Health Care Reform – Frequently Asked Questions

With October 1st (Open Enrollment) fast approaching and still so much uncertainty with regards to Healthcare Reform for both individuals and small businesses (less than 50 full time employees), I have compiled a list of the most frequently asked questions for your convenience. As always, free consultations are always available and highly encouraged.

1. I have heard that I will have to have health insurance in 2014; is this true? Starting in January of 2014, you will have three choices for health insurance if you don’t have a government plan. The first choice is the option of getting your health insurance through your employer. The second choice is to get health insurance on either the individual health exchange or directly through an insurance carrier. Brokers are able to help you with either of these choices. The third option is not to elect to get health insurance and pay the penalty.
2. What is the penalty? Beginning in 2014, the penalty will be $95.00 or the greater of 1% of your taxable income. In 2015, the penalty will be $325.00 or the greater of 2% of your taxable income. In 2016, the penalty will be $695.00 or the greater of 3% of your taxable income. There will be annual adjustments to the penalty each year after 2017.
3. Will my broker still be able to help me with all these choices? Yes, your broker is still able to help you through this process and give you choices that are the most beneficial for you.
4. Do you know what the insurance will cost? At this time, we still don’t know the exact cost of the plans. We have been told by insurance carriers that the rates will be out on 10/01/2013.
5. What happens if I can’t afford the insurance? There will be both subsidies and credits that you may qualify for to help with the premiums.
6. How will I know if I qualify for these subsidies as well as credits? Your broker will be able to help you with this process and share what is the best option for you.
7. Will there be just one plan that is available? No, there will be several plans that you can choose from and each plan will have a different price. The plans will be set up in four tiers – Platinum, Gold, Silver, and Bronze. As the name implies, the platinum will cover more throughout the calendar year, however, it will be more expensive to purchase. The Bronze plan will cover less, however, it will be less expensive to purchase.
8. How will I know that the plan I pick will cover what I need? As an individual or a small business purchasing a health plan on the exchange, there are ten essential benefits that must be covered. Otherwise known as EHB (Essential Health Benefits), they are ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation services, laboratory services, preventative and wellness services, and pediatric services including pediatric vision and dental.
9. You said that all these services will be covered; will they be covered at 100%? No; depending on the tier of plan you choose (Platinum, Gold, Silver, and Bronze) will determine your out of pocket costs for the calendar year.
10. My employer offers insurance – should I get my insurance through my employer or individually? This is determined by the size of your employer and what your employer offers. It is best to have your employer speak directly with their broker so they know the best options for their business as well as their employees because they also can receive both penalties and more taxes.


512803HBW_LogoTerri Trepanier is the owner of Balanced Care Health and Supplemental Insurance and a licensed insurance consultant and broker with Associated Brokers.    Licensed in both Maine and NH,  her specialty is working with small businesses, individuals, and families with their health and life insurance needs.  She is certified to offer health plans both on and off the exchange and is contracted with every health insurance company that offers plans in both New Hampshire and Maine.  Her other passion is assisting Medicare beneficiaries with their Medicare Supplemental, Medicare Part D Prescription Drug Plans, and Medicare Advantage plans. Terri has seen firsthand the importance of insurance products and how they help families.  Her goal with Balanced Care is to “Insure Security and Peace of Mind One Family at a Time”.

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