Under the ACA employers can use look-back periods of between 3 and 12 months. If an employee works more than 30 hours a week over a 120 day period, or at least 130 hours a month, they are considered full-time.
If you go less than three months in a row without coverage or if you get covered during open enrollment, you can claim an exemption on form 8965 and avoid the fee
Children are required to be offered dental, but adults aren’t. Medical coverage doesn’t always extend to dental, this leaves major dental surgery uncovered for many.
If you have been out of the country and move back to the US then it triggers a special enrollment period to get coverage outside of open enrollment.
You are still eligible to get health insurance and cost assistance through the marketplace. However, you must report social security benefits (except Supplemental Security Income) as income.
The Kaiser Family Foundation recently posted a tabular summary of the Medicaid Income Eligibility Limits for Adults.
Losing your health coverage by turning 26 qualifies you for a 120-day Special Enrollment period starting 60 days before your 26th birthday. During this period you can shop for a plan and qualify for cost assistance.
You don’t have to accept your employer’s offer. You may decline an offer for affordable, job-based health insurance, but then you won’t be eligible for cost assistance on the marketplace.
If you are no longer eligible for your current plan because you are moving, you qualify for special enrollment. This means that, even after open enrollment, you can switch to a plan offered in your area.
If you accept health insurance subsidies but end up making more than reported, you will have to pay back part or all of the subsidies you received.
Whether or not a treatment is subject to cost sharing is based on your plans cost sharing schedule as laid out in the plan documentation.
An employee can reject employer health coverage, but can’t get cost assistance on the Marketplace if coverage is offered. The employer mandate only applies to employer responsibility
A private insurer can’t drop you mid-treatment for any reason other than non-payment of fraud, however one could lose Medicaid mid-treatment.
You must reapply for the affordability exemption at least annually to qualify for this exemption for that year. The definition of “affordable” has changed from 2015 to 2017 and may change again in the future. In 2017, if your lowest cost minimal essential coverage you are eligible for (whether employer-based or Marketplace) which costs more than 8.13% of the household income is eligible for this exemption. You can claim it on the 8965 – Exemptions form, but you’ll need to get this exemption through the marketplaces.
If an employee works over 30 hours a week on average, they are considered full-time by law. If the business has over 50 full-time equivalent employees they must offer coverage
Social Security Disability (SSD) counts as income for getting cost assistance on the Marketplace. If your household income is between 100% – 400% of the Federal Poverty Level then you can get cost assistance.
If a child has been a citizen for more than 5 years, they may qualify for CHIP based on income. If a family member has access to the Marketplace they can join a family plan
Your insurer uses a drug schedule (drug formulary) to determine what tier a drug is on and it’s price. They can change these without notice.
ObamaCare is a nick-name for a law that crates a health insurance exchange with cost assistance. You can check out anytime you like and can leave whenever.
Access to cost assistance is based on filing status. If you plan to file separately then you can get an individual plan with tax credits, even if you aren’t divorced.
If I file head of house hold but only claim myself will that affect my cost for Obama care?
If you’re admitted to a hospital for observation and not for treatment of a specific ailment, are expenses covered?
If an employee changes employers often they should get a full-priced health plan on or off the Marketplace. This will avoid gaps in coverage.
Non-taxable Social Security benefits are counted as income for ObamaCare and affect tax credits. This includes disability payments (SSDI), but does not include Supplemental Security Income (SSI).
All health insurance plans must covered the cost of a breast pump, either as a rental or a new one. Breastfeeding support, counseling, and equipment for the duration of breastfeeding are all covered.