Frequently Asked Questions and Answers
About the Affordable Care Act
ACA Background
1. Does the Affordable Care Act require me to have health insurance?
Yes. All U.S. citizens and legal residents (with certain exceptions) have to have health insurance by January
1, 2014. That is referred to as “the individual mandate.” Exceptions to the individual mandate include
individuals who:

Cannot afford coverage based on formulas contained in the law

Have income below the federal income tax filing levels

Are members of American Indian tribes

Were uninsured for short coverage gaps of less than three months

Have received a hardship waiver, are residing outside of the United States, or are bona fide residents
of any possession of the United States
2. What kind of health coverage must I have?
 An employer-sponsored health plan, such as those offered by the University

A government-sponsored health plan such as Medicare, Medicaid, Children’s Health Insurance
Program (CHIP), TRI-CARE, and veteran’s plans

An individual health insurance policy purchased through a private insurer or through a state
Marketplace sometimes called a health care exchange.
3. What happens if I don’t have health insurance on January 1, 2014?
If you don’t have health coverage by that time, you may owe a tax penalty to the federal government. A
tax penalty will apply for every month you don’t have health coverage on and after January 1, 2014, and
you will be required to pay this tax penalty when you file your annual federal income tax return for your
2014 taxes.
4. Am I required to cover my spouse/same-sex domestic partner under the Affordable Care Act?
No, you don’t have to provide health coverage for your spouse/same-sex domestic partner. If you choose
not to cover your spouse/same-sex domestic partner, he or she will need his/her own coverage on and
after January 1, 2014. It can come from his/her employer, from health coverage purchased from a
Marketplace, or from an insurance agency.
Eligibility for UPlan Coverage
5. Does the Affordable Care Act mean I’ll need to give up my UPlan coverage?
No. If you currently have coverage through the UPlan, you can keep it as long as you still work an average
of 20 hours per week. If you’re getting your coverage somewhere else, such as from the employer health
plan of a parent or a spouse/same-sex domestic partner, it’s a good idea to check to see if there are any
changes to that coverage for 2014. The important thing is to be sure you’re covered on January 1, 2014,
and after.
6. If I’m covered by the UPlan, does that take care of the individual mandate for me?
Yes. If you’re covered under the UPlan on January 1, 2014, you’ll meet the requirements for the individual
mandate.
7. Is the University changing eligibility rules for health insurance?
For 2014, we’re not making any changes when it comes to your eligibility for coverage through the UPlan.
U.S. employees working an average of at least 20 hours a week will still be eligible for coverage, and
employees working an average of at least 30 or more hours are eligible for the University’s contribution.
8. Can I cover my children under the UPlan?
Yes, you can cover your children up to age 26.
9. What are my health coverage options for my spouse/same-sex domestic partner?
If you are eligible for the UPlan coverage, you can enroll your spouse/same-sex domestic partner in the
UPlan. Or, if you decide not to enroll him/her, he/she can explore other coverage options through his/her
employer, his/her parents’ health plan (if under age 26), a Marketplace where he/she lives, or another
source.
Eligibility for Coverage through Other Sources
10. What is a Marketplace?
A Marketplace (also called a health care exchange) is where people can buy individual health insurance
policies when they don’t have or don’t want health coverage through their employer or from another
source (such as through a parent’s or a spouse’s/same-sex domestic partner’s health plan). Each state will
have its own Marketplace that is either set up by the state, by the federal government, or by a partnership
of both the state and federal government. The Marketplace will offer health plan options so people can
choose the type of plan that works best for their health care needs and budget. Minnesota’s Marketplace
is called MNsure.
11. If I like a plan offered through a Marketplace better than what’s offered by the University, can I
choose coverage through it instead of the University?
Yes. You can choose health coverage through your state’s Marketplace instead of through the University.
But since you have comprehensive, high-quality, affordable health coverage available to you through the
University, be aware that you won’t be eligible for any subsidy from the federal government for coverage
purchased through a Marketplace.
12. If I want to get my coverage through the Marketplace in the state where I live, what’s the
process?
The federal government expects state Marketplaces to begin open enrollment on October 1, 2013, with
coverage starting on January 1, 2014.
13. If I want to go to a Marketplace and I live in Wisconsin, but work in Minnesota, what state
Marketplace should I go to?
If you or your family are buying your plan on your own (not through the University of Minnesota) and want
to use MNsure, you must be a resident of Minnesota. The state is working with neighboring states on how
to handle cross-border employment situations.
14. I’ve seen advertisements about low-cost plans offered through Medica. Will these same plans
be offered through the University?
