The Affordable Care Act, commonly known as ObamaCare, has four new health insurance plans which set the standard of care, named Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan*. All plans must offer the same ObamaCare essential benefits, however individual providers and states may offer extended or additional benefits. This page is dedicated to comparing the four plans.
**Because California has standardized its health plans these are the costs associated with them. Each state will vary. Call 800-930-7956 or click here to get an exchange quote in your state.
Which is the right Healthcare Exchange plan for you?
To select the right health plan, you should ask yourself 5 key questions:
1) Do you qualify for federal cost-sharing subsidies and/or only federal premium subsidies?2) What will your actual monthly premium cost?3) What are the finalized coverage details of each plan?4) What is the right amount of coverage for your lifestyle and medical history?5) What is the plan’s network of doctors and hospitals?
ACA Application
There is now a website where you can get your paper application and access an agents help with subsidies and picking a plan. Here’s what you do:
1) Go to Healthapplication.com2) Fill out the application3) Print and then fax, scan and email, or mail your application to the contact information on the app*4) An agent will contact you to inform you of your subsidy status and explain the new plans
*Make sure to send your application in as soon as possible to ensure the earliest possible start date.
As you have probably heard, the ObamaCare website has had some serious glitches, but now there is a way to avoid all that. Medicoverage announced today that they are able to quickly submit paper applications for ACA Bronze, Silver, Gold, and Platinum plans in most states.
ObamaCare ACA Paper Application
The Affordable Care Act paper application is now available for individuals and families in the following states. This is the easiest way to apply for health coverage. Click on your state below to access the application.
You can call an agent to receive help while filling out the app or selecting the right plan by calling 800-930-7956. We are here to help you. Many people don’t realize that there is no fee to work with an agent. With our help and the new paper application you won’t experience the ObamaCare website timing out nor the long wait times for hotline assistance (apparently reported up to 45 mins!). And, not to worry, you will be still be eligible for ObamaCare subsidies if you qualify.
When you’re done with your application fax it to 310-765-4136 or mail it to the address on the cover sheet of your application.
The Health Insurance Marketplace opening is on October 1, 2013, we have compiled a list of preliminary premiums for all 50 states plus DC. The new Affordable Care Act plans are known as the Bronze, Silver, Gold, and Platinum Affordable Care Act plans.
US State ACA Premiums
The following premiums are for the Silver Plan based off an average for a single 35 year old, non-smoker, in one region of the state. As well as these premiums do not include federal premium subsidies to help with the monthly cost of the policy to give you the raw cost of the plan. Click on the state on the left to learn more details about your state.
Each state and provider has its own dental plans offered and states have chosen to do adult stand-alone plans -just means separate from the actual health plan. Click here for your state’s dental quote.
Remember the above are averages only. For your specific premium call 800-930-7956 or contact Medicoverage.
We get a lot of questions about how the Affordable Care Act, aka ObamaCare, affects people like you. So, we figured we’d explain a few of the key details of the new law. While this is a quick overview we have included links to allow you get more detailed information on each topic below. The information below is geared for individuals and families. If you have a small business you will want to visit our Small Business ObamaCare page.
What is ObamaCare?
ObamaCare is the nickname for The Patient Protection and Affordable Care Act that was passed in March 2010. Most people just call the act the ACA, for short. This law overhauls how we buy health insurance, who can be covered and what benefits it must cover. Under the law, most Americans are required to have health coverage and will pay a tax penalty if they choose to go without insurance. Also the government is offering subsides to help lower income people pay for these plans. Finally, under ObamaCare no one can be turned down for health insurance regardless of previous health history.
What are the New ACA Plans?
There are 4 types of health plans for individuals and families to chose from. The plans are called Bronze, Silver, Gold, and Platinum and you can compare the 4 Affordable Care Act’s plans here. Bronze is the least expensive but requires more upfront cost sharing than the other plans. The Platinum plan is the most expensive but requires less of your money up-front should you get injured. There is a low-cost ObamaCare catastrophic plan available to some young people and/or those with financial hardship, in addition to the four “Metal” plans listed above.
What are the Exchanges?
