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Individual Mandates, Medicaid & Subsidies

The Affordable Care Act (ACA) requires that adults have acceptable health insurance through Medicaid, their employer, or the new health insurance exchange in each state. There are a few exceptions, but this requirement applies to most people age 19-64. Most people who do not have acceptable health insurance by April 1, 2014 may have to pay a penalty, unless their income is low enough that they do not have to file federal income taxes.

With all the changes, your employees are confused about requirements under the ACA and are likely to turn to you to help them figure it out. If your plan is not an affordable qualified health plan, your employees may be eligible for a subsidy. The following chart can be provided as a useful tool in helping employees understand income levels at which subsidies are available.

In Michigan, low-income uninsured adults will gain health coverage through the 2014 ACA expansion of Medicaid to adults (age 19 to 64) with incomes under 133% of the 2014 Federal Poverty Level.

Most adults and families with incomes between 133% and 400% of the 2014 Federal Poverty Level will be eligible for subsidies to help them purchase coverage on the ACA health insurance exchange in each state. The Exchange has one-stop-shopping for health insurance with approved benefits and costs. The Exchange also provides information about subsidies to help eligible adults and families purchase insurance. Also starting in 2014, adults with incomes between 133% and 250% of the 2014 Federal Poverty Level will be eligible for subsidies to lower out-of-pocket costs not covered by their insurance plans.

Adults and families with incomes over 400% of the 2014 Federal Poverty Level will not be eligible for any subsidies. These individuals and families will be required to get healthcare insurance in 2014 (through their employers or ACA insurance exchange) or pay a penalty.

SERPEO can help!

Employers will want to help their employees understand their choices when it comes to health insurance coverage and the ACA. SERPEO utilizes systems that will continue to adapt to the changing requirements of the ACA. We have professional staff that keeps abreast of the latest changes and we will keep you compliant.

As always, if you have any questions call Dan Jacey, SPHR at 248.205.7208.


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