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How Health Reform Impacts You

You Buy Insurance Through Your Employer

If you currently buy your health insurance through your employer, and you plan to continue to buy through your employer in 2014, the impacts of the ACA may be little or minimal for you.

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You Work for a Small Business (50 employees or less)

Currently, there are no laws requiring your employer to offer you health insurance. The ACA does state, however, that if you are offered insurance coverage through an employer, you are not eligible for a subsidy on the public exchange unless:

  • the premium for the health insurance plan you get from your employer is more than 9.5% of your income
    or
  • the plan you get at work covers less than 60% of your allowed medical expenses

If you meet one or both of the conditions above and end up buying from the public State Exchange, you may qualify to receive financial help through federal Subsidies that can:

  • lower your monthly premiums
  • help lower your out-of-pocket health care expenses like copays and coinsurance

You can only get Subsidies if you meet the government’s qualifications, apply on the public State Exchange, as well as buy your plan on that Exchange. What's more, the Cost-Share Subsidy only applies to Silver Level plans.

If your company employs 25 or fewer full-time people, if the average wage is $50,000 or less, and if your company pays at least half of the cost of your insurance, your company could earn a tax credit to help it pay for part of your insurance coverage. If they don’t have a workplace wellness program, they are eligible for a grant to start one.

You’re Employed by a Large Company (More than 50 employees)

You’re not really affected unless one or both of the following conditions apply to you, in which case you can decline your employer’s health insurance coverage.

You can buy a new ACA plan from the State Exchange if:

  • the premiums for your health insurance plan you get from your employer are more than 9.5% of your income,
    or
  • the plan you get at work covers less than 60% of your allowed medical expenses

If you do decide to buy from the public State Exchange, you may qualify for federal Subsidies that can:

  • lower your monthly premiums
  • help lower your out-of-pocket health care expenses like copays and coinsurance

You can only receive a subsidy if you meet the government’s qualifications, apply on the public State Exchange, and also buy your plan there. Keep in mind the Cost-Share Subsidy only applies to Silver Level plans.

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