Since lower-income people may get a subsidy to help pay for the above plans, each state is setting up an Exchange (or Marketplace) to purchase a plan with subsidies. Some states chose not to set up an exchange. So, those will be run by the federal government. If you do not think you will qualify for a subsidy you can purchase an off-Exchange plan to avoid extra paperwork and questions about your income. Agents, such as the team at Medicoverage, will be able to sell plans both on and out of the exchange at no charge to customers.
Individual Mandate: What Does That Mean?
In the plainest language possible, it just means that the majority of Americans are required to have health insurance. There are a few exemptions like financial hardship or religious conviction. If you decide to forego insurance, there is an ACA penalty. This penalty is up to 2.5% of your income in 2016 and should stay the same through 2017.
What Subsidies are Available?
There are two types of subsidies available for those that qualify:
1)Premium Subsidies reduce the cost of your monthly insurance bill (which is called a Premium for some reason). People who make between 100% to 400% of the Federal Poverty Line (FPL) may qualify for this subsidy.
2) Cost-Sharing Subsidies help pay additional costs once you are insured such as deductibles, copays, and coinsurance. People who may qualify for this coverage fall between 100% to 250% of the FPL.
Some low income Americans will be able to qualify for both subsidies while individuals making roughly over $46,000 a year may not qualify for either.
When do I sign up?
For most Americans, you’ll sign up during Open Enrollment: November 1st thru January 31st. The earliest plan coverage will begin is January 1st, but if you wait too long to sign up for an ACA your start date will be pushed back.. Some people might qualify for a Special Enrollment Period. Examples of a Special Enrollment Period are if you released from incarceration, lose your insurance, give birth or adopt a child, or get married.
We hope this has cleared up any of your basic questions about the Affordable Care Act, however if you have any further questions or would like to get a quote to see how much the new plan will cost, please call 800-930-7956 or contact Medicoverage.
When you enroll for ObamaCare affects when your coverage starts. The new Health Insurance Marketplace offers plans by private insurance companies, the plans are known as the new “metal” plans: the ObamaCare Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan. You must be enrolled and have made a payment by the enrollment date to be eligible for the following start dates.
Enroll By
Coverage Begins
October 1, 2013 - December 15, 2013
January 1, 2014
December 16, 2013 - January 15, 2014
February 1, 2014
January 16, 2014 -February 15, 2014
March 1, 2014
February 16, 2014 - March 15, 2014
April 1, 2014
March 16, 2014 - March 31, 2014
May 1, 2014
Don’t forget most plans do not include dental. If you want a stand-alone dental plan, there are plans available today in your state with relatively low premiums.
It is important to note that there are plans available for an earlier coverage date through insurance providers now that will be good until the end of 2014. To learn how to sign up for the new Health Insurance Marketplace plans or about plans currently available call 800-930-7956 or contact Medicoverage.
In Vitro Fertilization is a procedure many Americans select to help them have children. Most are unaware if this procedure is covered by ObamaCare. While maternity care must be covered by essential health benefits required by the Affordable Care Act, most states do not cover In Vitro Fertilization (IVF).
UPDATED: August 1, 2016
Is In Vitro Covered by Essential Health Benefits?
In Vitro is not covered by the fed’s essential health benefits; however a rare few states may require that non-religious employers offer coverage for IVF, and even fewer states require that individual plans offer IVF.
Does My State Cover IVF?
Most likely not! While approximately 11% of women between the ages of 15-45 are afflicted with fertility issues according to the Centers for Disease Control and Prevention, it is unlikely that your state will require IVF coverage is available. If it is offered in your state it is usually offered by your employer, not by individual plans.
With that said, not all employees will cover IVF, even if you live in a state that does require it. Here are two of the exemptions: employers who have over 1000 employees are considered self-insured, and can choose to opt out of IVF coverage, as well as, religious employers.
Does IVF Kick in Immediately in States that Require It?
Depends on the state. Some states, like Texas require that a couple has tried for five years to get pregnant with no success, while other states have more lenient policies. It is important that you understand how your health benefits are covered before enrolling.
BlueCard® is included in ObamaCare PPO plans. BlueCard members belong to a national Blue Cross Blue Shield program that enables them to receive care when traveling away from home or living in another…away from home or living in another Blue Cross and Blue Shield (BCBS) Plan area. This is for those that need emergency services in another state or if you are bi-coastal/a snow-bird/two-state resident.
