What is Minimum Essential Coverage?

Minimum Essential Coverage includues the following:

  • Employer -sponsored coverage, including COBRA & retiree benefits
  • Coverage purchased on individiual market
  • Medicare
  • Medicare Advantage
  • Medicaid
  • Children’s Health Insurance Program (CHIP)
  • Certain Veteran health plans
  • TRICARE

*does not include specialized coverage, such as the following stand-alone coveages,  vision care, dental care, workers compensation plans, disability plans, or coverage only for specifice disease or condition.

What is an Individual & Family Marketplace

These Marketplaces offer coverage to consumers who do not have coverage through an employer plan.

Public Individual Marketplaces are the only place a consumer can access any available premium credits or cost sharing subsidies

What is an “Exchange” or Marketplace”?

Formally refered to as an “EXCHANGE”, a “MARKETPLACE” is a new way to purchase health coverage. An online “store” where consumers can compare comprehensive insurance options based on price and benefits specific to a consumers need. Marketplaces are typically ran by State or Federal Government.

What is Affordable?

Employee monthly contribution for employee only coverage must be less than 9.5% of said employees prior years W2 earnings (box 1 of tax form W2)

What is a Short Coverage Gap?

A short coverage gap period is a period less than three consecutive month.  Coverage gap waiver is only allowed once during a calendar year.

Should the gap period extend between two calendar years (example, November to Febuary) there is no tax/penalty/shared responsibility due unless a full three month consecutive period is spent in one calendar year.

Public or Private Marketplace?

A Public Marketplace is ran by a government entity.

A Private Marketplace is ran by a private company, similiar to how many access coverage now.

Individual Penalty

2014:

2015:

2016:

2017:

Dependent child under age 18: 1/2 the flat dollar amount