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8152 S. Cass Avenue | Darien, Illinois 60561


Under 65 Health Insurance

(Information on Healthcare Reform and New Products)

In March 2010, the Affordable Care Act was signed into law and dramatically changed healthcare in America. The intent of this healthcare reform is to provide new consumer protections, increase access to affordable care, and improve the quality of care at lowered costs. Ultimately the healthcare law hopes to eventually extend coverage to more than 30 million uninsured people by signing up low-income adults for medicaid and providing middle class households with tax credits for private insurance while allowing all eligible people the right to secure healthcare coverage without regard to prior healthcare conditions.

With all the talk about the Affordable Care Act and the healthcare changes that come with it, what does the new law really mean to you?*

*Please keep in mind that the information provided is a summary of a very complex law.

For clarification, more detailed information, or help in anyway, please feel free to contact us directly via phone (1-800-572-7512 or 1-630-963-2202) or email [email protected]. We will do our best to steer you in the right direction.

The issues surrounding health care are complex and we will do our best to help you in whatever way you choose!

Key Features

Coverage Will Be Guaranteed and Required

You will be able to get health insurance coverage, even with a pre-existing condition. With the new law, starting in 2014, you can get health insurance even if you already have an illness or are pregnant (pre-existing condition). What’s more, you won’t have to pay more to have pre-existing medical conditions covered. Most Americans will be required to have health insurance coverage or pay a penalty.


Beginning in 2014, most people who choose to go without coverage will pay a tax penalty, unless they are part of an exempt group or qualify for an exception.


The individual shared responsibility tax penalty is the lesser of:

  1. The sum of the monthly penalty amounts for each individual in the shared responsibility family; or
  2. The sum of the monthly national average Bronze plan premiums for the shared responsibility family.
  • In 2014, the penalty is $95 per adult and $47.50 per child (with the penalty for a family capping at $285) or 1% of income, whichever is greater.
  • In 2015, the penalty is $325 per adult and $162.50 per child (with the penalty for a family capping at $975) or 2% of income, whichever is greater.
  • In 2016, the penalty is $695 per adult and $347.50 per child (with the penalty for a family capping at $2,085) or 2.5% of income, whichever is greater.

For each of these years, neither of these penalties may exceed the cost of the national average of the lowest Bronze metallic plan on the exchange.


Note that some people are exempt from the individual shared responsibility tax penalty because of financial hardship, religious beliefs, incarceration, or if they have special coverage as established by another law, such as American Indians.

All New Plans Will Include Coverage for Essential Health Benefits

Health plans will include more benefits considered essential to good health.


Beginning in 2014, certain health plans must cover your basic health needs. The new law defines this coverage as essential health benefits. Essential health benefits include:

  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health/substance abuse treatment
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive services and disease management
  • Pediatric services including oral and vision care
Preventive Care Comes With No Out-of-pocket Cost

You may be able to get preventive health services — that can help you stay healthy — at no cost. This means you may not have to pay a co payment, coinsurance or deductible.


You may get — at no cost — preventive services such as:

  • Blood pressure, diabetes and cholesterol tests
  • Many cancer tests, such as mammogram and colonoscopies
  • Help to stop smoking, lose weight, fight depression and reduce alcohol abuse
  • Well-baby and well-child visits, from birth to age 21
  • Vaccines, such as measles and polio
  • Care for healthy pregnancies
  • Flu and pneumonia shots

Starting in 2014, all new individual health care plans must cover these essential health benefits. Many group health plans will also cover these benefits.

Your Health Plan Won't Limit the Amount It Will Pay for Essential Health Benefits within a Year or Over the Lifetime of Your Plan

Your health insurance plan cannot limit how much it will pay for essential health benefits. Essential health benefits cover your basic health needs and include preventive services and some prescription drugs.


Previously, insurance companies could limit what they would spend, either yearly or for the entire time you were enrolled in a plan (the “lifetime”). Under the new health care reform provisions, there are no lifetime limits on most benefits you receive. The law also restricts annual limits and does away with them entirely in 2014.


Important Notes:

  • Health insurance plans can still limit spending on health care services that are not considered “essential.”
  • Health plans can also limit the number of visits or how often you obtain essential health benefits.
  • The new ban on lifetime limits applies to every health plan.
You May Qualify for Cost Assistance

Based on your income and household size, you may now be able to get help paying for health insurance coverage. Premium tax credits and help with cost-sharing are available to those who qualify.


When shopping for a new health insurance plan, you may qualify for help with the cost of buying coverage by:

  • Lowering your premiums through a premium tax credit
  • Qualifying for help with out-of-pocket costs
  • Getting low or no-cost coverage through a government program


You generally won’t qualify if your estimated 2020 income is above:

  • $49,960 for an individual
  • $103,000 for a family of 4


The lower your income, the lower your costs.


You may need to fill out an application on Get Covered Illinois, the Official Health Marketplace for Illinois, to find out what kind of assistance you qualify for. You can access the marketplace directly or through Blue Cross and Blue Shield of Illinois.


The above link will take you to the Blue Cross and Blue Shield of Illinois' web site for plan and premium information as well as provide direct access to the market place for premium tax credit and other cost saving help if eligible.

The Health Insurance Marketplace Offers a New Way to Shop

You can compare plan prices and benefits from a number of health insurance companies offering coverage on the marketplace.


All plans on the marketplace have similar benefits, and all include essential health benefits. Where they differ is on how the costs of the benefits are applied.


Plans on the marketplace are divided into four different levels —BronzeSilverGold and Platinum.


Bronze Lower monthly payments
Higher cost when you receive medical care
View Bronze Plans: On Exchange | Off Exchange
Silver Higher monthly payment than a Bronze plan
Lower cost than a Bronze plan when you receive medical care
View Silver Plans: On Exchange | Off Exchange
Gold Higher monthly payment than a Silver plan
Lower cost than a Silver plan when you receive medical care
View Gold Plans: On Exchange | Off Exchange
Platinum Highest monthly payments
Lowest cost when you receive medical care


The marketplace also offers a catastrophic health plan option for people under 30 and to some low-income people. A catastrophic health insurance plan has a lower premium than other health plans, but has a high deductible. It is meant to serve as a “safety net” to cover large medical costs in case of a serious illness or injury.

What is the Address of the Health Insurance Marketplace Web Site?

The address of the marketplace is healthcare.gov. You can access the marketplace through Blue Cross and Blue Shield of Illinois. When you enter your information, it will direct you to the offerings in Illinois.


However, you can still buy directly from an insurance company or agent if you'd like. It's your choice.

Health Plans Inside and Outside the Marketplace are Similar

No matter how you buy your health insurance, health insurance plans generally offer the same set of essential health benefits, free preventive services, coverage for pre-existing conditions, and other rights and protections under the health care law.


Most plans available outside the Marketplace meet the requirement for providing sufficient coverage under the health care law. This means you won’t have to pay the penalty that some people must pay if they don’t have coverage in 2014. But not all plans you buy outside the Marketplace meet the requirement. Most insurers must tell you if the plan you’re buying qualifies as coverage under the health care law. Be sure to ask.


There’s one very important difference between plans sold inside and outside the Marketplace: The only way to get lower costs on your monthly premiums based on your income is through the Marketplace.


If you become confused or need assistance of any kind, please call 1-800-572-7512 or 1-630-963-2202, or email [email protected] or drop in at our office K&B Financial Inc., located at 8152 S. Cass Avenue, Darien, Illinois 60561.

Want more information? Contact K&B.