CA-Affordable Care Act

CHAPTER 2 Exchange Customers Exchanges are designed to serve both individual consumers (and their families) and small businesses (and their employees), offering insurance options for each. Those that serve individuals…

CHAPTER 3 Which Model? The decision as to the exchange model that is implemented in any state was left to the state. As of the date by which this decision…

Eligibility for Enrollment in a QHP The ACA intends that health care be available to virtually all U.S. citizens; therefore, eligibility for a QHP through an exchange is based only…

Qualifying SHOP Employers To qualify for a SHOP plan, an employer must meet the following requirements: The employer must be a “small employer.” For this purpose, the ACA defines a…

Employer Mandate Though the federal government proclaimed that the ACA does not impose an employer mandate, the law stipulates that beginning in 2015, employers with 50 or more full-time (or…

What Does a Benefit Level Mean? It is important to understand that these QHP benefit levels do not reflect the quality or amount of care a plan provides; all plans…

Community Rating and Premiums Another change that the ACA brought about is the requirement for QHP insurers to use community rating as the basis for their plan rates and premiums.…

Overview In keeping with its title, one of the key objectives of the Affordable Care Act is to help make health insurance affordable for all Americans. Accordingly, written into the…

Amount of Premium Tax Credit The amount of the credit is based on household income and the premium for the exchange plan in which the individual (and his or her…

Medicaid and the Exchanges A full discussion of the effects of the ACA on Medicaid eligibility and its interaction with health insurance exchanges is well beyond the scope of this…

Exchange Consumer Support Functions A key function of every exchange—and critical to its operation—is to ensure that consumers are aware of the exchange and what it offers; can easily apply…

Registration with the Exchange For federally facilitated and partnership exchanges, producers must first register with the exchange. This involves three steps: Confirm their identity through a simple application/registration form. Complete…