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PRSRT STD ECRWSS U.S. POSTAGE PAID EDDM RETAIL Local Postal Customer Helpful ACA Resources: Kaiser Family Foundation 24/7 National Marketplace Toll-Free Call Center 1.800.318.2596 TTY: 1.855.889.4325 accessHealth SHOP Toll-Free Call Center 1-800-706.7893 TTY: 1.800.706.7915 Monday - Friday 8 a.m. - 4 p.m. (CST) ACA health care news to keep you in the loop. The Marketplace & You Next year, the Patient Protection and Affordable Care Act (ACA) will require all American citizens to purchase approved health insurance plans or pay a tax penalty of $95, per person in the household, or one percent of income, whichever is greater. In 2015, the fee increases to $325 per person in the household, or 2 percent of income. And in 2016, these penalties rise to $695 per person, or 2.5 percent of income. Penalties increase each year and are collected by the IRS. at According to the Centers for Medicare and Medicaid Services (CMS), one section of the marketplace will serve individuals and another, employers. Applicants looking to purchase health insurance through the marketplace will be asked a set of questions. Based on their answers, the applicant's eligibility for insurance will be determined and then they will be directed to private insurance plans, Medicaid, Children's Health Insurance Program (CHIP) or TRICARE. In order to comply with the mandate, each state will open a healthcare marketplace, sometimes referred to as an exchange, to make "low-cost" insurance more accessible for individuals and small businesses. ACA calls for states to develop and manage their own exchanges, but Missouri and 25 other states failed to submit plans before last February's deadline. As a result, the federal government has developed Missouri's marketplace. For applications filed online, the web site offers a comparison tool to evaluate policies, and a calculator to estimate each plan's premiums, co-payments, deductibles and maximum outof-pocket costs. Filtering options let the user narrow plan selection based on specific criteria. The most relevant plans are presented first and are based on the applicant's answers. How it works Coverage through the marketplace begins as early as January 1, 2014. The first enrollment period begins October 1, 2013 and ends March 31, 2014. In subsequent years, consumers can enroll between October 15 and December 7. The automated marketplace has the ability to confirm job status and income from previous years. Applicants have an opportunity to note changes in job status and any other pertinent information after they enroll. Often compared to discount travel web sites like Travelocity or Expedia, the online marketplace will offer qualified health insurance plans that allow enrollees to compare prices. The marketplace will be accessible For people who do not use the internet, trained navigators and certified assistance counselors will be available to provide support either in person or by phone. Touted as a "fairer system" In 2014, private insurers can no longer deny coverage or charge a higher price based on a person's medical history, and women will no longer be charged more than men their same age. Mandate exemptions Individuals are exempt from the mandate if they can prove that they have insurance through an employer, purchase individual insurance or have Medicare, Medicaid, CHIP, Veteran's Administration or TRICARE for Prices for individuals will vary active duty and retired military, based on four criteria: age, Indian Health Services, or a tobacco use (up to 50% higher health care sharing ministry. than non-smokers), location and family size. Additionally, the mandate requires expenditures of no Essential health benefits more than eight percent of In 2014, all health insurance household income on the plans must cover what is now cheapest qualifying health called essential health benefits insurance plan – after tax (EHBs). They include: credits and subsidies. If the ambulatory patient services, cheapest plan in the emergency services, marketplace costs more than hospitalization, maternity and eight percent of household newborn care, mental health income, even with the subsidy, and substance abuse, behavioral that family can decline the health treatment, prescription health insurance and not pay a drugs, rehabilitative and penalty. habilitative services and devices, lab services, preventive and Who qualifies for tax credits? wellness services, chronic Credits will be available for disease management, and individuals and families who are pediatric services including oral up to 400 percent of the federal and vision care. poverty level. This means that an individual who makes up to Important notes: $45,960 annually, will qualify. A Insurance through the family of four with an annual marketplace is optional. Insurers income of up to $94,200 will must provide the same coverage also qualify for a tax credit. both inside and outside of the marketplace. Some dependents Catastrophic plans of middle class households may These plans cover adults under be eligible for CHIP. Applicants age 30, or who have a hardship may enroll in the marketplace waiver from the marketplace. online, by phone, through a These plans have high trained navigator, certified deductibles, lower premiums broker or agent, or by mailing and cover three primary care a completed application. visits at no out-of-pocket costs.

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