Since both the University and MNsure (Minnesota’s Marketplace, also called an exchange) are offering
coverage through Medica for 2014, there may be some confusion. The advertisements you might be
seeing are for plans offered through the Marketplace only. They typically are offered at low prices, but
with high deductibles. In the majority of cases, coverage offered through the University will continue to be
your best option for affordable, high-quality, comprehensive coverage.
15. I’m eligible for the UPlan coverage, but what if I’d rather join my spouse’s/same-sex domestic
partner’s plan that he/she purchases through a Marketplace?
You don’t have to enroll in the UPlan. If you’d rather be covered under your spouse’s/same-sex domestic
partner’s plan (through his or her employer or under a plan purchased through a Marketplace), that’s OK.
But since the health coverage available to you through the University more than meets all federal
requirements, be aware that you won’t be eligible for any subsidy from the federal government for
coverage purchased through a Marketplace.
16. Can my spouse/same-sex domestic partner and I get our health coverage from different
places—my coverage under the University health plan and his/her coverage through a
Marketplace plan?
Yes, you and your spouse/same-sex domestic partner can enroll in different health plans. Remember the
important thing is that you both need to have health coverage on and after January 1, 2014, whether it
comes from the same health plan, from two different plans, one through the Marketplace, or a plan at the
University.
17. If I get my coverage through a Marketplace, will I be able to choose the doctors I want?
Many different plans will be offered through the Marketplaces. Some will offer more choice in providers
than others. When you compare the plans, you’ll be able to see which ones let you choose any doctor and
which ones only offer benefits from doctors who are part of a certain network.
Health Care Costs
18. How do I pay for coverage?
The University pays a portion of your UPlan health coverage premium if your appointment is 75% time or
greater. The University’s paid portion of the premium is not taxable income and your portion of the
premium is taken from before-tax dollars. If you buy coverage through the Marketplace, you will need to
pay for your coverage with after-tax dollars.
19. Will my health care costs continue to go up?
One of the goals of the Affordable Care Act is to make health insurance affordable for all Americans. The
University also wants to make sure that our health plans stay affordable for our employees. Health care
costs keep rising and some of what’s causing prices to go up isn’t in our control. But the University is
working hard to control what we can, and we ask our employees to use their health plan benefits wisely.
20. If I buy coverage through the Marketplace, will I lose my employer’s contribution toward
coverage?
Yes, if you decline UPlan coverage and purchase your coverage through the Marketplace.
21. I’ve heard something about an excise tax. What is that?
Starting in 2018, employers with health plans that are too expensive will have to pay an excise tax. The
University is doing everything it can to keep our plans affordable for you and the University so none of us
has to pay more because of the excise tax.
22. Does the Affordable Care Act limit my out-of-pocket health care costs?
Yes. The Affordable Care Act puts limits on what you have to pay out of your own pocket each year.
Whether you get your coverage through the University, a Marketplace, or from somewhere else, these
limits will be in place to help keep your costs down.
23. I saw a number on my Form W-2 that showed the value of the health care coverage the
University provided to me in 2012. Am I being taxed on that?
No. Reporting the value of your health care coverage is another requirement of the Affordable Care Act.
The University puts that value in box 12, code “DD” of your Form W-2, but the value of your Universityprovided health care coverage isn’t taxable to you. It’s there just for your information.
Help With Paying for Health Insurance Costs
24. Is it true that the government will give some people money to help pay for health insurance
costs?
Yes. For certain low- and middle-income people who cannot get health coverage at work at a price the
Affordable Care Act calls “affordable” or who are not eligible for comprehensive, affordable health
coverage from their or their spouse’s/same-sex domestic partner’s employer, the federal government will
offer financial help to pay for health insurance purchased through a Marketplace, also called an exchange.
This financial help is called a “subsidy.” Employees who are eligible to enroll in UPlan are not eligible for
subsidies through the Marketplaces.
25. How much of a subsidy is the government providing?
The subsidy amount will depend on each person’s household income. It’s important to know that,
generally, if you are eligible for coverage through the UPlan you are not eligible for a subsidy. If you are
not eligible for coverage through the UPlan, you may be eligible for a subsidy depending on your
household income. Remember that it’s not just your income that counts, but the combined income of
everyone in your home. Starting in October 2013, you can contact the Marketplace in your state to see if
you qualify for a subsidy. Check www.healthcare.gov, the website sponsored by the Department of Health
and Human Services, to get contact information for the Marketplace in your state.