Navigating the Affordable Care Act — How the ACA affects solo attorneys

Read other posts from our Navigating the Affordable Care Act series.

Last week we determined that most solo and small firms are probably small employers. This week we speak to the solo attorney.

How does the ACA affect you when you are the only employee of your firm?

If you are a true solo, meaning you do not have any employees except you in the firm, then you are not considered an employer and you can get health insurance through the Washington Marketplace (or a state or federal Marketplace for your location, if you are not in Washington).

The ACA uses the common law definition of employee. Generally, if you can control what that person does for you, she is considered your employee. This broad definition may very plausibly bump even a contract attorney or a contract bookkeeper into the employee category for purposes of the ACA, making you an employer with certain notice and reporting requirements. Even if you don’t think you are, do the analysis to determine if you are an employer.

I’m a true solo attorney. How do I use the Marketplace?

1. You don’t have to wait for the Small Business Health Options Program Marketplace to open in Washington state. Go to the Marketplace and click Find Quality Coverage if you want to research plan options. Researching beforehand is smart! The ACA is designed for engaged and informed consumers, and health insurance plans are more complicated than one might think. (Next week, we’ll talk about the components of a health insurance plan.)
2. When you are ready to sign up, click Apply for Coverage. You will need to create an account and do a fairly lengthy application process. You can opt out of being considered for tax credits, cost-sharing, and Washington Apple Health (rebranded Medicaid) if you wish, by skipping the questions in the Medicaid application process, but you could be giving up significant possible benefits if you do.
3. If you have a disability, there is a button to click for consideration of other state benefits, following verification. Many processes are being centralized at the Marketplace.
4. It is important to list all members of your household, even if you are not seeking coverage for some of them. Certain benefits, subsidies, and tax credits are calculated by household number, regardless of coverage.
5. You will get a screen that says Confirm Your Identity or something similar, with a set of questions you may find eerily personal (e.g. “Did you own a Toyota Corolla in 1998?,” “Did you live at 1234 Broad Street in 2008?”). Don’t become paranoid; this is a backend system generated by Experian, the credit rating company, to verify you are who you say you are. Warning: You have to answer these correctly to continue. If you get locked out, see #7 below.
6. Once you complete everything, the computer does a data match against federal and other sources and questions any discrepancies. You can do a self-attestation at this point, which may require further proof from you if your information doesn’t match. The result is a real-time eligibility determination, which sometimes requires additional information from you later.
7. If you get stumped and need help at any point, the assisters (who will be called navigators after the turn of the year) are your best friends. If your situation is complicated (e.g., immigrant status applies or you have detailed medical needs), you may want to start with the assisters. Recent reports are that the assisters are well-trained and very helpful in Washington. And remember, there is more than one way to apply: by phone, in person with an assister, or by mail.

Tell us what you most want to know about the ACA today by commenting or emailing us at lomap@wsba.org. We will do our best to incorporate your questions and feedback into this ongoing Navigating the ACA series.