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QUOTE & ENROLL ACA https://www.healthsherpa.com/?_agent_id=bernard-esberner

Individual and Family Health Insurance

Beginning in 2014, all new individual and family health insurance plans must meet the Affordable Care Act (ACA) standards, known as Obamacare.  Insurance is still purchased through the same private insurance companies that you’re used to, but now all plans must meet essential benefit guidelines set forth by the ACA.  Plans are no longer allowed to underwrite for health conditions, which means you cannot be denied or charged a higher premium based on pre-existing conditions.

The new platform has simplified the application process in some ways, but made it much more complicated in others.  The ACA has tied the cost of your health insurance to your household income.  If you qualify for a subsidy, then you must request a tax credit and apply it to your monthly premium – something we help you to do.  Over 70% of Arizonans qualify for a subsidy!  The main qualifier is that your income be under 400% of the Federal Poverty Level (the chart is available below).  As you may expect, there are many additional rules that come into play, so best to call us to discuss your particular situation.

The Open Enrollment Period runs from November 1st to December 15th  each year.  You may qualify to enroll outside that timeframe if you have a life-changing event: lose a job, have a baby, move, etc..

With the introduction of Obamacare, most carriers created new smaller provider networks for some of their plans.  This was to give consumers the ability to lower monthly premiums by accepting less provider choices.  Some carriers disposed of their large PPO networks altogether.  If you try to purchase a plan yourself, it is difficult to determine the doctors available to you.  This is another service we provide.  We’ll make sure you select a plan that maintains your current provider relationships. 

Penalties For Not Having Coverage (you pay the greater of the two)


The penalty rises yearly with inflation. For the 2017 plan year, the fee is calculated 2 different ways — as a percentage of your yearly household income, and per person. You’ll pay whichever is higher.

Percentage of income

  • 5% of yearly household income
  • Maximum:Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
  • Per person per year
  • $695 per adult
  • $347.50 per child under 18
  • Maximum:$2,085 per household

For plan years through 2018, if you can afford health insurance but choose not to buy it, you may pay a fee called the individual Shared Responsibility Payment when you file your federal taxes. (The fee is sometimes called the “penalty,” “fine,” or “individual mandate.”)

Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the Shared Responsibility Payment no longer applies.

Note: Some states have their own individual health insurance mandate, requiring you to have qualifying health coverage or pay a fee with your state taxes for the 2019 plan year. If you live in a state that requires you to have health coverage and you don’t have coverage (or an exemption):

  • You’ll be charged a fee when you file your 2019 state taxes.
  • You won’t owe a fee on your federal tax return.

Check with your state or tax preparer to find out if there is a fee for not having health coverage.

Employer Sponsored Group Insurance. If you are offered group health insurance at work, you may not apply for a subsidy through the Marketplace.If your spouse is offered group health insurance at work with dependent coverage and/or family coverage, you may not apply for a subsidy through the Marketplace.Determining Your Income For A SubsidyThe Marketplace and the IRS use your Modified Adjusted Gross Income to determine your subsidy eligibility.Making less than 138% of the Federal Poverty Level qualifies you for state insurance through AHCCCS.

Subsidies: Premium Subsidies vs. Cost-Sharing Subsidies

If you have a family income under 400% of the Federal Poverty Level, you will most likely qualify for lower premiums.

If you have a family income of under 250% of the Federal Poverty Level, you will most likely qualify for lower premiums and significant discounts on your co-pays, deductibles, and maximum  out-of-pocket liability (Silver Plans Only).

QUOTE & ENROLL ACA https://www.healthsherpa.com/?_agent_id=bernard-esberner


Health Insurance Resources  

Federal poverty level
Modified Adjusted Gross Income – 
OutlineFederal Poverty Levels –
Special Enrollment Periods – 
Can You Enroll Outside Open-Enrollment?