What’s the difference between the Health Care Reform Act, the Affordable Care Act, PPACA and Obamacare?

There is no difference. These are the different names for the same law.

What is the Affordable Care Act (ACA) going to do?

One of the main goals of the ACA is to limit the number of Americans without health insurance coverage. This is being done by:

  • Requiring most Americans to some type of health insurance coverage or pay a penalty, and
  • Making it easier for individuals to obtain coverage by:
    • Creating insurance exchanges
    • Encouraging larger employers to provide coverage to all full-time employees
    • Making it easier for people who have medical problems to get insurance
What is the requirement to have health insurance?

Most Americans and other people legally in the US must have “minimum essential” coverage, or they will have to pay a penalty with their federal income tax. This is otherwise known as the “individual mandate.”

What is “Minimum Essential Coverage”?

Minimum Essential Coverage is basic medical coverage. It can be provided by:

  • An employer
  • The government (Medicare, Medicaid, CHIP, TRICARE, VA, etc.)
  • An individual policy (which can be purchased through or outside the insurance exchange)
What happens if I don’t have minimum essential coverage?

People who don’t have the needed coverage will have to pay a penalty with their federal income tax return.

What if my family doesn’t have coverage?

The penalty will apply to each adult in the household who does not have coverage. One-half of the penalty applies to dependent children under age 18 who don’t have coverage. The maximum penalty per family is three times the individual penalty.

What if I can’t afford coverage?

No penalty will apply if the cost of the least expensive health plan through your employer is more than eight percent (8%) of you household income. Other types of assistance, such as Medicaid, may be available to employees with low incomes.

What kinds of employer-provided coverage will meet the health coverage requirement?

Most employer-provided medical coverage will meet the requirement. This includes PPOs, HMOs, and high deductible health plans, whether they are insured or self-funded.

Grandfathered plans will meet the requirement. Plans that provide limited coverage, like dental only, vision only, hospital indemnity, accident only, certain diseased only, standalone HRAs and plan with lifetime or annual dollar limits will not meet the requirement.

You can be covered as an employee, spouse, retiree, or COBRA participant under the employer-provided coverage.

I currently have coverage through the University through the Public Employees Benefits Program (PEBP). Does this coverage meet the health coverage requirement?

Yes, this coverage meets the health coverage requirement and the cost of this coverage to you is intended to be affordable, based on employee wages. For more information on this coverage, check the PEBP Master Plan Document or the HMO Summary of Plan Description or contact the Public Employees Benefits Program at 775-684-7000 to 800-326-5496.

Do my spouse and children have to be covered under the same plan or policy that covers me?

No, you may be covered under different plans or policies.

What if I only have coverage for part of the year?

You will not owe a penalty if you go without coverage for less than three consecutive months during the year. (if you have coverage for even one day in a month, that will count as coverage for that month.)

What’s a Health Insurance Marketplace?

A Health Insurance Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in November for coverage starting as early as January 1, 2017.

Does the State of Nevada have an Insurance Marketplace?

Yes, the state’s health insurance marketplace is managed by the Silver State Health Insurance Exchange. If you decide to shop for coverage in the Marketplace, you can access information through nevadahealthlink.com.

Who can buy coverage through a Health Insurance Marketplace?

Although most people who can buy insurance through their employer or Medicare are expected to keep that coverage, you and your family members will be able to buy coverage through the Health Insurance Marketplace if you prefer.

Are there any advantages to having coverage through my employer instead of the Health Insurance Marketplace?

You will not be able to buy coverage through the Health Insurance Marketplace with pre-tax dollars. It is also unlikely that your employer will contribute to a Health Insurance Marketplace plan as it does for its own plan.

Are there any advantages to having coverage through the Health Insurance Marketplace instead of my employer?

The Health Insurance Marketplaces may offer more choices than most employer plans. If your employer does not provide coverage that meets requirements for minimum value and affordability, and your income is low enough, you may be able to get a tax credit if you buy coverage through the Health Insurance Marketplace.

Are there limits on stopping and starting coverage in a Health Insurance Marketplace?

People may only enroll in a Health Insurance Marketplace during open enrollment or if they have a special enrollment event.

People who have a special enrollment event (marriage, birth, adoption, loss of coverage under an employer plan, loss of coverage that was affordable and met the minimum value requirements) will have a 60 day special enrollment period in which they can elect coverage through a Health Insurance Marketplace, or change plans within the Health Insurance Marketplace.