Affordable Care Act: Marketplace Notice

Synergis is required to provide to you the New Marketplace Coverage Options and Your Health Coverage notice under the federal Affordable Care Act (ACA).  Please follow the link to access the notice.  The first page explains the purpose of the notice and how you may use it.   

 

To further assist you, below are some commonly asked questions that may provide additional guidance for understanding the notice.

 

Question

Answer

Why did I receive the “New Health Insurance Marketplace Coverage Options and Your Health Coverage” notice?

 

Employers are required to provide this notice to all employees regardless of whether or not they are eligible for employer-provided health benefits in accordance with the Affordable Care Act (ACA).

What if I am covered under my employer’s plan? Can I keep it? Will I be penalized if I keep my employer’s coverage?

 

 

Yes. You may still maintain your employer coverage for which you are eligible or obtain health coverage from other sources. You do not need to purchase coverage through the Marketplace in order to avoid the individual mandate penalty.           

Why was the Marketplace established?

 

 

Under the ACA, beginning January 1, 2014 most individuals will be required to have minimum essential health coverage, or else be subject to a penalty. This is referred to as the “individual mandate.” The Marketplace is intended to help individuals meet the individual mandate requirement by providing another place to purchase coverage, and possibly qualify for federal assistance to do so. Information and details are available at www.HealthCare.gov

Do I have to purchase health coverage through the Marketplace?

No. You may still maintain your employer coverage for which you are eligible or obtain health coverage from other sources.

When can I enroll in the Marketplace plans?

At open enrollment for each Marketplace. If you do not enroll during this period, you will not be permitted to enroll in Marketplace Coverage without a qualifying life or special enrollment event until the next Marketplace enrollment period.

Can I drop myself or my dependents from the employer plan if I purchase a plan through the Marketplace or outside of the Marketplace?

In some cases, yes, but in many cases, no. Employer plans have very specific rules that allow enrollment only during the employer’s annual open enrollment period. Generally, employees may not change their elections unless the employer allows a change due to a qualifying life or special enrollment event (such as marriage, divorce, birth of a child, or loss of other coverage).

How do I know if I qualify for assistance to purchase my coverage through the Marketplace?

Individuals who are not offered qualifying health  coverage through their employer may be eligible for government subsidies to help pay for health insurance premiums for plans purchased in the Marketplaces. Subsidies are based on the household income level and how many dependents you have. If the employer health plan is considered affordable according to government definition and meets minimum value requirements, you won’t be eligible for government subsidies on premiums in the Marketplace. This is true regardless of your household income and family size. The  Marketplaces provide details about subsidies.

Who offers Marketplace coverage?

All plans offered through the Marketplace are sold and issued by private health insurance companies and HMOs. 

How will purchasing through the Marketplace affect my tax credits?

If you decide to purchase coverage through the Marketplace, you may be eligible for tax credits to lower your monthly premiums or reduce your cost-sharing expenses.  Eligibility for financial assistance is based on several criteria, such as your household income, family size, and whether you have affordable health coverage available from your employer.

If I lose my health coverage during a leave of absence or due to termination of employment, do I have the option to enroll in Marketplace coverage?

Yes, those would be events that would likely permit enrollment in Marketplace coverage. 

 

More information about the Marketplace and the Affordable Care Act is available at www.healthcare.gov.  California residents also can get information about the California Marketplace – called Covered California – at www.coveredca.com.