Stay tuned for the next episode of “As the ACA Turns”

Word has come down that the Obama Administration (actually the IRS) is delaying one key element of the Patient Protection and Affordable Care Act (PPACA, ACA) until 2015….the requirement for mid to large companies (that would be 50 employees and above) to offer health insurance to their employees or pay a fine. Technically though, these companies are still REQUIRED to provide health insurance to their full-time employees by January 2014 but they won’t have to pay the fine (at hundreds of dollars per day per employee) for not providing insurance until 2015.

So, were the delays due to difficulties in the reporting requirements of these companies or is it political maneuvering, mid-term elections, or just plain whining? Personally I don’t know…and really don’t care why it was delayed but I DO care that employees will go without employer-sponsored health insurance for another year.

So what happens to all those individuals that were counting on health insurance come January 2014? Well, for some of you, it might actually be a bit of a blessing in disguise. “What? How? I don’t believe you!,” you say. Let me remind you of one of THE KEY elements of the ACA that will take affect 1 October 2013. Remember that little thing called the Health Insurance Marketplace (also known as the Exchange)? Remember how it relates to the Federal Poverty Level (FPL)? Remember the term “premium tax credit” or now also referred to as “cost-sharing reductions”? Light bulb just went off didn’t it. Yeah!!

Refresher course: Individuals making between about $15,000 and $45,000 per year (133%-400% of the FPL) will be eligible for a premium tax credit, that is, help with paying for health insurance premiums. The lower your salary, in comparison to the FPL, the higher your tax credit. For a family of four, 400% of the FPL equates to about $92,000 per year. So, you might be surprised to see that you are actually eligible for financial relief in purchasing your health insurance on the Exchange. (Note, the government will be paying the insurance companies directly for your reduced premium costs, so don’t expect a check in the mail for the difference.)

Let’s review how the Health Insurance Marketplace (Exchange) will work. Individuals and families with incomes between 133%-400% of the FPL will be able to pick from a range of Qualified Health Plans (QHP), and fortunately, most will be eligible for help from the government to pay their premiums.

Low-income individuals and families will be directed to safety-net programs for which they might qualify – Medicaid, CHIP (Childrens’ Health Insurance Program). But alas, this could be a problem in states that choose not to expand their Medicaid programs under a separate part of the health care law. One of our recent posts listed those states that are/are not expanding their Medicaid program. In that case, sadly, many low-income residents in those states would remain uninsured…which basically negates the premise of the ACA of providing affordable and accessible health insurance to all legal Americans.

So…don’t agonize too much at this time because the big companies convinced the IRS to delay one of the ACA requirements…check out or and play around with their premium tax credit calculators. You just might be surprised to find a little bit of sunshine peeking out from behind those grey storm clouds.

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