Mastering The ACA (Obamacare) Maze - What You Need To Know To Find A Plan In 2014

I Want To Sign Up!

Whoa! Like everything that involves the government, it might not be that simple to sign up for coverage. You'll need to have some basic information to be able to navigate the sign up process. Luckily, we are here to help provide information and if you need us to help you find a great plan, just give us a call at 713-422-2935 or contact us at

Subsidy or No Subsidy?

The following chart details the subsidies available based on the size of the family unit and the income benefit limits based on Family Poverty Level (FPL):

This matrix helps individuals and families determine if they qualify for a federal subsidy for insurance coverage.

If your income exceeeds the highest amount listed on the chart above, you do not qualify for a subsidy. Call us and we'll walk you through the easy online process to examine plan options and prices. You can also click on our website to get a free quote today!

The great thing about the new plans available in 2014 is that they will offer enhancements like maternity coverage, no penalty charges for pre-existing conditions, and they are mandated to provide mental health benefits as well. There may be opportunities to obtain coverage BEFORE 2014 to take advantage of lower pricing for policies issued in 2013 that will cover you for the entire year at lower cost. It's worth a few moments to analyze the different options and impact of starting your policy early. Give us a call.

My Income Falls In The Chart - What Do I Do?

If you fall within the chart listed above this means that you will qualify for a subsidy based on your income, but there are a few more questions we'll need to address before you can sign up. Let's dive in and we'll make sure that you know the information you'll need to have to be able to get through the online sign up process to qualify for an exchange plan with subsidy.

If I thought I might be eligible for a subsidy, I probably would like to know exactly how much the subsidy for my family will be.  Here is a great link to a Subsidy Calculator to determine the exact amount of subsidy eligibility. 

3 Basic Pieces Of Information You Must Know!

1) Does Your Work Or Spouse's Employer Provide Health Insurance?

First, if you are employed by a company that offers health benefits to you and/or your family, you may be required to take the coverage and you may be ineligible for subsidies that you might otherwise receive if your employer didn't offer coverage! You need to know if your company has more than 50 full-time employees as they will be required to provide coverage to you.

You can use the checklist and employer benefit form below, which can help you determine if your employer offers coverage. This form can also help you determine affordability, but we'll cover that in the next section. This form may be very helpful for employees that aren't certain about the benefits they are offered. I have a feeling that in future years, this type of form may become mandatory.

Checklist And Employer Benefit Form

2) Affordability Test

The ACA law writers wanted to provide employees an out if their employers offered really expensive coverage they couldn't afford. The law defines whether a plan offering is affordable or not. If the plan is affordable, you will not be eligible to purchase coverage on the exchange and receive a subsidy, you'll need to stick with what your employer provides.

If your employer does offer health coverage, you'll need to determine if the cost of the employee's contribution for health coverage for just the employee self-only coverage does not exceed 9.5 percent of the employee's household income. Did you catch that? 9.5% of the household income! This effectively means that almost every group or employer based plan WILL pass this test. So if you are employed by an employer of 50+ employees, you can almost bet that you won't be eligible to buy coverage out of the group plan.

There is one other technical calculation we can make and that is that we can determine the total out of pocket cost for health insurance premiums for the entire family (employee+spouse+children) if the coverage is offered. If the total family premium of the employer offered plan and/or the Bronze level plan on the exchange exceed 8% of the entire household income, the employee and family officially has an EXEMPTION to the requirement that they purchase health insurance. Yes, this means they don't have to buy the employer plan or any plan at all! While there is this official exemption, I cannot find ANY data that tells us if the family could then purchase coverage on the exchange outside of the employer offered plan if they wanted to. Obviously citizens will want health coverage, not just have some exemption from a penalty. I will continue to search for this answer, but it just isn't in print right now!

3) Your Income (Last Year And An Estimate For This Year)

Yep, if you didn't already guess, you'll need some documents to confirm the income you made in the previous years and perhaps a copy of your last paycheck so we can try to calculate what your family income will be by the end of the year in 2013. This income calculation will help determine the amount of a subsidy you'll get over the course of 2014. At the end of 2014 during the time you file your tax return, the government will then net out any difference between the subsidies you actually received to help pay for your health insurance premiums and the amount you should have received. This could result in a larger tax bill or a larger refund if you didn't get the subsidy you deserved. Obviously this will all be sorted out by April 15th of 2014 during your tax filing deadline.

Wrap Up

I had a simple goal of trying to highlight the three pieces of information you'll need to apply for coverage beginning in October. If you stuck with me and read to this point, it is obvious that this process will be anything but simple. We will work with you to clarify all of the information and provide clear options to help you find great coverage for your budget. We'll help you navigate the search for plans on the exchange where you may receive a subsidy and also off the exchange where you'll want to find affordable coverage that provides great benefits.

We look forward to serving you. Please call us at 713-422-2935 to discuss this post or any other questions you may have. Click here for a fast and easy quote to begin the search process.

Jason W Bohmann
Texas Health Design