Who Can Use BlueCard?
In most states, if you enroll in a Blue Cross Blue Shield PPO plan you will given a BlueCard with your enrollment package. This practice was on hiatus with some plans for 2014 and 2015, but is back for 2016. Click here to get a BCBS quote.
For further questions about your current BlueCard plan call 800-930-7956 or contact Medicoverage.
Anthem BlueCard is back after a two year hiatus. This program allows anyone enrolled in an Anthem Blue Cross CA PPO, purchased on or off the Obamacare exchange, to use the BlueCard to see any doctor or facility in the nationwide Anthem network.
This may or not be available in your state, as well as, our contact at Anthem tells us it is not for HMO, POS, or EPO type plans. Click here to get an individual healthcare quote in your area, and call us to see if BlueCard is available for your Anthem health plan.
Almost half of the Obamacare health insurance coops are shutting down due to not receiving certain subsidies needed to stay afloat. 11 of the 23 coops are shutting down, and will affect its enrollees who need to find a new plan for 2016, as well as, it lessens competition in the areas they were created.
What is a Health Insurance Coop?
Just like a dairy coop or a electric coop used in farming communities for years, a non-profit health insurance cooperative is owned by the same people it insures. For many years, health insurance coops have been around, but 23 were established to create competition for Affordable Care Act exchange and off-exchange plans. These ACA coops were designed to help in underrepresented areas.
Who is Affected by ACA Coop Closures?
Over 500,000 people are affected, and this number may grow as more coops may bow out in the next few weeks. Some of the coop closures are in Arizona, Colorado, Kentucky, New York, Oregon, and Tennessee (complete list of coops has not been released; not all coops in these states are closing). If you are in a coop that is closing you will need to find a new Bronze, Silver, Gold, or Platinum ACA plan for 2016.
Next Steps
Since, in less than a week coop closures went from 8 to 11, you’ll want to check with your coop if they plan on continue enrolling people for 2016. If they do not, you’ll want to get an ACA health insurance quote or, if you know the plan you want, apply for an Obamacare on or off exchange plan.
To speak to an independent Medicoverage agent call 800-930-7956.
The Affordable Care Act, commonly known as ObamaCare, has four new health insurance plans, listed from least expensive monthly premium to the most: Bronze, Silver, Gold, and Platinum*. All “metal” plans will all offer the same Healthcare Exchange essential benefits, regardless of any additional or extended benefits an insurance provider offers. Silver is considered the standard of these plans, offering a low monthly premium with the second highest cost-sharing (combination of deductible, copayment, and coinsurance).
*This is California’s breakdown of the Silver. For specific information of your state’s plan click here for a health insurance marketplace quote.
How many Silver Plan Deductibles will be offered?
Depends on the provider and state, as both may interpret the plans separately after meeting the essential benefits. Silver plans will have both different deductibles (the amount you pay before the insurance company pays for health services) and coinsurance (the % you pay after the deductible is satisfied and until you meet the out-of-pocket max).
How Does the Silver Plan Compare to the Other New Plans?
Silver is the standard plan, it must be offered, if any plan is offered by a provider, and, as we said above, Silver is also the only plan that offers cost-sharing reductions for out-of-pocket costs. Silver offers a relatively low monthly premium, with a fairly low deductible, so that a member may manage his/her costs. Click here to compare Bronze Plan, Silver Plan, Gold Plan, and the Platinum Plan side-by-side.
The Affordable Care Act, commonly known as ObamaCare, has created four health insurance plans which are named Bronze, Silver, Gold, and Platinum*. All plans must offer the same ObamaCare essential benefits, however individual providers may offer extended/additional benefits. Platinum is the most comprehensive of all theses plans with the highest monthly premium but has the lowest out-of-pocket costs (combination of deductible, copayment, and coinsurance).
The following information below is for individual and family members. Click here to learn about how the Platinum plan works for Small Business owners under ObamaCare.
90/10 split, with you paying 10% for healthcare expenses
*This chart is based on California’s Platinum plan. For plans available in your store click here to get an Exchange Quote.
Is there only one Platinum Plan?
Although it is expected that Platinum plans will not have a deductible, there may be multiple Platinum plans offered in the same state. Specific plans will be determined by state leaders and insurance providers.
