About The Affordable Care Act

The Affordable Care Act, or “Obamacare,” has expanded the availability of health insurance coverage to millions of Americans. However, signing up for insurance and getting the coverage you need can be confusing. With these New Jersey Health Care Quality Institute approved and authored resources, we hope to provide important information and links to help you learn more about the Affordable Care Act.

Important Dates

  • 2015: Individuals who do not have health coverage during 2015 will be subject to a  penalty. The fee in 2015 is higher than it was in 2014.  The penalty will be either 2% of an individual’s income or $325 per adult and $162.50 per child, whichever is more.
  • 2015: Hospitals which are in the top 25th percentile of rates of hospital acquired conditions for certain high-cost and common conditions are subject to a payment penalty under Medicare.
  • January 1, 2016: Employers with 100 or more full-time equivalent employees must offer coverage to at least 95 percent of full-time employees as one of the conditions for avoiding an assessable payment.
  • January 1, 2016: Employers with at least 50 but less than 100 full-time equivalent employees must offer coverage to avoid assessable payments.
  • 2016:  Individuals who do not have health coverage during 2016 will be subject to a penalty. In 2016, the fee is 2.5% of income or $695 per person.
  • September 2017: Insurance plans that do not meet ACA coverage requirements will be terminated.
  • 2018:  A 40% excise tax (“Cadillac tax”) will be imposed on insurance companies providing high cost employer-sponsored coverage. Insurance plans costs more than $10,200/year for individuals or $27,500 for family coverage (not including dental or vision plans) will be subject to a 40% tax on the excess cost.  The tax will be incurred by the insurance companies which could result in higher premiums for the employer.
  • 2020:  The Doughnut Hole Medicare prescription drug benefit gap ends.  Seniors continue to pay the standard 25% of drug costs until they reach the threshold for Medicare catastrophic coverage, when their copayments drop to 5%.  Under current law, Medicare stops covering drug costs after a plan and beneficiary has spent more than $2830 on prescription drugs. It starts paying again after an individuals out of pocket expenses exceed $4550.  This gap in coverage ends in 2020.

To Sign Up or Renew Your Healthcare Coverage

For individuals to get coverage, renew or keep their insurance plan: visit https://www.healthcare.gov/ or call the Health Insurance Marketplace Call Center at 1-800-318-2596  TTY: 1-855-889-4325.

For Businesses – employers and employees visit Small Business Health Options  Program (SHOP) or call the SHOP Small Employer Call Center at 1-800-706-7893 (TTY: 711). Mon-Fri, 9 a.m. – 7 p.m.  Agents and brokers helping small businesses can use this phone number also.


PLEASE NOTE: The information contained in this site is for general guidance only.

The application and impact of laws can vary widely based on the specific facts involved. Accordingly, the information on this site is provided with the understanding that the authors and publishers are not herein engaged in rendering legal, accounting, tax, or other professional advice and services. As such, it should not be used as a substitute for consultation with professional accounting, tax, legal or other competent advisers.

While we have made every attempt to ensure that the information contained in this site has been obtained from reliable sources, Quality Institute is not responsible for any errors or omissions,or for the results obtained from the use of this information. Certain links in this site connect to other websites maintained by third parties over whom Quality Institute has no control. Quality Institute makes no representations as to the accuracy or any other aspect of information contained in other websites.

 

Frequently Asked Questions

Overall Resource Links

  • HealthCare.gov
    Link: Where individuals can purchase plans, determine whether or not they are eligible for subsidies, or be connected to appropriate resources (like local in-person help) should they need them.
  • Georgetown University Health Policy Institute's Navigator Resource Guide
    Link: This guide is focused solely on the private insurance reforms of the Affordable Care Act, including the health insurance marketplaces, rating, benefit and cost structures, and premium tax credits. It is intended to supplement the Navigator training available from the U.S. Department of Health and Human Services. It is not intended to be a comprehensive, stand-alone resource for all the reforms of the Affordable Care Act.
  • Health Insurance Marketplace Call Center
    Link: 1-800-318-2596. TTY users should call 1-855-889-4325.
  • Information from the NJ Department of Banking and Insurance
    Link: Where individuals can find answers to questions about the Patient Protection and Affordable Care Act offered by the New Jersey Department of Banking and Insurance.
  • Glossary of Health Insurance Terms
    Link: Glossary of health insurance terms developed by the National Association of Insurance Commissioners.
  • Health Plan Report Card
    Link: A report card on performance in quality and patient satisfaction offered by the National Committee for Quality Assurance.
  • U.S. Department of Labor: Health Reform Regulations
    Link: Department of Labor Health Reform Regulations - Affordable Care Act regulations for employers and employees.

Consumer Resource Links

Employer Resource Links