Ron Bliss: ACA creditable coverage includes VA, Medicare Part A, tri-care and qualified employer plans

The end of open enrollment for the Affordable Care Act is at hand. If you don’t sign up or a plan by midnight, Sunday, Feb. 15 you will need to go without health insurance in the form of a qualified ACA plan until next year.

Of course, there is fine involved -- $325 per individual and $162.50 per child or 2 percent of your adjusted gross income -- whichever is more.

A lot of folks are questioning whether the coverage they have will exempt them from a fine.

That is my subject for today.

There are several coverages that qualify. They include:

Medicare Part A. If you qualified for a free Medicare Part A through your years of work and contributions to Medicare, you are considered to have creditable coverage and will not be fined.

Also, if you have Veterans Administration coverage, that is considered creditable coverage. So is Tri-Care and other military-sponsored plans.

If you have a plan through an employer that is considered a Qualified Health Plan under the ACA, you are fine and will not be penalized.

However, if you did not contribute to Medicare through your work and are not eligible for a free Part A because of it, you are eligible for a qualified health plan on the Federal Marketplace. Medicare Part B in itself is not considered essential coverage and will not allow you to avoid a fine.

You would need to drop your Medicare Part B in order to take the Health Marketplace plan.

Those who only have short-term medical plans or fixed benefits plans do not qualify. Only major medical plans that are ACA-qualified will allow you to avoid a penalty.

Individuals must be covered with a qualified plan for at least nine months out of the calendar year.

After Feb. 15, individuals can still get coverage if they have a qualifying life event such as loss of creditable coverage, marriage, divorce, a birth or a death in the family or moving into the state from another state. . Everyone must have a plan in place by then or will have to go without coverage until the next enrollment period Oct. 15 to Dec. 7 for coverage that would begin on Jan. 1, 2016. An exception is made for Native American Indians and Alaskan Eskimos, who can enroll any time during the year.

Businesses can also do a group plan for their employees any time during the year. If that happens, anyone on a Health Marketplace plan must take the offer of coverage from the employer if cost of their premium is no more than 9.5 percent of their income. If it is not, that will be allowed to stay on their Health Marketplace plan.

Ron Bliss is a former sports writer who has been selling health insurance for five years. Affordable Healthcare Pros is located at 2307 North Carson Street in Carson City. Those who need help with health plans – on and off the Marketplace or Medicare supplements – can contact them at 775-450-6769, 775-450-6867 or 775-450-7754. Bliss can also be reached at 775-224-7169. He is certified for Covered California, as well as the Nevada Health Link.


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