Many provisions of the Affordable Care Act take effect soon. We're sending this bulletin to keep you informed of the changes that will impact you... an Individual


  • Individual Mandate - Starting January 1, 2014, most individuals will be required to have health insurance or pay a penalty. The penalty will be reflected on your taxes. The greater amount applies: In 2014, the penalty is $95/individual, $285/family, or 1% of income. In 2015, it's $325/individual, $975/family, or 2% of income. And in 2016, it's $625/individual, $2,085/family, or 2.5% of income.
  • Health Insurance Marketplaces - Starting October 1, 2013, individuals without access to affordable, employer-sponsored plans that provide qualifying coverage can enroll in plans offered through state-based exchanges, with coverage beginning January 1, 2014. They may also qualify for federal subsidies.
  • Guaranteed Issue - Insurance companies must sell coverage to everyone, regardless of pre-existing conditions, and can't charge more based on health or gender. Rates may vary based on age, tobacco use, geography or family size.
  • No Annual or Lifetime Limits - Individual and group health plans may not impose annual or lifetime limits on essential health benefits.


Get more details and answers to frequently asked questions in this bulletin:

Healthcare Reform: What Individuals Need to Know [PDF] a Business


To enable you to provide coverage for your employees and avoid penalties, the following options have become available: 


  • Option 1 - Provide Coverage through the SHOP Exchanges: These are online marketplaces offering an array of qualified health insurance plans. The goal is to reduce the burden and costs associated with small group plans, and provide the cost advantages and choice enjoyed by large employers.
  • Option 2 - Provide Coverage Outside the Exchange: Employers currently offering small group coverage can continue offering coverage through the small group market. Plans that may be deficient (do not offer minimum essential benefits) will be upgraded on January 1, 2014, or their next plan anniversary date. In some states, insurers are offering an early renewal option-scheduled for December 2013, which allows employers to lock in rates and benefits before potential market uncertainty occurs in 2014.
  • Option 3 - Defined Contribution: The employer provides a pre-determined level of funding that employees can then use to purchase a plan of their choice. This model appeals to employers wanting to contribute toward benefits for recruitment/retention advantages, without having to select, purchase or manage the plans.
  • Option 4 - Do Nothing: There is no requirement under ACA for small businesses to
    provide coverage to their employees; employers with less than 50 full-time employees are exempt from ACA fines. When deciding whether or not to offer coverage, however, employers must weigh a number of factors including cost, employee individual mandate requirements, and the value that such benefits lend to recruitment and retention


Get more details by downloading this bulletin: 

Healthcare Reform: What Businesses Need to Know [PDF]


We hope this helps you understand the changes coming with the Affordable Care Act. Have a great Labor Day weekend, and don't hesitate to contact us with questions!



 - Maco & Associates