Read Time: 4 Min

The Affordable Care Act and You

December 6, 2013

Who is required to participate? All taxpayers must enroll themselves and dependents with “minimum essential coverage” by January 1, 2014, or pay a penalty.

What is the cost of not participating?

The greater of:

  1. 2014 = $95.00 or 1% of income (the lesser of)
    2015 = $325 or 2% of income (the lesser of)
    2016 = $695.00 or 2.5% of income (the lesser of)
  2. 1% of the excess of the tax payer’s income over the income tax return filing threshold (2% in 2015 and 2.5% in 2016)

The penalty is capped at 300% of the adult flat dollar penalty or “bronze” level premium.

**For taxpayers under 18 years of age, flat dollar amount is one-half the amount above.
**The penalty is calculated on a monthly basis and is payable with your year-end tax return.

What is the “Exchange”?

In the past, most individuals obtained health insurance through their employer.  For those without this option or for those not offered affordable coverage through their employer, a Health Insurance Exchange will now be an available option for purchasing coverage.  It is best to think of the exchanges as an online marketplace. The exchanges are user-friendly and will now allow these consumers, including some employer groups, to research and shop for health insurance plans with ease and clarity.

The general public will now easily view and more importantly, compare the following for each plan:

  • Rates
  • Scope of services covered
  • Provider Networks
  • Geographic coverage by defined ranges
  • Quality ratings

Health plans on a public exchange will be given a metallic designation: platinum (covers 90%), gold (covers 80%), silver (covers 70%), or bronze (covers 60%). This metallic level will help shoppers understand the level of coverage a plan offers and how much they will need to pay out of pocket and what the plan pays.

Subsidies and tax credits will help make insurance affordable for many qualifying consumers who shop on the public exchanges.

The exchanges are due to be open for business starting in October 2013, allowing individuals or employer groups to shop for health insurance coverage that will begin on January 1, 2014.

The health care reform law creates a new web portal,, that will help individuals and small businesses find health insurance coverage.

All states are given the option to create and run their own exchange.  In the event any state does not run their own Exchange, its citizens will have the option to shop on the Exchange run by the Federal Government. All citizens will have an exchange available to them, despite their state’s offering.

There will also be private exchanges offered by private companies.

Am I eligible for a subsidy?

Consumers are eligible for a subsidy if their household income is between 100% and 400% of the federal poverty level and they purchase insurance coverage on the exchange.

Employees are not eligible for a subsidy if they are covered through their spouse’s plan that meets Affordable Care Act requirements or if they are eligible for Medicare or Medicaid.

I am uninsured with a pre-existing medical condition. How do I obtain coverage right now?

Uninsured residents with medical conditions that are expensive to treat may be eligible for the NY Bridge Plan, a new pre-existing condition insurance plan. (Until January 2014 when more options will be available through the exchange)

  • You may qualify for reduced-cost health insurance through New York State programs such as:
    • Child Health Plus
    • Family Health Plus
    • Healthy NY
    • Medicaid

I am currently enrolled in Healthy New York-What are my options after January 2014?

As of January 1, 2014, Healthy NY will no longer be available to individuals or sole proprietors.

DON’T WAIT! Individuals and families will be able to shop for and enroll in coverage on the New York Health Benefit Exchange beginning in October 2013 for coverage starting January 1, 2014.

For additional details and information, please feel free to contact us at 716-636-7600.