ACA Marketplace Connection

The Affordable Care Act

What is the ACA Marketplace?

What is The Affordable Care Act (ACA)?

The Affordable Care Act, also known as Obamacare, is a federal law enacted in 2010. It requires all U.S. citizens and legal residents to have health insurance or pay a penalty. The ACA established the Health Insurance Marketplace, an internet-based system, to provide a public access to shop for qualified health plans and it’s the only way to apply for financial assistance (tax credits) to reduce monthly premiums.

When can I Apply and Enroll?

Open Enrollment for 2017 coverage starts November 1, 2016 to January 31, 2017

Outside the Open Enrollment period, you may only get health insurance if you have a Life Changing Event. Visit an Assister to apply for a Special Enrollment Period (SEP).

Who Is Eligible?
  • US Citizens
  • Immigrants lawfully present in the U.S.
  • People with pre-existing health conditions
What Will You Need To Apply?

Returning individuals and families that want to renew their coverage or apply for an exemption need to bring:

  • Folder with Marketplace user name & password
  • Marketplace letter with Application ID
  • Current family income information

Individuals applying for the first time, please provide the following information for all the people reported in your income tax return:

  • Names, birth dates & Social Security numbers
  • Family income information (tax return, W2, pay stubs, net income from self-employment, unemployment, Social Security benefits, pensions, etc.)
  • Proof of Legal Status (Resident card, Visa, Citizenship Certificate, etc.)
  • Employer’s name, address & phone number
  • If job-based health insurance is available, please provide cost of premiums & health benefits covered
  • Email address that you can access on your cell phone or computer
How Can You Apply?
1) Visit an Assister
Call us: (210) 977-7997

Email us: CentroMed.Marketplace@centromedsa.com

In Person:

SOUTHSIDE

CentroMed Southside Medical

3750 Commercial Avenue, San Antonio, TX 78221

CentroMed Palo Alto Clinic

9011 Poteet Jourdanton Freeway, San Antonio, TX 78224

CentroMed South Park Medical

6315 S. Zarzamora, San Antonio, TX 78211

MHM–Wesley Health & Wellness Center

1406 Fitch St, San Antonio, TX 78211

SOUTHEAST

CentroMed City Base Clinic

3127 S.E. Military Drive, San Antonio, TX 78223

SOMERSET

CentroMed Maria Castro Flores Clinic

7315 S Loop 1604 West, Somerset, TX 78069

NORTHEAST

CentroMed Noemí Galván Eling Clinic

5542 Walzem Road, San Antonio, TX 78218

NEW BRAUNFELS

CentroMed County Line Clinic

1034 W County Line Rd., New Braunfels, TX 78130

2) Online: www.HealthCare.gov
3) By Phone: Marketplace Hotline 1-800-318-2596
For other locations Call 211, option 1 or

Visit www.EnrollSA.com & click on Get Help to make an appointment or

Ask a local representative to call you by completing the card at this link:

https://www.getcoveredamerica.org/commit/

What is the Penalty for Being Uninsured and How are your Taxes Affected?

People who do not have health insurance must pay a penalty fee when they file their tax return. In 2016, the penalty fee is 2.5% of your annual income or $695 per adult. In 2017, the fee will increase based on inflation to approximately $709 per adult or 2.5% of your annual income (whichever fee is higher).

There will be NO PENALTY for not having health coverage IF YOUR INCOME is below 100% of the Federal Poverty Level or if you receive an EXEMPTION from the Marketplace.

How do I get an Exemption from the Penalty?

People that have an income less than 100% of the Federal Poverty Level are automatically exempt. There are various situations that may provide you an exemption, such as family coverage is more than 8.05% of the household income, eviction or foreclosure, etc. Visit an Assister to apply for an exemption.

Who Does Not Need To Apply?

People with coverage from Medicare, Medicaid, CHIP, COBRA, TRICARE, Veterans Health Programs, job-based insurance, student health plans or private insurance do not need to apply. Others that don’t need to apply are people without legal status, some Americans living abroad and non-tax filers.

If your job offers health insurance, neither you nor your family may qualify for assistance, unless the plan costs more than 9.66% of your yearly salary or the plan does not cover the Essential Benefits required by law. If family coverage is more than 8.05% of the household income, you may qualify for an exemption. However, if the employer does not offer coverage for the family, your family may qualify for assistance.

People on CareLink or other medical discount programs do not meet the federal requirement to have health insurance and may be penalized. We recommend that they apply in the Marketplace and enroll in a health insurance plan or apply for an exemption.

What are the Plans, Benefits, and Costs?

Health Insurance companies can offer four types of plans that cover the same benefits at different percentages: Bronze=60%, Silver=70%, Gold=80% and Platinum=90%. Premium rates (paid monthly) will vary based on income, family size, age, coverage area and the type of plan you choose.

People with incomes between 100% to 250% of the Federal Poverty Level will qualify for additional assistance to reduce out-of-pocket costs but must select a Silver-level plan to receive these benefits.

What is Covered?

10 Essential Health Benefits
1. Outpatient services
2. Emergency services
3. Hospitalization
4. Maternity & New Born Care
5. Mental Health and Substance Abuse Services & Treatment for Behavioral Health
6. Prescription drugs
7. Rehabilitative Services & Devices
8. Lab tests
9. Preventive and Wellness Services & Chronic Disease Management
10. Pediatric Services (including dental & eye care for children)