Passed in March 2010, the Affordable Care Act (ACA) aims to increase the quality and affordability of health insurance as well as care for individuals and the government. Let John Austin of Austin & Austin Insurance Services answer your questions about this important legislation.

1. Phone: (800) 987-1475
Website: http://www.a-ains.com
5890 Stoneridge Drive, Ste. #209
Pleasanton, CA 94588
Presented by John F Austin, CFP
CA Lic. 0C10853
June 2013
Serving The Real Estate Community Since 1988

2. PPACA
We’ll be talking about the Patient Protections and
Affordable Care Act (PPACA).

3. Areas To Be Covered
What is the PPACA?
Time deadlines
What’s available
Taxes levied against people who are required to, but
don’t get health insurance.

4. What is the PPACA?
The PPACA is the national health insurance program
that was passed in March 2010. Covered California is
the agency that will administer the PPACA in
California. The PPACA sets guidelines such as:

5. Guaranteed Approval
Guaranteed approval for eligible people – pretty
much everyone who is here legally is eligible.

6. Effective Dates of Coverage
For a January 1st, 2014 effective date on a PPACA plan,
applications need to be in by December 15th, 2013.
If you are on a group plan, that plan should continue
as is until your next renewal – check with your plan
administrator for details.
The Bay East Association of REALTORS® Kaiser plan’s
open enrollment is November for December 1st , 2013
effective dates.

7. Carriers
The carriers:
1. Kaiser Permanente
2. Blue Cross
3. Blue Shield
4. Health Net
5. Western Health Advantage
Plus various other small region carriers.

8. Metal (metal plans); Bronze, Silver, Gold and Platinum.
Tiers
The plans
Each has a set level of benefits.

9. Federal Poverty Guidelines
Household
Size
100%
133%
150%
200%
300%
400%
1
$11,490
$15,282
$17,235
$22,980
$34,470
$45,960
2
15,510
20,628
23,265
31,020
46,530
62,040
3
19,530
25,975
29,295
39,060
58,590
78,120
4
23,550
31,322
35,325
47,100
70,650
94,200
5
27,570
36,668
41,355
55,140
82,710
110,280
6
31,590
42,015
47,385
63,180
94,770
126,360
7
35,610
47,361
53,415
71,220
106,830
142,440
8
39,630
52,708
59,445
79,260
118,890
158,520
For each
additional
person, add
$4,020
$5,347
$6,030
$8,040
$12,060
$16,080

10. Assistance Levels Based on MAGI*
*Modified AGI = AGI plus or minus various items, see next page
Income Level
Maximum % of Income Paid as
Premium
Up to 133% of the Federal Poverty Level
2% of income
133 – 150% of the Federal Poverty Level
3% - 4% of income
150 – 200% of the Federal Poverty Level
4% - 6.3% of income
200 – 250% of the Federal Poverty Level 6.3% - 8.05% of income
250 – 300% of the Federal Poverty Level
8.05% - 9.5% of income
300 – 400% of the Federal Poverty Level 9.5% of income
• Any premium payment that surpasses the maximum % of income paid as
premium is the subsidy.
• Cost-Sharing Reductions are available for Silver plans for people who are
below 250% of the FPL.
• Premium Assistance is available for anyone under 400% of the FPL.

11. What is considered in MAGI?

12. Examples of Subsidies
Number of
Family
Members
Income (Annual)
FPL%
Premium Cost Before
Subsidy
Payment After
Subsidy
1
$22,980.00 – Annual
$1,915.00 – Monthly
200%
$3,600.00 – Annual
$300.00 – Monthly
$1,447.74 – Annual
$120.65 – Monthly
2
$62,040.00 – Annual
$5,170.00 – Monthly
400%
$5,800.00 – Annual
$483.33 – Monthly
$5,800.00 –Annual
$483.33 – Monthly
3
$58,590.00 – Annual
$4,882.50 – Monthly
300%
$6,720.00 – Annual
$560.00 – Monthly
$5,556.05 – Annual
$463.00 - Monthly
4
$35,325.00 – Annual
$2,943.75 – Monthly
150%
$10,800.00 – Annual
$900.00 – Monthly
$1,413.00 – Annual
$117.75 – Monthly

13. Taxes for those who don’t participate
Tax levies for those who are required to, but don’t
actually acquire health insurance – can be a group or
individual plan inside or outside the exchange.
Either income or a fixed penalty is used each year,
depending on which is greater.
Year
2014
2015
2016
Taxable Income
1.00%
2.00%
2.50%
Penalty Per Adult
& Per Child
$95 / Adult
$47.50 / Child
$325 / Adult
$162.50 / Child
$695 / Adult
$347.50 / Child
Maximum Penalty
Per Family
$285.00
$975.00
$2,085.00

14. Who isn’t required to participate?
Everyone, with a few exceptions, is required to acquire
health insurance:
1.You are part of a religion opposed to acceptance of
benefits from a health insurance policy
2.You are incarcerated.
3.You are a member of an Indian Tribe.
4.Your family income is below the threshold for filing a
tax return (10,000 for Ind. / 20,000 for Family)
5.You would have to pay more than 8% of your income
to have health insurance.

15. Grandfathered Plans
The PPACA plans become effective January 1st, 2014. If you
have been on the same individual plan since March 24,
2010, your plan can be grandfathered – check with your
carrier.
If you are an individual plan that is not grandfathered, and
do nothing, your carrier, if participating in the PPACA,
will move you to one of their “metal” plans.
Some carriers have opted to discontinue offering plans,
and have sent notices as required to their participants. If
that is the case for you or you don’t have coverage, you are
required to obtain health insurance coverage by January 1st,
2014 or be subject to a tax.

16. The Bay East Association of Realtors®
Kaiser Group Plan
The Bay East Kaiser plans will not change for the
12/01/2013 to 11/30/2014 period, and the rates are
expected to increase less than 3% from the current
rates. Open enrollment for the Bay East Kaiser plans
is November, for a December 1st effective date. Those
rates will be available the first week of November and
will be on our website http://www.a-ains.com
From feedback we’ve been getting, I expect the Kaiser
individual rates to increase much more than for your
Bay East Kaiser group plan.

17. Other Plans
Other plans outside of Covered California are also
available. An example is Anthem Blue Cross’
individual plans – for which enrollment is expected to
be available starting November 11th, 2013.

18. What do I do?
My recommendation to you is to check out all of your
options, your current plan’s offering effective
01/01/2014, the Bay East Kaiser plan for 12/01/2013 –
11/30/2014, and plans inside and outside of the
PPACA.
You can try to go it alone, or work with a Covered
California Certified Insurance Agent – which we are.

19. Phone: (800) 987-1475
Website: http://www.a-ains.com
5890 Stoneridge Drive, Ste. #209
Pleasanton, CA 94588
Presented by John F Austin, CFP
CA Lic. 0C10853
June 2013
Serving The Real Estate Community Since 1988