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2022 Affordable Care Act Health Insurance

Our team at Hart, McConahy, Martz Insurance, has been constantly educating ourselves to help you make the right choices regarding your insurance with the new and complex changes to the Health Care System.  Please call us for an in-depth look into your personal health insurance needs, and we will help guide you through the web of options you have to choose from. 

The 2022 Open Enrollment period, for Affordable Care Act health insurance plans, is set to kick off November 1, 2021 and will run through December 15,2021.  This means if you have a 2022 ACA health plan, or if you have no coverage, it's time to act.  You are required to either renew your current plan or switch to another plan if you so choose.  Many variables, such as PRICE, COVERAGE, and PLAN DESIGN, are set to change January 1, 2022  This is your ONLY time to make changes to your plan without qualifying for a "special enrollment period".  Call us today to set up your one on one meeting to review your options for 2020. 



Can I Change My Plan Mid-Year?

After the closing of the Annual Open Enrollment Period you may ONLY change health insurance plans if you experience a qualifying event.  Here is a list of such events:

 1: Did you or anyone in your household lose qualifying health coverage in the past 60 days OR do you expect anyone in your household to lose coverage in the next 60 days?

 2: Did any of the following apply to you or anyone in your household in the past 60 days?

  • Got Married
  • Had A Baby
  • Adopted A Child or had a child placed with you for foster care
  • Got divorced or legally separated and lost health insurance
  • Death in immediate family

 3: Changes in residence or income:

  • Change your primary place of living
  • Had a change in income

 4: Changes in Status

  • Gained citizenship or lawful presence in the U.S.
  • Released from incarceration

 5: Are you a member of a federally recognized tribe, or an Alaska Native corporation shareholder?


How Marketplace plans set your health insurance premiums


Factors that can affect premium costs

Under the health care law, insurance companies can take into account only 5 things when setting premium costs. 

  • Age: Older people can be charged up to 3 times more for premiums than younger people.
  • Geographic location: Where you live has a big effect on your premiums. Competition, local regulation, and cost of living in different areas account for this.
  • Tobacco Use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.
  • Individual vs. family enrollment: Insurers can charge more for a plan that covers a spouse and/or dependents.
  • Plan category: Plans are available in five categories: Bronze, Silver, Gold, Platinum, and catastrophic. The categories reflect how you and the plan share costs. Bronze plans will likely have lower premiums and higher out-of-pocket costs. Platinum plans are likely to have the highest premiums and lowest out-of-pocket costs.


Factors that can’t affect premiums

  • Insurance companies can’t charge women more than men for the same policy.

  • They also can’t take health status into account when setting rates. All Marketplace policies must cover treatment for pre-existing conditions from the first day coverage begins.


Income levels that qualify for health coverage savings


Estimating your household income for the coverage year 

Many people can start with their most recent year’s adjusted gross income and update it to account for upcoming changes. (Savings are based on your income estimate for the year you want coverage, not last year.) Learn more about estimating household income. 

Including the right people in your household 

Count yourself, your spouse if you’re married, plus everyone you’ll claim as a tax dependent, including those who don’t need coverage. There are a few exceptions and details. Learn more about who to include in your household, and whose income is counted.  

What if my income turns out to be different from what I estimate? 

When you apply for coverage in the Marketplace, it's important to double-check the information you put on your application. If the amount of expected income you report turns out to be inaccurate, you may not get the right amount of premium tax credit. 

  • If you wind up making more money than you estimated on your application, you could have to pay back some or all of the premium tax credit you’ve received. You would make this payment with your next tax return.

  • If you wind up making less money than you estimated on your application, you could qualify for a higher tax credit. You would get this money refunded on your next tax return.

    Note: During the year, it’s very important to report changes in your income or household size to the Marketplace as soon as possible. You can adjust your tax credit so you don’t wind up owing money or getting a big refund on your next tax return.


How to save on out-of-pocket health care costs


If you qualify for savings on out-of-pocket costs, you’ll pay lower deductibles, coinsurance, and copayments. These are costs you have to pay when you get care. 

When you apply for coverage in the Marketplace, you'll learn if you’re eligible for savings, which are sometimes called “cost-sharing reductions.” 

Out-of-pocket savings apply only to Silver plans 

Plans in the Marketplace are grouped into 4 categories: Bronze, Silver, Gold, and Platinum. Learn more about plan categories and what they mean. 

IMPORTANT If your income qualifies you for out-of-pocket savings, you must choose a Silver plan to get the savings. You can choose any category of plan you want, but you'll get the out-of-pocket savings only if you enroll in a Silver plan. 

Free or low-cost coverage through Medicaid & CHIP 

When you apply for health coverage in the Marketplace, you or some members of your household could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). 

This will depend on your household size and income, and on whether your state is expanding its Medicaid program to cover more people.


See The Affordable Care Act Plans for Western PA


Click Here >HMM's ACA Plan Outlines<


Individual Affordable Care Act Application Procedure


1. Determine Subsidy Eligibility. Please referrance the 2019 Federal Poverty Line (FPL) Guidelines Chart.

2. Determine Max Monthly Premium. Please refer to the Individual Health Insurance Tax Subssidy Chart.

3. “Contact us” to determine which of the 42 on and off the Marketplace plans best fit your needs.



To determine your network of doctors please contact us. 


Group Affordable Care Act Procedure


1. Determine number of full-time employees (FTE's). Please reference the 2019 Federal Full-time Employee (FTE) Calculator.

2. Determine your eligibility for the Small Business Tax Credit. Please refer to the Small Business Health Care Tax Credit Estimator.

           a. Tax credit could be up to 50% of employer's health care contribution!

3. Complete the "fillable" SHOP Application to be eligible for the Small Business Tax Credit. Click the following link to open SHOP Application. 2018-2019 SHOP APPLICATION.

4. “Contact us” to determine which of the on and off the SHOP Marketplace plans best fit your needs.

 QSEHRA (Qualified Small Employer Health Reimbursment Account)

Is your small business eligible to offer a QSEHRA?

To qualify for a QSEHRA, a small employer generally must:

  • Have fewer than 50 full-time employees
  • Provide the arrangement on the same terms to all full-time employees (reimbursement amounts may only vary based on age and the number of individuals covered)
  • Not offer a group health plan, like SHOP coverage or a flexible spending account (FSA)


To determine your network of doctors please contact us. 


Health Care Reform Links and Additional References:

Highmark's Health Care Reform page

UPMC's page on Health Care Reform

Health America's Health Care Reform Page

Aetna's Health Care Reform Page

NAHU Exchange Update


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