The Patient Protection and Affordable Care Act Which Was Signed Into Law on March 23, 2010. Also Known as "Obamacare".

ObamaCare's health care reform does a number of important things including offering Americans a number of new benefits, rights, and protections in regards to their healthcare, and setting up a Health Insurance Marketplace where Americans can purchase federally regulated and subsidized health insurance during open enrollment. The law also expands Medicaid, improves Medicare,requires you to have coverage in 2014 and beyond, and contains some new taxes and tax breaks, among other things.

The Health Insurance Marketplace helps uninsured people find health coverage. We can assist you to fill out a Marketplace application and we'll tell you if you qualify for:

  • Private health insurance. Plans cover essential health benefits, pre-existing conditions, and preventive care. Some plans include dental coverage. In other cases, free-standing dental plans are available.
  • Lower costs are based on your household size and income. Most people are eligible to use the Marketplace.

Most people must have health coverage or pay a penalty. If you don't have coverage in 2016, you'll pay a fee of either 2.5% of your income, or $695.00per adult ($347.50 per child), whichever is higher. You'll pay the fee on your 2016 income taxes.

Some people qualify for an exemption from the fee, based on income or other factors.

You're considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.

You can also buy a plan outside the Marketplace and still be considered covered. If you buy outside the Marketplace, you won't be eligible for premium tax credits or lower out-of-pocket costs based on your income.

If you're eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won't qualify for lower costs based on your income unless the job-based insurance isn't considered affordable or doesn't meet minimum requirements.

If you have Medicare, you're considered covered and don't have to make any changes. If you have Medicare, you can't use the Marketplace to buy a supplemental plan or dental plan.

Coverage, Credits, Payments

  • If you are like most people, you probably already have qualifying health care coverage and don't need to do anything more than continue your insurance.
  • If you don't have or maintain coverage, you will have to get an exemption or make a payment with your federal income tax return.
  • If you don't have coverage, you may be able to get it through the health insurance marketplace.
  • If you get coverage through the health insurance marketplace, you may be eligible for the premium tax credit.
Woman paying with card at pharmacy
Tax credits binder with pen

Premium Tax Credit (PTC)

  • The premium tax credit can be paid in advance to your insurance company or to you when you file your federal income tax return. Find out more about the option to get it now or get it later.
  • If you receive advance credit payments, you need to report changes in circumstances that will affect the credit to the Marketplace as they happen.
  • If you don't have coverage or qualify for an exemption you may have to make an Individual Shared Responsibility payment when you file your income tax return. You will report your coverage, exemption or payment on your federal income tax return.

Small Business (SHOP) Overview

The Small Business Health Options Program (SHOP) Marketplace helps businesses provide health coverage to their employees.

For 2014, the SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). If you have fewer than 25 employees, you may qualify for tax credits if you buy insurance through SHOP.

If you're self-employed with no employees, you can get coverage through the individual Market Health Insurance Marketplace, but not through SHOP.

  • Benefits of the SHOP Marketplace
  • You control the coverage you offer and how much you pay toward employee premiums.
  • You can choose from 4 levels of coverage to find a plan that meets the needs of your business and employees.
  • You can start coverage any time. Enroll by the 15th of the month and coverage can begin on the 1st of the following month. If you buy SHOP coverage and have fewer than 25 employees, you may qualify for a small business health care tax credit worth up to 50% of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. Beginning in 2014 the tax credit is available only for plans purchased through SHOP.

  • How to know if you qualify for the SHOP Marketplace
  • In 2014, SHOP is open to employers with 50 or fewer full-time equivalent (FTE) employees.
  • In order to use SHOP, you must offer coverage to all of your full-time employees – generally those working 30 or more hours per week on average.
  • In many states, at least 70% of your full-time employees must enroll in your SHOP plan. (Employers who apply for SHOP coverage between November 15 and December 15 each year can enroll without meeting this requirement.)
  • There is a SHOP Marketplace in each state. You must have an office or employee work site within the SHOP's service area to use that particular SHOP.

To enroll in a SHOP plan, you'll use an agent, broker, or insurance company. You'll also fill out a SHOP eligibility application.