Looking for some easy-to-understand talking points about the Affordable Care Act (ACA) to help your groups—and their employees—grasp the key aspects of the legislation? Or maybe you just need a quick rundown yourself! Dive into these short and sweet facts:

• Health reform places regulations on the health insurance industry. The law’s intention is to increase quality, affordability and availability of health insurance.
• Open Enrollment for individuals begins Nov. 15 and runs until Jan. 15. Groups can apply on the SHOP (Small Business Health Options Program)—a subsection of the Marketplace—at any time. Enrollment is ongoing. They should enroll by the 15th of the month for coverage starting as soon as the 1st of the month.
• Individuals who have income at least as high as 100% of the federal poverty level ($15,060 for a single adult or $31,200 for a family of four) may be eligible for premium tax credits through the Marketplace. These tax credits help offset the cost of insurance premiums.
• Health insurance plans must offer a comprehensive package of items and services, called essential health benefits (EHBs). EHBs include services in at least these 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
• Health insurance carriers can’t place lifetime limits on coverage. Annual limits (caps on the amount an insurance company will pay in a year for EHBs) are eliminated as well.
• Medicare isn’t part of the Marketplace, so if individuals have it, they should keep it!
• Medicaid and Children’s Health Insurance Program (CHIP) benefits have been expanded to provide insurance to up to 82 million people nationwide.

What Employers Need to Know

• All full-time workers employed by companies with over 50 employees must be offered job-based health insurance.
• Large groups will pay a penalty if they:
  1. Don’t offer minimum essential coverage to a certain percentage of their full-time employees and their employees’ children, or
  2. Offer coverage to a certain percentage of those employees and their children, but the coverage doesn’t provide “minimum value” (generally, covers at least 60 percent of the cost of benefits), or is not “affordable” (generally, the cost of coverage doesn’t exceed 9.5 percent of the employee’s income
  Note: The penalty won’t kick in unless a full-time employee receives a premium tax credit or cost-sharing reduction because of the circumstances outlined above.
• Small businesses with under 50 full-time employees can use the SHOP to purchase group health plans for their employees. However, businesses of this size are not required to offer health coverage.
• Small businesses with under 25 full-time employees may qualify for a small business health care tax credit, making the cost of providing health insurance lower. The tax credit is only available if the business gets coverage through the SHOP.

What Individuals Need to Know

• Kids can stay on their parents’ health insurance plan until age 26.
• They can’t be denied health coverage based on health status.
• They can’t be dropped from coverage when they are sick.
• Pre-existing conditions and gender discrimination are eliminated and will no longer affect the cost of their insurance on or off the Marketplace.
• If they don’t currently have coverage, they can go to the federal government’s Health Insurance Marketplace, or to their state’s exchange, if applicable, during open enrollment to buy a private insurance plan.
• They’re not required to buy insurance on the Marketplace, but it’s worth it to fill out an application to see if they qualify for assistance before shopping for outside insurance.
• When they apply, they’ll find out if they qualify for free or low-cost coverage from Medicaid or the CHIP.
• To buy Marketplace insurance outside of open enrollment, they have to qualify for a special enrollment period. Qualifying events include things such as marriage, birth/adoption of a child, or loss of health coverage.
  
  

And there you have it: a quick and easy look at the ACA! While there's a lot more to explore, these are the main points to get you started. If you're curious and want to learn more about the ACA, the Marketplace website is packed with helpful, easy-to-understand information. Just use the 'Search' feature to find answers to any questions you might have. Check it out at www.healthcare.gov. 

Any questions about your current Solstice products? Login to your portal on https://www.solsticemarketplace.com/ 

Want to start selling Solstice? Give us a call at 877-760-2247 or email us at sales@solsticebenefits.com