How does the Platinum Plan Compare to the Other New Plans?
Platinum will cost you the most per month, but will have the least out-of-pocket expenses, therefore you will be able to predict your spending in case of emergency or illness. California currently states that the Platinum plan out of pocket Maximum will be $4000 for individuals and $8000 for families. Something important to note is this plan is likely to attract the highest risk persons, which may in turn raise premiums in the future. Click here to compare Bronze Plan, Silver Plan, Gold Plan, and the Platinum Plan side-by-side.
Health Care Reform and Seniors
Seniors do not have the same options because they will still be enrolled in Medicare. Click here to learn about Medicare and the Health Care Exchange.
For any questions or assistance in applying (open enrollment is from November 15, 2015 to February 15, 2015, please call 800-930-7956 or contact Medicoverage. Click here if you’re ready to apply for a Platinum plan.
The Gold plan is one the Affordable Care Act, AKA ObamaCare, plans. The four plans ranked from least expensive monthly premium to most: Bronze, Silver, Gold, and Platinum*. All plans will all offer the same essential benefits, however additional/extended benefits may be offered by different insurance providers. Gold is one of the plans that must be offered by your insurance provider if they choose to offer any of the plans, the other is Silver. Gold offers comprehensive coverage with predictable out-of-pocket expenses (combination of deductible, copayment, and coinsurance).
*The chart above is for California. To learn what insurers cover in your state get a Healthcare Exchange quote.
Is there only one Gold Plan offered?
There may be multiple plans within states. Specific plans will be determined by state leaders and insurance providers.
How Does the Gold Health Plan Compare to the Other New Plans?
Gold will have the 2nd highest monthly premiums, but Gold plan members, due to the 20% co-share, will have lower cost-sharing expenses than a plan with a lower monthly premium. Click here to compare Bronze, Silver, Gold and Platinum health plans side-by-side.
The Patient Protection and Affordable Care Act, AKA Obamacare, offers 4 insurance plans called Bronze, Silver, Gold, and Platinum. In a 2013 survey only 4% of Americans understood the difference between the plans, one of the most important facts of the new plan is all plans must cover the same Healthcare Exchange essential benefits, however each state and/or provider may offer additional or extended benefits. The Bronze Plan is set up to have the lowest monthly premium of the 4 new categories of plans*, with the highest out-of-pocket costs (combination of deductible, copayment, and coinsurance).
The following information below is for individual and family members. Click here to learn about how the Bronze plan works for Small Business owners under ObamaCare.
60/40 split, with you paying 40% for healthcare expenses
*These rates are based on California figures. To learn which plans are available in your state get an exchange quote or call 800-930-7956.
Is There Only One Bronze Deductible?
No, Bronze offers different plans with high and low deductibles (the amount you pay before your insurance kicks in) and different amounts of co-insurance (% you pay after deductible is satisfied, and before out-of-pocket max is met). Remember, regardless of the deductible, all Bronze plans will ultimately equal that 60/40 split.
Multistate Affordable Care Act plans are available on the Health Insurance Marketplace but many people confuse them with PPOs.
Article Updated: 6/22/2016
What is a Multistate Plan?
When a carrier offers the same plan in more than one state it is a Multi-State plan. It does not necessarily mean that consumers selecting the plan will have health plan coverage in multiple states. It just means insurance companies now can offer the same plan in more than one state.
What is a PPO plan
PPO stands for Preferred Provider Organization. PPO health plans often have a national network of doctors and will allow you to see health care professionals outside of your home state.
Remember: Multistate plans do not necessarily mean they cover you in multiple states.
If you are looking for coverage outside of your home state, please consider a PPO with a national network of doctors. Click her to see available plans, prices and networks..
A multi-state plan is ONLY for competition. What we mean by competition is in some states or areas there were only be one insurance plan offered on the Obamacare Exchange, and multi-state plans are offered so that you have options. This does not mean that a multi-state plan works in multiple states.
Does a Multi-State Plan Cover You in More Than One State?
Multi-State is a confusing name, because it sounds like it works in multiple states, but most do NOT. like we said above it is meant for competition, not to offer nationwide coverage. If you’re looking for nationwide or regional coverage you’ll want to look into PPO plans.
