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Health Care Reform Plans

Learn About Metallic Plan Types, Benefits, Prices, Subsidies, Employer Requirements and More

At the end of the 2016 Open Enrollment, approximately 12.7 million Americans had enrolled in a Health Care Reform Plan through one of the State or Federal Marketplaces. Millions of these enrollees were determined eligible for financial assistance. Health Care Reform plans are the only ones that can receive a Premium Tax Credit, and all are considered Qualified Health Plans and meet certain standards and requirements set forth by the Affordable Care Act of the United States. For more information, see Obama Care Plans and Prices.

Obamacare Metallic Plans include:

  • Minimum Essential Coverage (MEC) – meets the required standard of coverage required by law so you don’t have to pay the Tax Penalty
  • 10 Essential Benefits – a set of health care services required by the Health Care Reform law including maternity and newborn care, mental health services, and free preventative services
  • Guaranteed Issue – you will be approved regardless of pre-existing health conditions without a higher rate
  • Metal Tiered Plan Designs (Bronze, Silver, Gold, Platinum) – offer various levels of coverage options; makes understanding plan types easier: the more precious the metal, the richer the benefits of that plan
  • Subsidies or Tax Credits can be applied and lower your prices if you qualify
  • Cost Sharing Reductions can be given if your income qualifies – This means lower out of pocket expenses by reducing deductibles, coinsurance, or co-pays
  • Private Insurance Carriers to choose from
  • Network Choices – PPO, EPO, HMO, HSA and others
  • Dental and Vison Benefits for children in some states

Important to Know:

Individuals must apply for their Health Care Reform insurance only during an annual Open Enrollment period whether they have a plan inside or outside of the Marketplace.

If you missed Open Enrollment, you may qualify for a Special Enrollment Period if you have had a life triggering event such as having a baby, getting married, moving, or involuntarily losing your health insurance. Document proofs are required to substantiate your qualifying life event.

The Individual Mandate requires all Americans/Lawful Immigrants to have MEC health insurance, or have an exemption, or pay a Tax Penalty.

So far the ACA has not instituted the Cadillac Tax on richer health insurance plans. However, this tax may come into effect in the next couple of years.

Requirements for Employers

The Employer Mandate requires all employers of 50 or more full-time equivalent employees to offer health insurance to at least 95% of their employees and dependents or else pay a tax penalty. Generally, if you are offered health insurance by your employer, then you do not qualify for a subsidy for a Health Care Reform Plan (some exceptions apply), but you may apply for a plan without a subsidy.