NRA: Individual Marketplace

The Affordable Care Act & You

7 Things You Should Know About ACA

On January 1, 2014, a number of Affordable Care Act's major provision became effective. Learn what you should know.

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Get answers to frequently asked questions about the Affordable Care Act and it's impact on you.

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7 Things You Should Know About ACA

A number of the Affordable Care Act's major provision for individuals became effective in 2014. These provisions have significant implications for all Americans. Here are seven key provisions of the law.


Beginning with the 2014 tax year, the individual mandate is in effect and most people will face a financial penalty if they do not get health insurance. The open enrollment period for 2015 coverage runs until February 15, 2015. If you have a qualifying life eventlike getting married or divorced, or having a baby or moving into a new stateyou may be able to purchase new coverage at other times of the year.


Some individuals will be exempt from the individual mandate and financial penalties. The law exempts certain individuals from the mandate and penalties, including individuals for whom health insurance premiums exceed 8 percent of household income.


Government-run health insurance marketplaces offer many individuals a new way to obtain coverage. An individual can shop for health insurance through the marketplace if his/her employer does not offer insurance or if the insurance that’s offered is unaffordable or fails to meet the ACA’s minimum-value requirement.


Health plans that offer “catastrophic coverage” will be available through the health insurance marketplaces to individuals under age 30, and certain other individuals. A catastrophic plan will offer benefits similar to those offered by plans in the health insurance marketplaces, but benefits will begin after reaching a high deductible. The higher-deductible plan will help keep premium costs lower.


The ACA makes financial assistance available to help lower- to moderate-income individuals get health coverage. Under the ACA, states have the option of expanding their Medicaid programs to cover most people with incomes below 138 percent of the federal poverty level. The law also provides financial assistance to individuals who meet certain income thresholds and who don’t have access to affordable, minimum-value insurance through their employer.


Although the 2015 open enrollment period for the health insurance marketplace closes on Feb. 15, 2015, you may still qualify for a special enrollment period or to enroll in Medicaid or CHIP. Additional information can be found at


The ACA is bringing a lot of changes and change can be unsettling. Restaurant companies want to help provide team members with the best and most complete information about the upcoming changes. As the ACA continues to unfold, let your employer know your questions. Visit for the latest news about the ACA.



Q: When do I have to be covered?
A: January 1, 2014.

Q: How will I get this coverage?
A: There are many ways to meet what the law calls the “individual responsibility” requirement. You can accept coverage provided by your employer, purchase a policy on your own, buy a plan through a public exchange, or get coverage through Medicare, Medicaid or through other types of governmental programs.

Q: Is health insurance going to be free?
A: No. This is a common misconception. While starting in 2015 many employers will be required to offer full-time employees (and their dependents) the option of enrolling in coverage, in most cases employees will be required to cover a share of the costs. You may also be eligible for coverage through your state’s exchange or health insurance marketplace, but that option may also require individuals to pay a share. Go to to learn more.

Q: How is the government going to know if I have coverage or not?
A: Starting for 2014, you’ll be required to state on your federal tax return that you have health care coverage and identify the source. If your employer is large enough, your employer will have to file separate paperwork to declare whether they offered you coverage and whether you accepted or rejected the offer.

Q: How much is it going to cost me?
A: This is probably the most important question for many employees. The short answer is that it depends on where you and your family obtain coverage. Here’s a look at various situations:

