Initial Enrollment Period (1st year of Obamacare) – October 1st 2013 – March 31st 2014. This is when we all enroll (unless you already have a major medical plan in place.) If you enroll in October, November or December up to the 15th of December in 2013, your start date will be Jan 1st 2014. After December 15th 2013, you’ll have a Feb 1st, 2014 start date. Each month, if you enroll before the 15th, you’ll start the next month. If you sign up after the 15th of Jan or Feb or March, you’ll start not the next month but the month after. If you don’t qualify for a subsidy or you didn’t buy a health plan during the enrollment period, you may buy insurance anytime you would like, however, there is a 90 day waiting period, and you could be subject to a tax penalty for not having coverage, and the coverage can’t go back in time. It is not wise to wait until you are sick to try and get coverage because you won’t be able to. Small businesses can enroll into health insurance throughout the year.
SUBSIDY (Financial Assistance) – A subsidy is an “Advanced Premium Tax Credit” that is available on the Individual Exchange but NOT the SHOP Exchange for small businesses. A “subsidy” means that you get a reduced premium payment to pay for your medical insurance, kind of like getting a gift card from the Government to help pay a portion of your health insurance premiums. The factors that affect the premium you pay would be your income, the number of family members you are insuring, your age, and if you smoke (there is no subsidy on the increased portion of your premium due to smoking). The only way to get a “Subsidy” is to get a health insurance plan through the Nevada Public “Exchange” (an Exchange is an online website where you can buy health insurance.) If your income is in between 138% to 400% of the federal poverty level, you may qualify for a subsidy. Call us here at the Nevada Insurance Enrollment Marketplace and we’ll help you with a “subsidized” or “unsubsidized” health plan. We are a Full Service Private Marketplace.
Your income will be checked with the IRS records or a Federal Database, so if you claim a certain income, the “Exchange” will check with the IRS of your past years’ income tax records – before you get approved for a subsidy.
Individuals and families will state their income based on their MAGI – (Modified Adjusted Gross Income.) The State will then verify that information through the IRS against your previous tax returns. If the stated income on the application is more than 10% lower than what the IRS shows, the State will require the individual to prove their income within 90 days, but you’ll still get enrolled. Your financial information is run through a Data Services Hub – A tool the government is using to verify applicant information and income for the “Advanced Premium Tax Credits.” (To see if you qualify for a subsidy.)
BE VERY CAREFUL NOT TO GET TOO MUCH SUBSIDY. The reason being would be you’d have to pay the extra subsidy back to the IRS. For example, if your health insurance premiums are $1,000/month and you get a Government Subsidy of $800/month and you only have to pay $200/month. At the end of the year when you have to settle up your taxes on April 15th of each year, the Government will check your income, and IF you were only supposed to have received an Advanced Premium Tax Credit (subsidy) of $700/month instead of $800/month, you’ll owe the Government an extra $100/month X 12 months is $1,200. How do you avoid this? (It is VERY important to read the “Redetermination for income changes” AND the “Reconciliation of Premium Credits” definitions both).
Please note: If you are providing insurance to your employees, and if you offer health insurance benefits only to your employee, in Nevada the employee’s spouse and children are able to get a subsidized plan, but the subsidy is based off of the “household” income. HOWEVER, if you DO OFFER coverage to the spouse and dependents and they elect not to take the coverage for whatever reason, (the spouse may feel your employer plan is too expensive), then that spouse is NOT able to go and get a subsidized plan!! Please keep this in mind. You may repel employees if you are not careful.