Frequently Asked Questions about the Affordable Care Act

Q: Are small businesses required to offer group health insurance?
A: No, employers are not required to offer health coverage.

Starting in 2014, businesses with 50 or fewer full-time equivalent employees can use the Small Business Health Options Program (SHOP) to offer coverage to their employees. This applies to non-profit organizations as well, but not self-employed sole proprietors who have no employees.

If you have fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less, you may qualify for a small business health care tax credit.

Q: What constitutes a full time equivalent employee (FTE)?
A: Employees who work, on average, at least 30 hours per week are considered full-time.

Full-time equivalent (FTE) employees are calculated by adding all hours worked by non full-time employees in a calendar month (but not exceeding 120 hours for any individual employee) and dividing by 120.

Example: 6 PT employees work 20 hours for 4 weeks. (6 x 20 x 4)/120 = 4 FTE’s

Q: Can I buy my own health insurance plan, even if my employer offers major medical?
A: If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance is unaffordable or doesn’t meet minimum requirements. You also may lose any contribution your employer makes to your premiums.

Q: Does the ACA require everyone to buy health insurance?
A: Most people must have health coverage in 2014 or pay a fee. If you don’t have coverage in 2014, you’ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee.

Q: What qualifies for Minimum Essential Coverage?
A: You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.

Q: What is The Marketplace?
A: The Marketplace (also known as “the exchange”) is an online resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans; choose a plan; and enroll in coverage. In some states, the Marketplace is run by the state. In others it is run by the federal government.

The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for small businesses. SHOP is designed for small employers with 50 or fewer full-time equivalent employees. With one online application, employers can compare price, coverage, and quality of plans in a way that’s easy to understand. Health coverage through SHOP starts as soon as January 1, 2014.

Q: Can I use an agent or broker to buy insurance in The SHOP Marketplace?
A: You can continue using your current licensed agent or broker to buy health insurance in the SHOP. The premiums you pay will be the same with or without the help of agents or brokers. Agents and brokers are usually paid by the insurance companies whose policies they sell.

Do you have more questions about the Affordable Care Act?
Call Central Penn at 717-718-5687 for answers or assistance with SHOP Marketplace. Or bypass the exchange and let us help you compare premiums and coverage off the marketplace.