Affordable coverage - Glossary (2024)

FAQs

What is the definition of affordable coverage? ›

Affordable coverage under the Affordable Care Act (ACA)(opens in a new tab) is a standard for measuring the relative cost of an employer-provided healthcare plan. It's based on the maximum percentage of household income an employee would have to spend on the least expensive plan.

The Affordable Care Act (ACA) requires most Americans to have qualifying health insurance called "minimum essential coverage." Under the ACA's individual shared responsibility provision (also known as the "individual mandate"), most Americans must maintain minimum essential coverage.

Beginning in 2016, employers with 50 or more full-time workers or equivalents must offer coverage to at least 95 percent of full-time employees.

Plans in the Marketplace are presented in 4 health plan categories: Bronze, Silver, Gold, and Platinum. (“Catastrophic” plans are also available to some people.) Health plan categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care.

The adjective affordable can either mean "cheap," or it can imply that even if it's expensive, you have enough money to easily buy it. The verb afford is at the root, and its earliest meaning was "accomplish." Gradually, afford came to have the meaning "manage to buy."

The couple had spent hours looking for something affordable. We sell luxury clothes at affordable prices. Most choose to buy in more affordable villages a little way away. Credit unions can provide affordable loans for people in real need.

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and ...

What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.

The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

The affordability threshold is the maximum amount that the employee's share of the premium can be. To calculate this, multiply the employee's household income by 8.39%. For example, if the employee's household income is $50,000, the affordability threshold would be $4,195 ($50,000 x 8.39%).

What is the 3 month rule for ACA? ›

At a high level, the LBMM requires tracking employee hours for a certain period, called the “measurement period,” which determines the employee's FTE status for a subsequent period, called the “stability period.” The LBMM requires the plan sponsor to establish three things: (1) a “measurement period” of 3 to 12 months, ...

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

There are exemptions for reasons such as living only part of the year in California, reporting a hardship or going without coverage less than three months. People can also seek an exemption if health coverage is considered unaffordable, if that coverage would cost more than 8.17% of their household income.

each plan level must cover the same minimum EHBs; tiers represent the average portion of expected costs a plan will cover for an average population. -bronze plan: 60% -silver plan: 70% -gold plan: 80% -platinum plan: 90%

Kaiser Permanente is the cheapest health insurance company of 2024, according to our analysis. We evaluated health insurance companies based on cost, coverage options, NCQA quality rating and consumer complaints.