Health Care Reform: The Bill at a Glance

With the government also shutting down, I think many people have forgotten that Tuesday was also the start of Open Enrollment for the Affordable Care Act. I know many people have been confused about exactly what the ACA (A.K.A. Obamacare, PPACA, Health Care Reform) is. There has been much confusing media coverage, and people spreading around incorrect information. I just want to take a minute to give you a basic breakdown of what the bill entails.

  • No one will be turned down for coverage due to pre-existing conditions, any longer.
  • The age ceiling for young adults being covered on their parents’ health plans has been raised to 26.
  • You may have the ability to modify the way you pay for your coverage by adjusting your monthly premium payments with your deductible.
  • You may qualify for a premium tax credit.
  • Free preventative care.
  • Choose the best doctor for you within your plan.
  • Women’s health preventative care is also 100% covered.

These are just a few of the many new changes included with the Affordable Care Act. Call today to schedule your appointment to come in and get enrolled! We’ll help you find the best plan for you and your family or you and your employees! For more information on the Reform, check out our past blogs: Women’s Health Care, Pre-Existing Conditions, Improved Coverage Options, Q & A, Premium Assistance Calculation, Employer Mandate Delayed, Young Adults, Small Business Tax Credits, Individual Tax Credits, Getting Covered, Small Business, Health Insurance Plans at a Glance, Questions Answered, and many more.


Health Care Reform: Women’s Health Care

Beginning this past August, health insurance plans began covering certain women’s preventative care services at 100% (i.e. STI testing maternal support, birth control) unless you have a grandfathered plan. Now, what does this mean for you specifically? If you’re a female teen/young adult: important preventative care is covered including STI screenings, birth control as well as sometimes counseling services. If you do become pregnant, much of your pregnancy-care support is also covered through your new plan.

For women trying to get pregnant: During this time, both yours and your baby’s health are exceptionally important. You’re new plan covers many of the screenings you’ll need when you do get pregnant including Hep. B, gestational diabetes, and syphilis. Since fertility testing isn’t considered “preventative”, it’s not completely covered, but may be partially covered. Call your agent to find out what is and is not covered under your

If you’re a woman over the age of 40: Breast cancer screenings is one of the top priority for women in this age group. If detected early, breast cancer can be very treatable, and now your plan covers—completely—mammograms for every one to two years. (You only have to pay a copay if you’re under the age of 40 and not at an additional risk for breast cancer.)

For women over the age of 60: As you advance in age, your body goes through a number of changes. Regular checkups and screenings are an important part of staying healthy. These are now available at no cost to you.

Previously these services could cost you a pretty penny, but now, as long as you’re visiting an in-network doctor and buying covered drugs with a prescription, it’s all free. Feel free to call Sweeney & Sweeney with any concerns or questions, and of course, to get you a free quote on health insurance (either for you as an individual, or for your business).

Health Care Reform: Pre-Existing Conditions

My guess is, you at least know someone who’s heard this response to their healthcare application, “We regret to inform you that coverage has been denied due to a pre-existing condition.” If you’ve ever been denied for this reason, we have really great news for you. Under the Affordable Care Act, no one will ever be denied coverage for a pre-existing condition!

Beginning in 2014, when your coverage begins, so will the coverage for your illness. The only exception to this is if you have a “grandfathered” individual policy (health insurance not provided through your employer). If you have a policy that doesn’t cover your pre-existing condition, you can choose to switch over to the Marketplace to get your new inclusive plan.

Be sure to get enrolled between October 1, 2013 and March 31, 2014 (Open Enrollment). After the open enrollment period, you may not get Marketplace coverage unless you have a qualifying life event”. Sweeney & Sweeney is more than capable and willing to help you out with enrollment. Medicaid and CHIP will also cover pre-existing conditions.

Health Care Reform updates are coming out all the time, and the whole thing can get very confusing. We want to remind you that Sweeney & Sweeney is up to date on all the news and is willing to answer any questions, and alleviate any concerns. Call us today!


Health Care Reform: Improved Coverage Options

Part of what the Affordable Care Act guarantees, is that all new insurance plans have to meet certain requirements such as doctor visits, hospitalization, emergency care, maternity, pediatric care, prescriptions, etc.

New insurance plans will be rated based on the percentage of expenses covered by the plan and put into categories: bronze, silver, gold, and platinum. The goal of this system is to make it easier for individuals to compare plans either on the same level, or across levels, to determine which one meets your needs, best.

Plans are designed for as your coverage goes up, so does your monthly premium payment, but your out-of-pocket expenses go down when you actually receive medical care. You can also choose to go the other route where you pay less monthly, and more at the time you receive treatment. This design allows people to choose the payment plan that best suits their unique needs.

Health Care Reform: Q & A

Q: What is the household income eligibility requirement?

A: Americans with household income of 100% to 400% of the Federal Poverty Level (FPL) are eligible. For example:

  • 100% FPL- individual $11,490, family of four $23,550
  • 400% FPL- individual $45,960, family of four $94,200. 

Q: Do the credit amounts vary by income?

A: It is a sliding scale that comes into effect here. If you fall on the lower end of the FPL percentage spectrum, you can expect more help from the government than someone closer to 400% FPL. 

