Resources Related To 2016 ACA Enrollment

[AllenChicago]

Here is a link to the 2016 Federal Poverty Level chart.

https://obamacare.net/2016-federal-poverty-level/

Other resources are at the website as well.

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CMS Resources for Agents and Brokers
https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/a-b-resources.html

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Illustrated Step-by-Step Procedures for Changing or Cancelling Plans
https://marketplace.cms.gov/technic...s/consumer-options-select-different-plans.pdf

Above How-To is from:
https://marketplace.cms.gov/
Which contains many others, along with brochures, forms, etc..

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10-30-2015

See attachment for the 2016 Open Enrollment schedule of Operational Update webinars, for Agents and Brokers, from CMS. (I don't know how to insert an image that came in an e-mail)

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[Yagents]

Let me add value to the thread: www.Healthcare.gov

 

[pcbinsurance]

You continue to amaze me with your value added posts.

 

[taterpeeler]

lET ME ADD MORE VALUE............Federal Poverty Guidelines | Families USA

There, I have served my country today

 

[FLM2]

lET ME ADD MORE VALUE............Federal Poverty Guidelines | Families USA

There, I have served my country today

My value added for today is: A vote for POTUS is a vote for......POTUS!!!!

 

[CHUMPS FROM OXFORD]

Here's my value. Ohio State is up 14-0 and will win again.

 

[taterpeeler]

We are Great Americans... Long live ObamaCare...lol

 

[Ann H]

AllenChicago, I am absolutely amazed at you. You find the most pertinent data! You are an amazing researcher.

Here is my "Value Add"

APPLICABLE PERCENTAGE (MEMBER'S SHARE) The Member's Share of the premium (Applicable Percentage) goes up in 2016. Here are the figures:

Household income as percentage of Federal poverty line:
<133% - 2.03% to 2.03% (or Medicaid eligible)
133% but less than 150% - 3.05% to 4.07%
150% but less than 200% - 4.07% to 6.41%
200% but less than 250% - 6.41% to 8.18%
250% but less than 300% - 8.18% to 9.66%
300% but not more than 400% - 9.66% to 9.66%
https://www.irs.gov/pub/irs-drop/rp-14-62.pdf

FPL TABLES - Remember to use the 2015 FPL figures for 2016 APTC. The link that Allen gave are the right figures, but it inaccurately says 2016 at the top. The link TaterPeeler gave are the same figures, but correctly says 2015 at the top.

PENALTY (INDIVIDUAL MANDATE) These amounts go up in 2016 to:
$695 per adult
$347.50 per child
up to $2,085 OR
2.5% of Household Income
WHICHEVER IS GREATER
Capped at the the cost of the premium for the national average
lowest cost bronze plan (rated for age and family makeup)

Household income for the purpose of the penalty does not add back the non-taxed portion of Social Security Benefits, and it subtracts the tax-filing threshold first.


Unaffordability bars
8.13% for the "unaffordable" exemption to the Individual Mandate penalty - based on any and/or all family members' premium.

9.66% for affordable "employer sponsored" health insurance - based on the self-only premium.

9.66% affordable level for the Employer Mandate, but 9.5% if using the safe harbor.

Maximum MOOP -
$6850 ($13,700 family)



Just to put it all together, I am attaching my cheat sheet for MAGI definitions, which I have posted on another thread previously.

Modified Adjusted Gross Income (MAGI) is defined differently for different parts of the law.

For the Subsidy (Advance Premium Tax Credit):
Household income
AGI (line 37 of the Federal Form 1040)
Plus foreign income exclusion (under Section 911)
Plus tax exempt interest (line 8b)
Plus the non-taxable portion of Social Security Benefits (line 20a minus 20b)
http://www.irs.gov/pub/irs-pdf/p5187.pdf
http://www.irs.gov/Affordable-Care-...estions-and-Answers-on-the-Premium-Tax-Credit


For the Penalty (Individual Shared Responsibility Payment):
Household income
AGI (line 37)
Plus foreign income exclusion (under Section 911)
Plus tax exempt interest (line 8b)
Less the tax-filing threshold (generally $10,150 for singles and $20,300 for families for tax year 2014, but it is more for over age 65, and different for other tax filing statuses.)
http://www.irs.gov/pub/irs-utl/21-Individual Shared Responsibility.pdf


For the Affordability Exemption to the Penalty (the 8.13% unaffordability bar – 8% in 2014, 8.05% in 2016 and 8.13% in 2016):
Household income
AGI (line 37)
Plus foreign income exclusion (under Section 911)
Plus tax exempt interest
http://www.irs.gov/pub/irs-dft/i8965--dft.pdf


For Employer Sponsored coverage, as it pertains to a person wishing to get a subsidy (the 9.66% unaffordability bar – 9.5% in 2014, 9.56% in 2015, 9.66% in 2016):
Household income
AGI (line 37) for the household
Plus foreign income exclusion (under Section 911)
Plus tax exempt interest (line 8b)
Plus the non-taxable portion of Social Security Benefits (line 20a minus 20b
This applies to self-only premium
http://www.irs.gov/Affordable-Care-...estions-and-Answers-on-the-Premium-Tax-Credit


For Employer Sponsored coverage, as it pertains to an Employer wishing to avoid an Employer Mandate Penalty (another 9.5% or 9.66% unaffordability rule – 9.5% in 2014, 9.56% in 2015, 9.66% in 2016):
If no Safe Harbor is used, then it is
9.5% in 2014, 9.56% in 2015, 9.66% in 2016
AGI (line 37) for the household
Plus foreign income exclusion under Section 911
Plus tax exempt interest (line 8b)
Plus the non-taxable portion of Social Security Benefits (line 20a minus 20b)
http://www.gpo.gov/fdsys/pkg/FR-2013-01-02/pdf/2012-31269.pdf
If using the Safe Harbor, then it is
9.5% of W2 Box 1 income for 2014, 2015 and 2016

Both of these apply to self-only premium

 

[Yagents]

https://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/a-b-resources.html

 

[Ann H]

Latest Enrollment Manual from CMS

https://www.cms.gov/CCIIO/Resources...ns_Policy-and_Guidance_Final_9-30-2015_mb.pdf