Are you covered? Open enrollment for Affordable Care Act is underway

By Greg Grisolano, staff writer

The Patient Protection and Affordable Care Act takes effect January 2014, and requires most U.S. citizens and legal residents to have health insurance. The requirement to purchase health insurance applies only to people who do not currently have health insurance through their employers, or who are not eligible for Medicare, Medicaid, or some form of veterans insurance.

Open enrollment for individuals seeking health insurance from state, private, or federally administered health care exchanges began Oct. 1. Plans purchased through exchanges must meet minimum federal guidelines known as “Essential Health Benefits.” Those benefits include prescription drug coverage, hospital and emergency services, maternity, newborn and pediatric care, and preventive and wellness services. Qualified plans must also pay at least 60 percent of covered health costs.

The Owner Operator Independent Drivers Association is working to roll out its own private health care exchange program for members with a six-state pilot program. The six states are Illinois, Indiana, Kansas, Missouri, Ohio and Texas.

The pilot program will function as an online marketplace for individuals to compare rates and shop for health insurance. It will be set up like other state and federally facilitated health care exchanges, as mandated by the ACA. Exchanges will have the capability to tailor specific plans and costs to the individuals purchasing the plans.

In a white paper published on Sept. 9, the OOIDA Foundation has estimated that most truckers will exceed the maximum gross income guidelines – between 133 and 400 percent of the federal poverty level – to qualify for tax credits.

“While some individuals and families will be able to receive premium tax credits and subsidies to help them afford health coverage, the average owner-operator earns too much gross income to be eligible,” according to the white paper.

Another significant change under the Affordable Care Act will be the “guaranteed coverage clause,” which requires providers to insure the 129 million Americans with pre-existing conditions.

The Foundation also notes that all existing individual and group plans will be grandfathered in, so if you already have a health insurance plan, you won’t be liable for a tax penalty. The report goes on to state that “the cost of that grandfathered plan may increase with the additional elements that must be added as described by the ACA,” such as extending dependent coverage to adult children up to age 26, prohibiting rescission of coverage and eliminating pre-existing condition exclusions for children within six months and for adults by 2014.

However, owner-operators who are leased to motor carriers are not currently considered employees under the Employer Share Responsibility provision. As such, a company with 50 or more employees would not be required to offer a health insurance plan to leased-on owner-operators. However, the motor carrier must offer health coverage to professional employee drivers or else be liable for the penalty.

Those without health insurance will be subject to an IRS-enforced tax penalty. The penalties will follow a phase-in scheduled from 2014 to 2016. After 2016, the tax penalty will increase annually based on the cost-of-living adjustment.

Using its own Member Profile Survey, the Foundation has found that the average household income of an owner-operator who is married and has a spouse who works outside the home is approximately $69,723.

Based on that figure, if the average owner-operator household did not purchase a health plan, they would be forced to pay a penalty of $697 for the first year, $1,394 for the second, and $1,743 for the third. LL