Affordable Care Act FAQ’s
How Will Nevada Select Essential Health Benefits (EHBs)?
The Plan Certification and Management Advisory Committee will review the ten potential Benchmark plans for the State of Nevada. The Committee will recommend Nevada’s package of Essential Health Benefits be comprised of one of the benchmark plans plus any supplemental benefits that must be included to ensure all ten categories of Essential Health Benefits are covered. The Board will review the Committee’s recommendation, approve or adjust the recommendation and forward the recommendation to the Nevada Division of Insurance. Nevada will ultimately forward a recommendation to the Secretary of Health and Human Services who will make a final determination for EHBs for Nevada.
Are all Businesses Forced to Cover Their Employees Under the Affordable Care Act?
Businesses with less than 50 employees are exempt from requirements to offer coverage.
Does a Small Business Need to Have a Section 125 Plan to Participate in the Exchange?
A business does NOT have to have an established Section 125 plan to participate in the SHOP Exchange. listed below are the eligibility requirements for shop Exchange participation:
- 50 or fewer full time employees in 2014
- The SHOP will be opened up to employers with 100 or fewer full time employees in 2016
- Tax credits will be available in 2014 and 2015 for employers with 25 or fewer full time employees and average firm wages less than $50,000
Penalties will only be assessed to employers with more than 50 Full Time Employees. Employers with more than 50 FTE must offer a health insurance package for the employee that meets the Federal Essential Health Benefits (EHBs) and does not cost the employees more than 9.5% of their annual salary.
The penalty will be $3,000 per employee, but it is not to exceed $2,000 x (FTEs minus 30). For example if an employer had 51 employees and did not offer coverage that met the requirements, the employer would have to pay penalty of $2,000 X 21= $42,000
How do Small Businesses Use the Exchange to Purchase Coverage for Their Employees?
- Employers (with 2 – 50 employees) will be able to use the SHOP Exchange starting in 2014 to select plans in which their employees can enroll.
- Employees will log on and choose they coverage plan that they would like from the plans that the employer selected.
- Employers will receive one easy to read bill from the Exchange for all of its employees.
How does an employer qualify and apply for tax credits if they provide health insurance coverage for their employees?
To qualify for tax credits, an employer must:
- Have 25 Full Time Employees or less
- Have average firm wages of $50,000 or less
- Provide health insurance coverage for employees (the employer must contribute a minimum of 50% of the cost of the employees coverage)
- File the appropriate tax returns (Form 8941) (Line 44f of Form 990-T for exempt organizations) with their tax preparer
- Tax credits are available now and increase in 2014, businesses may apply for the credit for previous years if they qualified
If I have more than 50 employees and have a plan that meets the EHBs and does not cost employees more than 9.5% of their salary what happens if they don’t elect the plan and come to the exchange?
If an employer provides affordable minimum essential coverage (MEC) for their employees, the employees are not eligible for Advance Premium Tax Credit (APTC) on the Individual Exchange. During the enrollment process, the employee must:
- Attest that they do not have access to affordable MEC; and
- List their employer, employer’s address and employer’s telephone number,
The Exchange will contact the employer to verify that the employee does not have access to affordable MEC. If the employer provides affordable MEC, the employee is not eligible to purchase subsidized coverage on the Exchange. The employer will not be penalized for an employee who does not elect to participate in an employer sponsored health insurance plan that is affordable and meets MEC.
What Is A Qualified Health Plan?
A Qualified Health Plan is an insurance plan that is certified by an Exchange, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Exchange in which it is sold.
What is a HSA?
A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans. HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty.
What is a HRA?
Health Reimbursement Accounts or Health Reimbursement Arrangements (HRAs) are Internal Revenue Service (IRS)-sanctioned employer-funded, tax advantaged employer health benefit plan that reimburses employees for out of pocket medical expenses and individual health insurance premiums. Using a Health Reimbursement Account yields “tax advantages to offset health care costs” for both employees as well as employers. Health Reimbursement Accounts are funded solely by the employer, and cannot be funded through employee salary deductions. The employer sets the parameters for the Health Reimbursement Accounts, and unused dollars remain with the employer – they do not follow the employee to new employment
What is a FSA?
A Flexible Spending Account (FSA), also known as a flexible spending arrangement, is one of a number of tax-advantaged financial accounts that can be set up through a cafeteria plan of an employer in the United States. An FSA allows an employee to set aside a portion of earnings to pay for qualified expenses as established in the cafeteria plan, most commonly for medical expenses but often for dependent care or other expenses. Money deducted from an employee’s pay into an FSA is not subject to payroll taxes, resulting in substantial payroll tax savings. One significant disadvantage to using an FSA is that funds not used by the end of the plan year are lost to the employee, known as the “use it or lose it” rule.
The most common type of flexible spending account, the medical expense FSA (also medical FSA or health FSA), is similar to a health savings account (HSA) or a health reimbursement account (HRA). However, while HSAs and HRAs are almost exclusively used as components of a consumer driven health care plan, medical FSAs are commonly offered with more traditional health plans as well. In addition, funds in a health savings account are not lost when the plan year is over, unlike funds in an FSA. Paper forms or an FSA debit card, also known as a Flexcard, may be used to access the account funds.
