How Do Employers Measure Full-time Status?


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.

What is the Maxmium Gap In Coverage Allowed Under ACA?


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

Does ObamaCare Provide Orthodontic Coverage?


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.

Eligible for ObamaCare When Returning to US?


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.

Are you Eligible if you Collect Social Security?


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.

When do I Need Insurance After Turning 26?


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.

Do I Have to Take Employer Health Insurance?


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.

How do I Change my Health Care Provider if I Move?


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.

Why do You have to Pay Back Subsidies?


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.

Cost Sharing on MRI?


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.

Does An Employee Have to Take Health Insurance?


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

Do I Need to Reapply for Affordability Exemption?


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.

Can I Qualify For ObamaCare with SSD?


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.

Can A Child Who is a US Citizen Get Health Coverage?


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

Why is There a New Co-Pay on Prescriptions?


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.

Is ObamaCare Like the Hotel California?


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.

Can I Enroll in Individual Plan if Married?


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.

What Plan to Get When Changing Employers Often?


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.

Does Social Security Count Toward Income for ObamaCare?


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).

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