Affordable Care Act

Affordable Care Act

The federal Affordable Care Act (ACA) requires each state to operate a Health Insurance Marketplace, also known as an exchange, where people may purchase coverage. The 2016 open enrollment period is November 1, 2015 through January 31, 2016. Coverage would begin on January 1, 2016.

Through the online Health Insurance Marketplace, non-Medicare eligible consumers will be able to compare plans, prices and health-care providers. The primary goal of the ACA is to provide access to the uninsured and to provide a competitive marketplace for plan premiums and coverage.

Information and sign-up for the Affordable Care Act can be found at Healthcare.gov

There are four main points for ASRS retirees to consider:

  • The ASRS retiree health insurance program meets the health care requirements outlined by the Affordable Care Act.
  • If you are not eligible for Medicare and have health insurance through the ASRS retiree health insurance program, you now have additional options through the Affordable Care Act. You may review the available ACA options through the Health Insurance Marketplace to determine if they better suit your personal needs for health insurance.
  • If you are not eligible for Medicare and do not now participate in an ASRS retiree health insurance plan, or otherwise have no health insurance, in most cases you will be required to obtain coverage or pay a penalty.  Depending on your household income, you and your eligible dependents may be eligible for a government subsidy to help you pay for coverage through the Health Insurance Marketplace.
  • If you are eligible for Medicare and participate in a Medicare plan, either through the ASRS or some other option, the new Health Insurance Marketplace does not apply to you.

Affordable Care Act logo
View the 2015 ASRS Affordable Care Act & Arizona Health Insurance Marketplace Guide

Affordable Care Act Q & A

Q: What is the Health Insurance Marketplace?

A: The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. Each state must operate a health insurance marketplace, also known as an exchange, where people can purchase insurance coverage. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new tax credit that lowers your monthly premium right away and cost-sharing subsidies which are applied to copayments and/or coinsurance. The 2016 open enrollment for the Health Insurance Marketplace is Nov. 1, 2015 - Jan. 31, 2016 for coverage starting as early as January 1, 2016.

Q: What is the difference between the tax credit and cost-sharing subsidies?

A: Premium Tax Credits: Beginning in 2014, individuals or families who have incomes between 100 to 400 percent of the federal poverty level (up to $45,960 for an individual and $94,200 for a family of four in 2013) will be eligible for premium tax credits, which will help reduce health insurance premium costs. Cost-Sharing Subsidies:Beginning in 2014, individuals or families with incomes up to 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family of four in 2013) will be eligible for reduced cost-sharing, paid for by the federal government. Cost sharing subsidies lower the amount individuals or families pay out-of-pocket through copays, deductibles and coinsurance. The subsidies makes out-of -pocket costs lower because the government pays a portion of those costs by giving money to your insurance company.

Q: How does the Health Insurance Marketplace affect me as a non-Medicare member?

A: Non-Medicare members now have the option to shop the Marketplace to determine if the plans offered fit your budget and meet your needs. You may continue coverage with ASRS, your current insurance provider, or choose health care insurance from the Marketplace.

Q: How does the Health Insurance Marketplace affect me as a Medicare eligible member?

A:The Health Insurance Marketplace, at this point, does not apply to Medicare-eligible members. The Marketplace is designed for pre-Medicare health care consumers. Medicare members do not enroll through the new Marketplace but will continue to use Medicare’s traditional enrollment period to choose from eligible plans.

Q: Will my ASRS coverage change (i.e. less services covered, copayments change) because of the ACA?

A: For plan year 2014, your ASRS health care plans and benefits remain the same. Changes that may affect future years are being studied.

Q: Will the ASRS premium benefit be applied to insurance purchased through the ACA Health Insurance Marketplace?

A: No. Arizona statutes provide that the ASRS premium benefit may only be applied to ASRS insurance or ASRS employer insurance.

Q: If I drop my insurance purchased through the Health Insurance Marketplace, is that a Qualifying Event that would allow me to enroll in ASRS insurance outside of open enrollment?

A:No. The Health Insurance Marketplace consists of private insurance options. Dropping a private plan is not one of the qualifying events. Refer to the ASRS Retiree Group Insurance Initial Enrollment Guide for a list of qualifying events.

Q: Why do monthly premiums vary within the Marketplace compared to ASRS?

A:There are many things to consider when choosing the right health insurance coverage. A key component is balancing monthly premiums with out-of-pocket costs. As with all health plans, you have to pay a monthly premium. But it's also important to know how much you have to pay out-of-pocket for services when you receive care. The Marketplace has four standard benefit packages: Bronze (lowest premium/highest out-of-pocket), Silver, Gold, and Platinum (highest premium/lowest out-of-pocket). • Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you receive care. For example, if you have a Gold plan, you will likely pay a higher premium, but may have lower costs when you go to the doctor or use other medical services.
  • With a Bronze plan, you will likely pay a lower premium, but pay a higher share of costs when you receive care.
  • Platinum plans will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.
  • In general, when choosing your health plan, keep this in mind: the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium, the lower the out-of-pocket costs when you need care.

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