Q: What is the exchange?

A: You can think of the exchange as a marketplace to purchase insurance. Exchanges are new organizations that are being created to provide a more organized and competitive way to purchase health insurance. Consumers can view several options and easily compare rates and coverage details.  

Q: Will Agents be participating in the Health Care Reform?

A: Agents and Brokers have the choice to become Certified Health Care Reform Agents, to have the opportunity to better serve our community and help them get the best coverage available.  

Q: What if I already have an individual health plan?

A: When the new law comes into effect in January 1, 2014, all current plans will no longer exist. Your options are to either be moved to a plan that is closest to your current plan or you may call Sweeney & Sweeney Insurance to go over your options in the Exchange, as you may qualify for a tax credit.

Health Care Reform: Premium Assistance Calculation

With Health Care Reform keeping everyone on the edge of their seats, Sweeney & Sweeney Insurance is here to provide new details as much as possible. Many people are wondering where they will fall with premium assistance and are worried if it will be affordable for their family.

Premium assistance is calculated based on where you fall in the federal poverty level scale. If you make less than 138% of the federal poverty level, you qualify for free health insurance, known as Medi-Cal. The amount of assistance each person receives depends on the individual’s income, age, and zip code. The Affordable Care Act sets a monthly maximum that people will pay based on their poverty level. In general, the less the income, the more assistance you will receive. Below are some tables to give you an idea of the federal poverty level you may fall into:


federal table

For more information on The Affordable Care Act (ACA), you can always call Sweeney & Sweeney for more information, and to schedule your appointment for enrollment!


Health Care Reform: Employer Mandate Delayed

The U.S. Government has announced that the employer mandate, one of the most significant portions of the Affordable Care Act (ACA), will not be required until 2015. Under this provision, businesses with 50 or more full-time employees would have faced fines up to $3,000 per employee if they didn’t offer their employees affordable health insurance.

The one year delay is designed to accomplish 2 goals:

  • Allow the Government to consider ways to simplify the new reporting requirements consistent with the law.
  • Provide time to adapt health coverage and reporting systems while employers are moving forward with offering affordable coverage to their employees.

For more information you can click here and be directed to the Treasury Department’s website. Sweeney & Sweeney Insurance will continue to send out any updates that come along! And as always, feel free to call to talk to one of our Health Care Reform Certified Agents or make an appointment to come in with any questions or concerns.

Health Care Reform: Young Adults

As the country prepares for implementation of
the Affordable Care Act (ACA), a recent poll examined different age groups,
including young adults. The poll showed that a large majority of Americans want, and value, health insurance. Among the public overall, 87 % say it is “very
important” to them personally, 88% describe health insurance as “something I
need,” and 68% say insurance is worth the cost. This includes young adults, who
say health insurance is very important to them and that cost remains the biggest
barrier. Many young adults want health insurance, but struggle from
unemployment, employers not offering insurance, or getting coverage is just too expensive. With
the ACA coming into effect, more opportunities will be opened for young adults
to obtain affordable coverage. Large employers are required to offer coverage
to their full-time employees and tax credits are available for individuals
based off their gross income. Sweeney & Sweeney hopes the Affordable Care
Act will give people of all ages a peace of mind. We are aware of the struggles
and the cost restraints it brings to many people, which is why we are here to
help you through it

Health Care Reform: Small Business Tax Credits

In regards to the Patient Protection and Affordable Care
Act, small employers (those who have less than 50 full-time equivalent employees
(FTE)) are not required to offer their employees health coverage. However, an
employer with 25 or fewer full-time equivalent employees may be eligible for
incentives from the federal government to provide their employees with health


Many small employers do not realize they have the
opportunity to claim a federal income tax credit on their annual tax returns.
Unfortunately, a very low percentage of qualified business owners are taking
advantage of this credit. Here are the IRS guidelines to be eligible.

  1. The expenses that an employer can count towards the tax
    credit includes the premiums that are paid for each employee. The employer must
    contribute at least 50% of the cost of the health care coverage for employees.
  2.  Must have less than 25 FTE workers when totaling all
    individuals’ hours of employment.
  3.  Employers must pay their workers an average of less
    than $50,000 per year to qualify. The smaller and lower wage employers will
    receive a larger tax credit.

If your business meets these requirements, we encourage you
to contact a Health Care Reform Agent (such as our Health Department here at Sweeney & Sweeney) to verify your options and help you
calculate your eligibility of a tax credit.


Health Care Reform: Getting Covered

With the health care reform bill soon to take effect, many
people are worried about how they’re going to afford coverage. Fortunately,
there are many assistance programs available to make sure that your health care
is affordable. For more information, click here to read the full article. 

Cost-sharing subsidies help to reduce the amount of expenses
that an individual has to pay out of pocket (i.e. copayments). The assistance
programs are based on an individual/family’s income. The chart below shows some
examples of what you and your family could qualify for. 

Health Care Reform table

*Income levels are based on the year 2012

**California only 

Sweeney & Sweeney will be having more updates to
come. Please feel free to call us with any questions. Our amazing health team—
John, Jamie, Ellen, Dan, and Cheryl—are always ready and willing to help!