Tax Information Regarding the Affordable Care Act
Find Local Agents/Brokers Help at www.healthcare.gov for CMS ACA Certified Agents/Brokers, then “Click” on “Find Local Help” to insert your zip code/city.
Federal Resources
- www.HealthCare.gov Consumer site for eligibility, plan comparisons, subsidy and cost sharing reductions, enrollment and Q&A.
- Individuals, employees, agents/brokers: Toll-free FFM Call Center available 24/7 @ 1-800-318-2596 or TTY 1-877-871-6594.
- Employers, agents/brokers: Toll-free FF-SHOP Call Center M-F 8-4PM CDT @ 1-800-706-7893 or TTY 1-800-706-7915
- Missed Open Enrollment? https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=1
- Am I eligible for Special Enrollment Periods? https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2
- Taxes: Internal Revenue Service (IRS) http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions provides a summary of tax-related provisions.
- Regulations: Center for Consumer Information and Insurance Oversight (CCIIO) http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html is a source for federal regulations and guidance.
Federal Reform Insurance Provisions
- During Open Enrollment all Oklahomans can shop and enroll for coverage. Outside of Open Enrollment, you may apply for coverage if you fall into a category of eligibility called Special Enrollment. Consumers with incomes between 138% and 400% of federal poverty level may be eligible for premium assistance. https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/
- Find more information on www.healthcare.gov.
Essential Health Benefits
- The health care reform law requires individual and small employer group plans to cover a minimum package of essential health benefits beginning in 2014. https://www.healthcare.gov/what-does-marketplace-health-insurance-cover/
- The essential health benefits package is based on the coverage offered in the most popular plan in the Oklahoma small group market, called the benchmark plan, which is BCBSOK Blue Options Plan. For the Oklahoma Plan Summary and more information http://www.cms.gov/cciio/resources/data-resources/ehb.html#oklahoma
- Preventive Care: Individual and small and large employer plans are required to provide certain preventive care service without cost sharing. https://www.healthcare.gov/preventive-care-benefits
Pre-existing Conditions
- In 2014, health insurers must offer coverage to all individuals and employer groups in or out of the exchange who purchase an ACA compliant comprehensive medical plan, regardless of health status. More information on pre-existing conditions. https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition/
Employer Mandate
- The Employer Mandate Is the reason why you are getting Forms 1094-C & 1095-C to file with your tax return each year. These forms confirm you have health insurance through your employer’s health plan.
- Employers with 25 or fewer full time equivalent employees may be eligible for tax credits if they provide health coverage.
- General Information for Employers with less than 50 full-time equivalent employees – FF-SHOP. In Oklahoma, please talk to your agent/broker or an insurance company representative to see if you qualify.
Grandfathered Plans
- Plans issued before March 23, 2010 are not subject to many of the requirements of the federal reforms and will not include many of the required coverage. For more information on grandfathered plans. https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/