What Does the Exchange Have to do With Medicare?
The Exchange does not offer enrollment in Medicare. The Exchange offers Qualified Health Plans for those people age 64 and under.
Native Americans FAQ’s
What are the Special Provisions for Native Americans in the Affordable Care Act?
- Native Americans that are a member of a federally regognized tribe are exempt from the Individual Mandate.
- Native Americans that earn less than 300% of the Federal Poverty Level (FPL) are exempt from cost sharing, e.g. co-insurance, deductibles and co-pays.
- There are special provisions for the calculation of Modified Adjusted Gross Income for Native Americans, e.g. some revenue earned on reservations is exempt.
- Native Americans can change Qualified Health Plans (QHPs) once per month, they are not bound to the open enrollment dates.
How do QHPs Affect Providers (Doctors)?
Qualified Health Plans are offered by different insurance companies. While the Affordable Care Act affects many aspects of provider care and insurers, insurance companies will contract with providers in much the same way as is done today. However, insurance companies will contract with providers separately outside the Exchange. The Exchange does not govern provider/carrier contracts.
Purchasing Insurance on the Exchange FAQ’s
Can I purchase a Qualified Health Plan Outside of the Exchange?
Yes, Insurance Carriers that offer Qualified Health Plans on the Exchange will off the exact same product outside the Exchange.
I am currently uninsured by choice. I am a proponent of alternative and holistic medicine as preventative care and maintenance for overall health. I do not take any prescription medication or vaccines. I am in very good health and very concerned about this new healthcare law. I feel I will be forced into paying for something I will never use and if I don’t, then I will be penalized. What, if any, options are there for people like me?
The Supreme Court ruling issued in June of 2012 stated that the federal government could impose a tax on individuals who do not purchase health insurance. The Silver State Health Insurance Exchange is being put in place in Nevada to help Nevadans comply with the new law and the individual mandate. There are exemptions from the individual mandate for certain religious groups, Native Americans and for people who face a financial hardship that precludes them from purchasing health insurance. If you are a member of one of the groups spelled out in the Affordable Care Act, you are exempt from the individual mandate to purchase health insurance. If you don’t fall into one of the exempt classifications, the IRS will enforce a tax penalty of $95.00 or 1% of your income (whichever is greater) in calendar year 2014. The penalty will increase to $695.00 or 2.5% of your income (whichever is greater) in calendar year 2016. You may choose to forego the purchase of health insurance and pay the tax penalty instead.
Why Should I Purchase a Qualified Plan on the Exchange?
- The Exchange is the only place that you can receive premium assistance in the form of an Advance Premium Tax Credit or cost sharing reductions.
- The Advance Premium Tax Credit (APTC) is a Federal subsidy that will pay a portion of an individual’s or family’s health insurance premium. To be eligible for the APTC, you must be lawfully present in the United States, a current tax filer with the IRS and earn between 100% and 400% of the Federal Poverty Level (FPL). In 2012 this equates to $11,170-$44,680 for an individual or $23,050-$92,200 for a family of four.
- Cost Sharing Reductions (CSRs) are another subsidy that is applied to reduce the out of pocket costs for individuals and families who make less than 250% of the Federal Poverty Level. This equates to $27,925 for an individual and $57,625 for a family of four. There are special Cost Sharing Reductions that apply to Native Americans. Please refer to the Native Americans section.
- More information on the FPL is available at
How Will I Know What Programs APTC/Medicaid I am Eligible For?
The Exchange’s website will guide each consumer through a streamlined application. When the application is completed the website will communicate with secure federal data sources to determine the consumer’s eligibility for health insurance coverage. When the eligibility determination is returned, the consumer will know what programs they qualify for and how much they will be paying for health insurance.
When Can I Enroll in a Qualified Health Plan?
Open enrollment starts on October 1st, 2013 and ends on March 31st, 2014
When Will Insurance Coverage Start for the Qualified Health Plans?
- Anyone who signs up before December 15th 2013 will have coverage effective January 1st 2014.
- Anyone who signs up between December 16th 2013 and March 31st 2014 will have coverage effective from 15-45 days from the day they signed up.
How Can I Enroll in a Qualified Health Plan?
During Open enrollment (October 1st 2013 to March 31st 2014) you will be able to enroll in a Qualified Health Plan by:
- Visiting the Exchange’s web portal- The name and address of the website will be release in the Summer of 2013.
- Calling the Exchange’s Toll Free Call Center- The number for the Call Center will be released in the Summer of 2013.
- Meeting with your existing health insurance agent/broker.
- Meeting with a licensed Navigator- A list of licensed and certified Navigators will be posted on this website as soon as it is available.
- Visiting one of the Exchange’s Kiosk locations- A current list of kiosk locations will be available on this site as they are placed.
This information from: http://exchange.nv.gov/Resources/FAQs/