  • Employer-based coverage: If you choose to buy a health plan through your employer, you’ll continue to pay monthly premiums for individual or family coverage. It’s possible your monthly premiums for work-based coverage may increase under the ACA. The law imposes new fees and taxes that could affect your employer either directly or indirectly (see Chapter 8). Employers may decide to pass along some of these costs to employees through higher premiums.
  • Exchange plans: You may decide to buy a health plan for yourself and your family through the health insurance exchange in your state. If you meet certain income thresholds and do not have access to affordable, minimum-value coverage through your employer, you may be eligible for federal tax subsidies to buy health plans through an exchange. Once you compare options and select a health plan, you’ll be responsible for your monthly premium, minus any subsidies received. To learn more about plans, pricing and possible subsidies to buy exchange coverage, visit for a link to the exchange in your state.
  • Government programs: You may qualify for low-cost or free health care coverage if your income level qualifies you for a government program, such as Medicaid or the Children’s Health Insurance Program (CHIP). In many states, people with household incomes up to 138 percent of the federal poverty level will be eligible for Medicaid.
  • Tax penalties: If you choose not to obtain health insurance coverage for yourself and/or your dependents starting in 2014, you will be assessed a tax penalty equal to the greater of a flat dollar amount, or a percent of your income.

Q: So what happens if I just don’t get coverage?
A: In 2014, the penalty will be $95 per adult and $47.50 per child with a maximum of $285 for a family, or 1 percent of family income, whichever is greater. In 2015, the penalty goes up to $325 per adult and $162.50 per child with a maximum of up to $975 for a family, or 2 percent of family income, whichever is greater. In 2016 and beyond, the penalty will be $695 per adult and $347.50 per child with a maximum of $2,085 for a family, or 2.5 percent of family income, whichever is greater.

Q: Do all employers have to offer health insurance, or just big businesses?
A: Beginning in 2015, businesses with 100 or more full-time-equivalent employees are required to either offer minimum essential coverage to their full-time employees and their dependents (children up to age 26) or face possible penalties. In 2016 and beyond, this requirement applies to businesses with 50 or more full-time equivalent employees. Smaller businesses have the option of offering coverage, of course, just as they always have.

Q: I only work part-time. Is my employer required to offer me coverage?
A: No. The law doesn’t require any employer to offer part-time employees health coverage, though some may do so voluntarily. The law defines part-time as anyone who averages under 30 hours a week.

Q: What’s this tax credit I’ve heard about?
A: For people with incomes between 100 percent and 400 percent of the federal poverty level that do not have access to an offer of affordable coverage through their jobs, the law offers a subsidy in the form of a “premium tax credit” that can be used to help pay for the purchase of insurance on the exchange. The law considers coverage to be "affordable" when the employee is asked to pay no more than 9.5% of their household income toward the premium for single-only coverage for the employee. The exchanges will play a central role in determining if individuals are eligible to obtain the premium tax credit. Some individuals may also be eligible for “cost-sharing reductions” to help limit out-of-pocket costs for such costs as deductibles and co-pays. These government subsidies are for people who buy health plans on exchanges. Once an exchange determines an employee is eligible for a premium tax credit, the government will pay the tax credit amount directly to the health plan. To apply for subsidies, individuals and families must submit an application to the exchange in their state. Contact the exchange in your state for more information.

Q: What are these exchanges I keep hearing about?
A: The public exchanges or “health insurance marketplaces” are competitive marketplaces that offer a variety of plans administered by private insurance companies. Exchanges are open to individuals and small businesses to purchase coverage. The exchanges will be a resource for employees who may not have access to "affordable" health insurance through their employer. For 2014, most states will defer to the federal government to operate the exchange in their state. There will be multiple ways an individual can access an exchange: a website where you can learn about various insurance plans and select one that will help you meet the individual mandate; a phone option; and “navigators” within your community that can provide assistance in filing the necessary paperwork. Visit for information.





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The National Restaurant Association created the Edge Marketplace to offer a comprehensive suite of health care and personal insurance programs built around the needs of the restaurant industry. Through our partnerships with companies like UnitedHealthcare and eHealth, we are able to provide access to essential tools and health care options for individuals and families. We have chosen to work with these companies because of the wide range of innovative products and services they offer that can meet the unique requirements of restaurant employees and their families. Our goal is to help you find the right solutions for yourself or your small team of employees through our resources and understanding of the restaurant industry.

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