How the Affordable Care Act affects you

On Oct. 1, 2013, the first stage of the Patient Protection and Affordable Care Act (commonly known as the Affordable Care Act) went into effect, and the federal Health Insurance Marketplace became available online for Americans to explore their options.

What does this mean for you?

It means that when the annual enrollment window for HISD benefits rolls around next month (Nov. 7–21), benefits-eligible employees will have some important decisions to make.

Starting Jan. 1, 2014, most Americans will be required to have health insurance that meets certain guidelines to avoid paying a penalty on their federal tax returns. So benefits-eligible employees will have to make a choice between one of the health insurance plans being offered by HISD and those available in the Marketplace.

Are there any advantages to selecting an HISD healthcare plan?

Yes. All HISD plans meet the Act’s requirements for value, and the Consumer Basic-Limited plan qualifies as “affordable.” And because HISD makes a sizable contribution toward its employees’ coverage (more than 80% in some cases), you will likely pay far less for an HISD plan than for one obtained through the Marketplace.

The rates for all HISD medical plans are also going down for 2014, so employees enrolled in a Consumer or Open Access plan can expect to pay 20% less than they did this year.

Aren’t subsidies available to offset the cost of buying in the Marketplace?

Yes, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. Because HISD offers plans that meet the federal requirements, it is unlikely that any subsidies would be available to you.

If I elect to buy insurance through the Marketplace, when would coverage begin?

If you purchased your policy before Dec. 15, coverage would begin on Jan. 1, 2014.

What if I’m an employee who doesn’t qualify for benefits?

If you are not benefits-eligible, you can purchase coverage:

• Through another employer, or a spouse’s employer
• Through government plans such as Medicare, Medicaid, CHIP, or HIPP
• Directly from an insurance provider
• Through the federal Health Insurance Marketplace.

Visit www.healthcare.gov or call the Marketplace at 1-800-318-2596 for more information.

When is the deadline to sign up?

The deadline to sign up for a qualified health plan is March 31, 2014. But since HISD’s annual enrollment period ends Nov. 21, employees who wish to take advantage of one of the district’s plans will need to make a decision much sooner than that.

How much is the penalty if I don’t sign up for health insurance?

The first year, the fine for an individual without health insurance in 2014 is $95 per adult and $47.50 per child (up to $285 for a family), or one percent of the family’s annual income, whichever is greater. By 2016, those amounts will increase to $695 per adult, $347 per child, and $2,085 per family, or 2.5 percent of the family’s annual income, whichever is greater.

Dec. 15, 2013 is the deadline to sign up for a qualified plan to avoid paying any type of penalty this year. Partial penalties will be assessed starting in January for every month an eligible employee remains uninsured.

How is HISD planning to educate its employees about their choices?

By now, all employees (both benefits-eligible and non-benefits-eligible) should have already received the first of several mailers at their residences. HISD’s Benefits department is also planning to send out additional newsletters by email, as well as its usual materials related to annual enrollment. The first should arrive during the week of Oct. 7.