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Frequently Asked Questions:


Individuals and the health insurance marketplace


Am I required to have health insurance?

Under the Affordable Care Act, most Americans are required to carry health insurance that meets a minimum value or pay a penalty for failing to do so. 


I have a serious health condition. Can I be denied coverage?

The law includes protections for people with serious health conditions. Under the guarantee issue provisions, adults with pre-existing health conditions cannot be denied coverage nor can insurers charge more based on these conditions. This rule is effective for adults in 2014. It was effective for children (under age 19) in 2010.


How will individuals (and families) buy coverage in 2014?

Individuals can continue to use the same shopping methods they use today. For example, purchasing from a health benefits company with the help of an independent agent/broker. In addition, the federal government is introducing the Health Insurance Marketplace. Formerly called “health insurance exchanges,” there will be both public and private exchanges. 


What will coverage include?

Beginning in 2014, all non-grandfathered health insurance coverage in the individual market will be required to cover essential health benefits. These services include benefits that many individual plans don’t cover today such as prescription drugs and maternity coverage. Also, policies must have an annual limitation on cost-sharing for essential health benefits. 


What will coverage cost?

Changes in rating rules and additional taxes and fees will have the most impact on the cost of health coverage in 2014. Under these changes, insurance carriers can set prices in the small group and individual markets based on three things: geographic factor, age and tobacco use. Plus, the ACA has added five taxes and fees to the purchase of most plans.


Is there any help available to offset the cost of insurance?

Yes. The federal government will provide premium tax credits and cost-sharing subsidies to individuals who make up to 400 percent of the Federal Poverty Level (FPL).

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