Affordable Care Act simplified

The Aiken Chamber of Commerce recently hosted a business academy on the Affordable Care Act, featuring several experts in the field.  Katherine Nelson Todd, Community Relations Manager Midlands Market, Consumers' Choice Health Plan, helped to simplify the confusing topic with a Q&A presentation. 
As an Employer, what are my basic responsibilities under the Affordable Care Act (ACA)?

• In 2015, Employers with 50 or more employees will be required to provide health insurance coverage. Those that do not will be subject to tax penalties.
• Employers that already offer health care coverage should check with the administrators of their health plans to ensure the plans are in compliance with the new ACA regulations.
• Employers with 25 or fewer FTEs may receive a tax credit for offering health insurance coverage.

As an Individual, what are my basic responsibilities?

Virtually all American citizens must have qualified health insurance coverage either through an employer or individually – OR be subject to a tax of $95 per adult or 1% of income in 2014, and increases each year after.  There are exemptions for the following:

• those who make too little to file taxes with the IRS
• those in religious groups that oppose health insurance benefits
• incarcerated Americans
• undocumented immigrants
• those who are a member of an Indian tribe
• those who pay more than 8% of their income for health insurance after any employer contributions or tax credits

What does the word “Exchange” mean under the new ACA?

The new Health Insurance Marketplace (also called the “Exchange”) is meant to be a “one stop shop” for individuals and small businesses to purchase insurance plans that fit their needs. 

S.C. opted‐out of forming a state‐run exchange therefore individuals and small businesses will have access to the federally facilitated exchange, located at

Small businesses may shop for plans in the SHOP (Small Business Health Options Program) listed on the Health Insurance Marketplace.
Small businesses that do not offer health insurance plans to their employees can refer them to the Health Insurance Marketplace for individual coverage options.

What are CO-OP Health Plans?

CO‐OPs are non-profit entities and are required to use their profits to lower premiums, improve health benefits, improve the quality of health care and expand enrollment. CO‐OP members have a voice in their health plan. CO‐OP members elect the board of directors, a majority of whom must be members in the CO‐OP health plan.  CO‐OPs engage members in their own healthcare management, so employees are empowered and can strive to be healthier.

The Affordable Care Act includes legislation and funding to establish CO‐OP Health Plans. CO‐OPs (Consumer Operated and Oriented Plans) provide more competition in the healthcare marketplace and more choices for consumers and small businesses. Consumers’ Choice is South Carolina’s

How do I enroll in a CO-OP?

There are two ways to enroll.  You can enroll through the Health Insurance Marketplace (the “Exchange”) website at, or through your local agent or broker.

Important Date to Remember:
Coverage effective dates begin January 1, 2014.
Open enrollment begins October 2013

What does the Affordable Care Act (ACA) mean for pre‐existing conditions?
People will no longer be denied health insurance due to pre‐existing conditions.

Will my coverage be terminated if I get sick?
No. The ACA removed this penalty.

What if I have Medicaid?
A CO-OP is for individuals who are not Medicaid eligible. Private insurance options and subsidies are intended to begin at income levels where Medicaid eligibility ends.

What is the Medicaid expansion?
The expansion is the part of the ACA that will increase the income limit for being eligible for Medicaid. As of right now, South Carolina is not expanding Medicaid. This issue is being dealt with in the S.C. Legislature.

Is it true children can stay on the parent’s coverage until age 26?
Yes. This part of the ACA went into effect in September 2010.

Is it true that preventive services are now covered under the ACA?
Yes, for all plans that began on or after September 23, 2010. Plans that began prior are called “Grandfathered Plans” and do not have to cover preventive care, but some are choosing to do so. If you have health insurance, check with your plan administrator.

Need more Information?

The answers provided are for INFORMATION ONLY PURPOSES and are not intended to be used as a substitute for official and/or legal guidance or advice.

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