While we encourage you to know some of the basics of healthcare and the Affordable Care Act, we always invite you to reach out to us with questions. We want to you to feel confident knowing we offer the best guidance and service without having to research everything yourself. This is what sets us apart from other agents/agencies, navigators and the marketplace (healthcare.gov).

Advanced Premium Tax Credit

To make coverage more affordable, subsidies (aka Advanced Premium Tax Credits) will be available to help those with lower and moderate incomes. These subsidies are generally available to the following people:

Individuals who are not offered insurance through their work;

Those who are not eligible for a public plan like Medicare, Medicaid, or CHIP; and

those with an annual income between 100 and 400 percent of the Federal Poverty Level.

To receive a subsidy:

Individuals must purchase their health insurance through the Health Insurance Marketplace. If an individual qualifies for a credit, the federal government will pay a portion of the monthly premium directly to the chosen insurance company.

The credit is based on family size, income, and age. To see if you qualify for a subsidy, simply CLICK HERE and enter your zip code and ages of those to be covered.

To qualify for a subsidy, you must:

Be a citizen or legal resident of the U.S.

Have a family income between 100 to 400 percent of the federal poverty level

Not have access to a qualified employer-sponsored health plan that provides minimum value (actuarial value of at least 60 percent) and that is affordable (does not cost you more than 9.5 percent of your income)

Not be eligible for public coverage—including Medicaid, the Children’s Health Insurance Program, Medicare, or military coverage. However, in Utah Medicaid has not been expanded which is causing much confusion. Call for guidance if you’re unsure about this.

Use your subsidy to purchase insurance through Climbing Healthcare’s free assistance on the health insurance marketplace.

How much subsidy could I receive?

Plans offered in the health insurance marketplace are categorized by metal level: bronze, silver, gold, and platinum. Subsidies are based on the premium of the second lowest cost silver plan in each state. The amount of the subsidy varies according to the income of the individual or family. Those who qualify will only be required to pay a certain percentage of their income for premiums, as shown below:

Income Level Premium As A Percentage of Income Monthly Maximum of Premium
    Single Family of Four
Up to 133% FPL 2% of income $25 $51
133%-$150% FPL 3 to 4% of income $56 $115
150%-200% FPL 4 to 6.3% of income $117 $242
200%-250% FPL 6.3 to 8.05% of income $187 $387
250%-300% FPL 8.05 to 9.5% of income $265 $547
300%-400% FPL 9.5% of income $310 $730

Here’s an example:

Johnny is 31 years old and has an annual salary of 200% of poverty or $22,980.

The second lowest cost silver plan in the health insurance marketplace in Johnny’s area costs $3,600 annually.

Johnny will only pay 6.3% of income, or $1,448 annually, to enroll in that plan.

Johnny will receive an annual tax credit of $2,152 ($3,600 premium minus the $1,448 limit on what Johnny must pay)

Uninsured IRS Tax Penalty
Individual Mandate/Penalty

Beginning January 1, 2014, the Affordable Care Act requires all Americans to have minimum essential health coverage, qualify for an exception, or pay a tax penalty. The penalties are phased in, according to the following schedule:

2014—$95 per uninsured adult and $47.50 per uninsured child (capped at $285 per household) or 1 percent of the household income, whichever is greater.

2015—$325 per uninsured adult and $162.50 per uninsured child (capped at $975 per household) or 2 percent of the household income, whichever is greater.

2016 and beyond—$695 per uninsured adult and $347.50 per uninsured child (capped at $2,085 per household) or 2.5 percent of the household income, whichever is greater.

Most individuals in the United States have health coverage today that will count as minimum essential coverage. They will not need to do anything more than continue their current coverage.

For those who do not have coverage, who discontinue their current coverage, or who want to explore other affordable options, Health Insurance Marketplaces (formerly called exchanges) are open in every state, as of 2014.

These will help qualified individuals find minimum essential coverage that fits their budget and look for potential financial assistance to help with the costs of coverage.

Guaranteed Issue

Individuals are guaranteed coverage on a health plan regardless of health status (including pre-existing conditions), age, gender, or other factors that might predict the use of health services. Premium rating may only vary based on the following factors: age, geographic area, number of family members covered and tobacco use.

Essential Health Benefits

The Affordable Care Act states that all non-grandfathered plans in the individual and small employer markets both inside and outside of Health Insurance Marketplaces must cover Essential Health Benefits (EHB) beginning January 1, 2014 for new business, and at renewal for existing business. There are ten categories of Essential Health Benefits:

Ambulatory patient services

Emergency Services


Maternity and newborn care

Mental health and substance abuse

Prescription drugs

Rehabilitative and habilitative services

Lab services

Preventive and Wellness services and chronic disease management

Pediatric services, including oral and vision care