Common Reform Questions


Q: When can I enroll for coverage?
A:

The 2019 Open Enrollment period begins November 1, 2018 and will end December 15, 2018 for coverage beginning January 1, 2019.

The 2018 Medicare Open Enrollment period begins October 15, 2018 and will end December 7, 2018 for coverage beginning January 1, 2019.


Q: If my employer doesn't offer me coverage, can I get help to lower my premium costs?
A:

You could be eligible for a subsidy, a premium tax credit, if your household income is between 100% and 400% of the Federal Poverty Level.

A general guideline:  If you're single with an annual income between $12,060 and $48,242, or if your total household income doesn't exceed 400% of the federal poverty level, you may qualify for coverage assistance through the Health Insurance Marketplace. 

The amount of the credit is based on your actual adjusted gross income. Click the subsidy calculator to the see if you might qualify.


Q: If my employer offers me coverage, can I still get a premium tax credit?
A:

If your employer offers you affordable coverage that meets minimum value criteria, then you're not likely to be eligible for a premium tax credit. While you can still puchase coverage on your own, the loss of your employer's contribution could make it the more expensive option. 


Q: How does the government define affordable coverage?
A:

For plan years beginning in 2018, employer-sponsored health care coverage is considered affordable if the employee's required contribution for self-only coverage does not exceed 9.56 percent of the employee’s household income for the year.


Q: What are the 10 essential health benefits?
A:

Under the Affordable Care Act, health insurance policies, purchased on or off the Health Insurance Marketplace, must offer a comprehensive package of items and services known as Essential Health Benefits.

At mininumum, health plans must include items and services from these 10 categories of care:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care 
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Q: Where can I purchase coverage?
A:

Uninsured individuals and families can purchase health insurance, which meets Affordable Care Act requirements, through a variety of channels. However, beware of market newcomers who may try to sell you coverage that doesn't meet the new requirements.

A Bukaty Marketplace representative, certified in the Health Insurance Marketplace, can help you review your options, both on and off the Marketplace. Please call 913.333.3380 for more information.