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Frequently Asked Questions: Affordable Care Act (Known as “Obamacare”)

Do I have to purchase healthcare insurance and how do I apply?

The short answer, if you have no insurance, is yes. There are nine exemptions allowed by the Affordable Care Act and the method for claiming an exemption varies according to the IRS. Individuals may apply themselves or contact Richard Goodwin, who is certified to help complete your application. If you apply yourself and would like me as your agent, reference Richard J. Goodwin as your agent; NPN #8878701. It is valuable to have me assist you and at no additional cost. An agent can help in selecting a plan that best serves your needs, and serve as a third party advocate to help with potential claims or policy discrepancies. The completed application will give a final determination of eligibility for assistance with premiums in the form of a tax subsidy and possibly cost-sharing that would reduce out-of-pocket costs. This determination is based on household size and projected income.

What is the penalty if I am not exempt and do not purchase insurance?

$95.00 per adult and $47.50 per child, or 1% of your family income, whichever is greater. You would have to make the payment when you file your taxes. The penalty increases over time.

What if I have pre-existing health conditions?

In the past, health insurance plans could refuse coverage or charge more for a pre-existing condition. Under the provisions of the ACA, a marketplace plan provides coverage for your pre-existing conditions beginning immediately, even if you have been refused coverage in the past. The only exception is for individual plans created on or before March 23, 2010. These plans are called “grandfathered plans” and do not have to cover pre-existing conditions. If you have one of these plans you can switch to a Marketplace Exchange plan during the open enrollment period.

Is the open enrollment period the only time I can enroll?

There are special qualifying events that may make you eligible for a special enrollment period. Examples of qualifying events are moving to a new state, certain changes in income and changes in your family status - for example, marriage, divorce or having a baby.

What providers offer plans that are included in the Marketplace Exchange?

If your state participates in the Federally Facilitated Marketplace, your plans will be listed by county. In Volusia County, there are approximately 133 plans available. In Flagler County, there are approximately 121. These plans represent four levels of coverage, which are called bronze, silver, gold and platinum plans. There are four companies offering plans in Volusia and Flagler counties. These plans are known as “on exchange” and, depending on your projected income, you may qualify for a tax subsidy and cost sharing. The tax subsidy may reduce the premium cost, and the cost sharing may reduce out-of-pocket costs. Both are dependent on your income level. The actual amounts are determined when the application is completed.