The federal health law was created to:
- Make it easier and more affordable for Americans to get quality health insurance.
- Improve the quality of health insurance and health care.
- Increase the focus on preventive care.
What does the health law mean for individuals and families?
Most Americans are now required to have health insurance. There are some exceptions. It also means if you are uninsured or do not have access to insurance through your job, you can enroll in the Missouri Health Insurance Marketplace. It is an online marketplace where you can buy a Qualified Health Plan (, and in Missouri) or coverage from private insurance companies.
What does the health law mean for small businesses?
As a owner, you have access to the Small Business Health Options Program (SHOP), a website to compare and buy coverage for your workers. Currently, the SHOP Marketplace is open to businesses with 50 or fewer full-time equivalent employees. By 2016 the SHOP Marketplace will be open to employers with up to 100 employees.
The SHOP Marketplace is open year round. If you buy coverage by the 15th of the month, it will start the first day of the next month.
Affordable and minimum value coverage
Employers who offer insurance may be subject to penalties if the coverage they offer is not considered affordable or does not provide a minimum level of coverage. To be considered affordable coverage, a worker’s share of premiums should be less than 9.5% of their pay. For example, if a worker is paid $35,000 a year, his or her share of premiums for individual coverage should be less than $3,325 for the year.
For coverage to meet the minimum value requirement, it should have an actuarial value of 60%. For example, if a covered health service costs $100, the health plan would pay $60 and the worker would be responsible for paying $40.
Bronze health plan
A bronze health plan is one of four types of health plans you can buy in the Health Insurance Marketplace. Bronze plans usually have lower monthly costs, but higher out-of-pockets. They usually cover about 60 percent of your health plan costs. You would have to pay the other 40 percent.
Silver health plan
A silver health plan is one of the four types of health plans you can buy in the Health Insurance Marketplace. Silver plans usually have lower monthly costs, but higher out-of-pockets. They general cover 70 percent of your health plan costs. You would have to pay the other 30 percent.
Gold health plan
A gold health plan is one of four types of health plans you can buy in the Health Insurance Marketplace. Gold plans usually have higher monthly costs, but lower out-of-pockets. They usually cover about 80 percent of your health plan costs. You would have to pay the other 20 percent.
Catastrophic coverage or plan
An insurance plan in the Health Insurance Marketplace that offers limited coverage for health care services. This plan is only available to adults under age 30 or adults who get a hardship waiver. Rules for qualifying for Catastrophic coverage are shown at www.healthcare.gov.
Open enrollment period
Open enrollment is a time period, usually a few months, when you can choose or change your health insurance plan. Open enrollment often happens in the fall with changes to the coverage starting in January. If you have a major life change, like getting married, having a baby, or losing your job, you may be able to change your health insurance outside of the open enrollment period.
The Marketplace open enrollment period for 2015 ended February 15, 2015. For coverage starting in 2016, the Marketplace open enrollment period will be November 1, 2015 to January 31, 2016. Some job-based health insurance plans have an open enrollment period where you can add family members who may have been covered by a different insurance plan the year before. Medicare also has an open enrollment period.
Under the Affordable Care Act, a small business is a for-profit or nonprofit business with 50 or fewer full-time equivalent employees.
Full-time equivalent (FTE) employees
Rules in the health reform law count the number of workers a business has as full-time equivalent employees or FTEs. This may not be the same as the total number of employees a business has. FTEs are the combination of all full-time workers and part-time workers added together. Generally, if you have two part-time employees, they would count as one FTE.