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Employee Benefits and Health Insurance Marketplace

Employee Benefits and Health Insurance Marketplace

Healthcare Reform is a very important but complicated subject matter to understand. Trying to sort through it all can be overwhelming. Insurance Associates, a Marsh & McLennan Agency LLC Company and its staff of qualified trusted advisors are here to help make sense of the provisions of the Healthcare Reform Law that impact individuals, families, and businesses. It is our goal to ensure that all of our clients are able to secure the best quality and affordable healthcare that is available in the Marketplace today.

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Health Insurance Marketplace

Health Insurance Marketplace – Health Insurance Exchange for Individuals & Families

What is the Health Care Reform Law?

The health care law, known as the Affordable Care Act (ACA) was passed in March of 2010. It was created to give more Americans access to affordable health care. The ACA required each state to establish a “health insurance exchange” by 2014. The purpose of the health insurance exchange is to provide a marketplace where individuals and small businesses can explore, compare and enroll in health insurance and public assistance programs, as well as access federal tax credits and cost sharing subsidies.

What is a Health Insurance Marketplace?

Beginning in October 2013, the Health Insurance Marketplace is a new way to find health coverage. It is also sometimes referred to as a Health Insurance Exchange. Insurance plans in the Marketplace are offered by private health insurance companies. All the options available for your area are gathered in one place simplifying the search for health coverage for the uninsured.

What is the Individual Mandate?

The Individual Mandate is a key provision of the health care law that took effect on January 1, 2014 and requires that most U.S. citizens and legal residents have minimum essential health insurance coverage, qualify for an exemption or pay a fine.

How do I find a Marketplace to shop for, compare and purchase a health plan?

While all of the plans that are offered in the Marketplace are offered by private companies, the Marketplace is either run by your state, the federal government or a partnership between the two. If one is available, you will use your state’s website. Otherwise, you will use the federal Marketplace website.

Marketplace in Maryland/DC/Virginia

  1. If you reside in the state of Maryland:
    In the state of Maryland, the Health Insurance Marketplace or Health Insurance Exchange is operated by the state of Maryland and is called the Maryland Health Connection.
  2. If you reside in the District of Columbia:
    In the District of Columbia, the Health Insurance Marketplace or Health Insurance Exchange is operated by DC and is called the DC Health Link.
  3. If you reside in the state of Virginia:Virginia chose not to set up a state operated Marketplace or Health Insurance Exchange. The federal Marketplace is available for Virginia residents to search for health coverage.

What if I am offered health insurance through my employer?

You can always choose to apply for health insurance coverage through the Marketplace, but if your employer offers insurance that is considered affordable and meets certain minimum requirements, you may not be eligible for financial assistance.

Can I purchase a health plan outside of my state’s Marketplace if I choose to?

You can always choose to obtain a similar health insurance plan outside of the Marketplace, but the only way to receive a possible reduction in premiums based on your income is through the Marketplace.

What if I already have coverage through Medicaid?

If you are currently covered under Medicaid, you are in compliance with the healthcare law and are considered to have the required minimum essential coverage that exempts you from paying a penalty.

What if I can’t afford the coverage through the Marketplace for myself or my family?

You may qualify for free or low-cost care through Medicaid based on your income and family size. If you earn too much money to qualify for Medicaid, you children may be eligible for the Children’s Health Insurance Program (CHIP). Or, if purchasing a plan through the Marketplace and you do not qualify for Medicaid or the CHIP program, you may qualify, based on your household size and income, for a premium tax credit to lower your monthly premiums or qualify for cost sharing reductions to help reduce your deductibles, copays, and coinsurance.

How do I get started?

You should go to your Marketplace, create an account, complete an application, pick a plan, and enroll.

  1. Create an account. Provide some basic information, then choose a user name, password, and security questions for added protection.
  2. Complete your application. Provide information about you and your family, like income, household members, current health coverage, and more.
  3. Pick a plan. See all the options you qualify for and choose a plan
  4. Enroll. After you choose a plan, don’t forget to enroll online and
  5. Pay your first premium by the due date.

What is the deadline for applying for a health plan through the Marketplace?

The initial open enrollment period began on October 1, 2013 and ended on March 31, 2014. Because the initial enrollment period has ended, you will not be able to enroll in health insurance through the Marketplace until the next open enrollment period starts unless a special enrollment period applies due to certain life events. This means that if you are uninsured you may be subject to a penalty for 2014.


The SHOP Marketplace – Health Insurance Exchange for Small Business

We encourage businesses to utilize the Insurance Associates, a Marsh & McLennan Agency LLC Company team of experienced benefits professionals to secure the best employee benefits at the most affordable rates.

What is the Health Care Reform Law?

The health care law, known as the Affordable Care Act (ACA) was passed in March of 2010. It was created to give more Americans access to affordable health care. The ACA required each state to establish a “health insurance exchange” by 2014. The purpose of the health insurance exchange is to provide a marketplace where individuals and small businesses can explore, compare and enroll in health insurance and public assistance programs, as well as access federal tax credits and cost sharing subsidies.

What is the Small Business Health Options Program Marketplace?

Through the Healthcare Reform law, a new way of obtaining health insurance was created to provide a centralized location for small businesses to purchase health insurance for their employees. The Small Business Health Options Program (SHOP) is the name of this new Marketplace that was developed. Both the state-operated Marketplaces and the federally facilitated Marketplace must include a Small Business Health Options Program (SHOP).

What size group is eligible to purchase health insurance for its employees through the SHOP Marketplace?

In 2014, any employer with 50 or fewer full-time equivalent (FTE) employees will be able to purchase health insurance for their employees through the SHOP Marketplace. Beginning no later than January 1, 2016, the SHOP will be available for employers with up to 100 full-time equivalent employees.

How do I find a Small Business Health Options Program (SHOP) Marketplace to purchase health insurance for my employees?

Start by contacting Insurance Associates, a Marsh & McLennan Agency LLC Company. IA, a Marsh & McLennan Agency LLC Company’s trusted Agents can help you to choose a plan that meets your business’ needs.

SHOP Marketplace for small businesses in Maryland/DC/Virginia

  1. Maryland
  2. District of Columbia
  3. Virginia

Do I have to offer health insurance coverage to my employees?

As a small employer with less than 50 full time employees, you are not required to offer coverage to your employees and will not be subject to a penalty. However some larger businesses that don’t offer coverage or whose coverage doesn’t meet the minimum standards may be subject to the Employer Shared Responsibility Payment.

Can I purchase a health plan for my employees outside of the SHOP Marketplace?

If your business has an office or employee worksite in Maryland or Virginia you may purchase health insurance for your employees either in or outside of the SHOP Marketplace Exchanges. This also applies currently if you have an office or employee worksite in the District of Columbia. Although, beginning with your plan renewal in 2015 you will be required to purchase coverage through the DC Health Link SHOP.

Are employers eligible for health care tax credits?

If your company has 25 full-time equivalent employees making an average of $50,000 or less a year, your business may qualify for a Small Business Care Tax Credit if you pay for at least 50% of the full time employee’s premium costs. The credit is only available if you obtain your health insurance coverage through the SHOP Marketplace.

What health benefits are offered in the SHOP Marketplace?

The SHOP Marketplace offers Bronze, Silver, Gold, and Platinum category plans that all include the same essential health benefits. What differentiates the categories is the amount of the deductibles, copayments and total out of pockets expenses your employees will be responsible for. In general the lower premium plans will have the higher out of pocket costs and the higher premium plans will have the lower out of pocket costs.

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