll be finished on HealthSherpa.

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An Obamacare Success Story

Vea este articulo en Español 

33-yr old Jeff* from West Virginia called in to HealthSherpa.com last week. Jeff lives with his fiancée, his 4-yr old from a previous relationship, his fiancée’s child, and the 1-yr old they have together. Jeff works the 4am to 1pm shift at J-Mart*, and his fiancée stays home to take care of the three children.

Two years ago Jeff hurt his back off the job (herniated disc) and has needed surgery and been in pretty much constant pain. He’s been making do with painkillers and taking lots of sick days, but his illness has clearly affected his work and his boss is running out of patience.

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