The individual mandates under the Patient Protection and Affordable Care Act (PPACA or ACA) take full effect on January 1, 2014. All persons in America are expected to obtain "minimum essential coverage" for the "essential health benefits" Congress requires or face a "shared responsibility payment" imposed by the IRS when the 2014 federal tax return is filed. The penalty in 2014 is a minimum of $95 per person in a household (up to three persons, or $285) and a maximum of 1% of Modified Adjusted Gross Income, which could be significantly higher ($285 equals 1% of $28,500 -- an MAGI of $60,000 would mean a penalty of $600!). The penalty amount will rise in 2015, and again in 2016, and will be indexed for inflation beginning in 2017. Employers with 50 or more full-time equivalent employees will be required to provide employees and their children (but not their spouses) with minimum essential coverage beginning January 1, 2015, or face an employer shared responsibility payment.
To avoid this shared responsibility payment, enrolling in a qualified health insurance plan is required. However, there are a wide variety of plans available to individuals and small businesses now. Persons up to age 64 with incomes at or below 400% of the Federal Poverty Level (FPL) are eligible to receive "premium tax credits" in advance to help pay for the cost of health insurance.
Premium tax credits are only available to persons who enroll in a health plan through the Covered California health benefits "marketplace". Enrolling in a health plan can be done on your own by visiting the CoveredCA website (you may use the link at the bottom of this page), with the assistance of a Certified Enrollment Counselor paid by the Exchange, or with the free assistance of a Certified Insurance Agent.
The chart below shows the 2014 FPL tables (2015 values will be slightly higher). California residents with incomes below 138% of the FPL who attempt to enroll in a qualified health plan will be enrolled in Medi-Cal instead, and persons whose incomes are between 138% and 200% of FPL may be eligible for "enhanced" health benefit programs.
Only a Certified Insurance Agent can give you recommendations on choosing a specific health plan! Choosing a plan based on premiums alone could be a one year mistake.
When you choose to enroll in a health plan through the Covered California marketplace, you will not be able to change plans again until January 1, 2015. There are many factors to evaluate when choosing a health plan, including the "metal tier" of benefits (Bronze, Silver, Gold, or Platinum), the network of providers, the specific plan benefits, and the premium cost. Making a decision based on premium alone could be a big mistake, and spending just a few more dollars per month in premiums could actually reduce your total annual health care expenses by hundreds or thousands of dollars.
As a Certified Insurance Agent (see our "licensing" page), Max Herr will use his years of professional experience as a licensed agent to help you select the specific plan that best meets both your needs and your financial resources. Enrollment counselors may only assist you in determining your need and filling out the application for a health insurance plan -- they are prohibited by law from performing the detailed analysis that your personal situation may require and cannot recommend a specific plan for you and your family.
If you own a business and have at least one full-time employee who is not an immediate family member (parent, spouse, or child), and not more than 50 employees, you are eligible to obtain group health insurance at reduced cost for yourself and your employees (including coverage for spouses and children to age 26) through the Covered California SHOP marketplace. You may also qualify for premium tax credits for up to two years to help cover the cost of providing health insurance to your employees. Contact us for more information.
For information on health insurance plans available in your area, please call us or use the form on the Contact Us page to send us an email.
Vision and Dental Plans are not included in health insurance plans offered through the Covered California marketplace. However, stand-alone vision and dental plans are available. For more information about Vision plans, click on the link to VSP below. With more than 30,000 providers in their national network, you are assured of finding a vision specialist near your home or workplace.