We know you have a lot of questions regarding the Affordable Care Act, and how it will effect you. We’re wondering the same things, so send us your questions, and we’ll find the answers for you and share them each week.
Remember to email your questions to email@example.com and put “ACA Questions” in the subject line.
Q: Is a sole proprietor with no employees considered a business or individual under the ACA?
— Jeff C., Valparaiso
A: As a sole proprietor and no employees, you actually could receive insurance either way. The new law also provides a separate marketplace for small businesses with less than 50 full-time employees. Those businesses can qualify for a tax credit covering half the premium costs.
Will Glaros, president of Employer Benefit Systems in Dyer, recommends that you consider purchasing an individual plan because you’ll have a lot more options this first year.
If you can afford it, you might also want to talk to an agent about private plans offered outside the Marketplace. They might not have the same tax subsidies, but they also might not have the restricted networks that plans you find on Healthcare.org will have. That means that you need to know what doctors and hospitals are within your network.
Q: I wanted to enroll but I don’t know what type of text credit I’m going to get to help pay for the monthly premium. I am 54 and just lost my insurance due to a job layoff. I hope to find a job, but I need insurance now. Does the tax credit come one time a year, or is it put on your monthly premiums? Will they go by my yearly income, and now I don’t have income what will they do?
— Deryel R.
A: There’s a lot of elements here, so we’ll start with what to report.
You would estimate what your adjusted gross income would will be when applying. If you were the only income in the household and your income is less than $11,490, you won’t qualify for the tax subsidy. The law is designed to expand Medicaid for those under 138 percent of the poverty line. The state of Indiana decided not to expand Medicaid, so finding affordable coverage will be difficult.
The silver lining is, if you would have qualified for Medicaid, but the state didn’t expand the program, you won’t be required to pay the penalty of either $95 or one percent of your adjusted gross income.
There are other options, including the Healthy Indiana Plan and finding chartitable organizations and federally qualified clinics that offer care on a sliding scale.
If you do have some income coming in, and it’s above $11,490 for one person, or more with multiple people in the house, you would qualify for the credit.
The credit can be applied to monthly premiums or can be taken as a lump sum when you file your taxes.
Marc Connery, a pediatrician in Hobart familiar with the Affordable Care Act, suggests using The Kaiser Family Foundation subsidy calculator — http://kff.org/interactive/subsidy-calculator/ — to estimate what kind of tax breaks you could receive.
If you happen to find a job and it doesn’t provide insurance, you can still enroll outside of the established enrollment period (Oct. 1 to March 31) if you have a “life event,” like changes in income or family size.
Finally, if you need immediate insurance, you might want to see if you can buy COBRA, which allows you to keep your current coverage for 18 months, or another short-term coverage. However, those options don’t qualify for the same credits you would receive through the marketplace, so the costs could be high. Marketplace plans wouldn’t begin until Jan. 1, 2013 at the earliest, and that’s if you enroll in a plan by Dec. 15.