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8 Things Accountants need to tell their Clients about Health Reform

Out of Pocket Maximums

Out Of Pocket Limits have supplanted “Out of Pocket Maximums."  In the insurance plans previously, the OoPM referred only to " major medical"; you could continue to pay copays for expensive medications and physical therapy beyond the OoPM.  For 2015 - the Out of Pocket Limit is an aggregate number - $ 6,600 individual, $13,200 family. After this the insurance will pay 100 %

Coverage Available Thru Group Insurance

If someone has group insurance thru their employer,  they will NOT qualify for a premium tax credit if that coverage is BOTH:
 
1. Compliant in plan design - offering the new Essential Health Benefits
 AND  
2. Affordable -  under 9.5% of their salary. 

If only one  or neither is met, they may qualify for a subsidy.  For spouses and dependents, the coverage must be affordable in relationship to household size and income. Employers are required by law to supply employees with documentation OMB1210-0149
AND One More Point...
Folks may find help thru Healthcare.gov, calling  800-318-2596 , navigators or agents / brokers. If they choose to work with an agent, their premiums are the same and there is no additional cost. They will benefit from the knowledge and expertise an agent who is certified by the Marketplace- -helping them choose a new insurance which meets their needs, goals, values and budget.