Indviduals / Families

Are all individuals living in the United States subject to the individual mandate to buy health insurance?

All citizens are subject to the individual mandate, as are all permanent residents and all foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes. Foreign nationals who live in the United States for a short enough period that they do not become resident aliens for federal income tax purposes are not subject to the individual mandate, even though they may have to file a U.S. income tax return.

Noncitizens are exempt from having to purchase minimum essential coverage if they are 1) not U.S. citizens and 2) either non-resident aliens for the taxable year or not lawfully present in the U.S. on any day in the month.​

Does health care reform change the way premium rates are calculated?

Health insurance companies may use specific factors as determined by the Affordable Care Act in calculating premium rates for coverage in the individual and small group market for plan or policy years beginning on or after Jan. 1, 2014. These factors include: individual vs. family coverage, rating area, age and tobacco. These rules do not apply to the large group market at this time, nor do they apply to self-funded coverage.​

What is minimum essential coverage?​

Minimum essential coverage is the type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act. Minimum essential coverage does not include things like accident only coverage/disability insurance, liability insurance, worker’s compensation, etc.

If an individual has a deductible higher than $2,000, will the deductible have to be reduced in 2014? 

In 2014, the annual deductible for a health plan in the small group market may not exceed $2,000 for self-only coverage or $4,000 for family coverage. Individual market plans are not held to the same deductible limits but do have maximum out-of-pocket requirements.

Does the open enrollment period (October 1, 2013 – March 31, 2014) apply only to the Marketplace or does it apply to non-Marketplace products as well?

The individual Marketplace open enrollment will mirror individual initial open enrollment when buying directly from an insurance company. Child-only plans will operate like all other individual policies.