How is an Emergency Covered Out of my Multi-State Coverage Area?
All of the new ACA plans must cover emergency care as in-network care no matter which state, per the essential health benefits. So you don’t have to worry about excess charges for emergencies.
Who Needs a Multi-State Plan?
No one needs a multi-state plan, only if the price and network are right for you, would this be the right plan.
For further questions about Multi-State plans call 800-930-7956 or click here to get an Obamacare Exchange quote.
Health Savings Accounts are health plans with a high-deductible that allows individuals and their qualified dependents to contribute pretax dollars into a savings account to pay for their out-of-pocket medical costs as needed. These plans are available with off-Exchange plans and ObamaCare plans.
HSA 2015 and 2016 Limits
2016 HSA Limits
HSA
2016 Limits
Deductible
$1,300/$2,600 (ind/fam)
Contribution
$3,350/$6,750 (ind/fam)
Max Out of Pocket
$6,550/$13,100 (ind/fam)
2015 HSA Limits
HSA
2015 Limits
Deductible
$1,300/$2,600 (ind/fam)
Contribution
$3,350/$6,650 (ind/fam)
Max Out of Pocket
$6,450/$12,900 (ind/fam)
HSA Benefits
The following are some of the benefits of an HSA plan.
Tax savings: Money put in your HSA may reduce your taxable income.
Tax-free earnings: Money kept in your HSA earns interest tax free.
Tax-free spending: Money taken out to pay for qualified health care costs is never taxed.
You maintain ownership of account: Unused money is yours to keep.
Investment Options: After a period of time you may be able to use your HSA for investment opportunities.
An employer who doesn’t offer health insurance may still contribute to your HSA. This contribution, more than likely, does not count as earnings -always consult with your tax expert when figuring out new HSA plans.
To learn more about an HSA plan in your state call 800-930-7956 or contact Medicoverage.
HSAs are here to stay. Health Savings Accounts are included in some of the new ObamaCare plans offered on and off the exchange.
HSAs (Health Savings Accounts) will be available to enrollees in markets where they are available. HSAs are high-deductible, tax advantaged health savings plans. Money contributed to an HSA is not subject to being taxed when deposited. With these plans the money in the savings account can be used to pay for medical services right away, and funds not used will roll over and accumulate. These plans generally have lower monthly premiums because of their high-deductible. Click here to get an individual HSA health plan quote.
CMS just announced an Obamacare Special Enrollment Period for those who were uninsured in 2014 until now, during tax season. There are a few qualifications you must meet.
Tax Season Special Enrollment Period Qualifications
So, yeah, you were supposed to enroll up until Feb 15th of this year (some states and providers have extended their Obamacare deadline); however, most states exchanges are allowing people to enroll with a special tax time enrollment period. Since, some Americans will learn for the first time their tax penalty responsibility, here are the Exchanges we currently know that are allowing this special enrollment period and the dates from which you can apply for this:
Healthcare.gov from March 15-April 30, 2015
Covered CA from now until April 30, 2015
MN Sure from now until April 30, 2015
Here are the required qualifications:
Owe a penalty from 2014
Currently not enrolled in a health plan
State that you first became aware of, or first learned the implications of the penalty, AFTER Feb 15, 2015
For help enrolling in during the tax season Special Enrollment Period call 800-930-7956 and/or click here to get a Health plan quote. UPDATED 2/23/2015
Anthem’s, formally known as Wellpoint Inc., database has been the victim of the largest cyber attack in history, with over 80 million current and former clients’ and employees’ information compromised. At this time Anthem believes that medical records and credit card data has not been extracted, but social security numbers, member IDs, birth dates, email addresses, street addresses, names, income information, and phone numbers have been. For further information click on Anthem’s dedicated cyber attack page or call them directly at 877-263-7995.
Cedars-Sinai just announced that it is will join the Blue Shield of California network as of March 1, 2015.
Which Blue Shield Plans Cover Cedars?
All Blue Shield on and off-exchange PPO plans will cover Cedars-Sinai Medical Center, and have access to Cedars-Sinai Medical Group and Health Associates. Having “access” means that some doctors may choose not to work accept new patients or to take Blue Shield. You’ll want to confirm with your doctor before visiting to make sure they take your insurance.
Even if you enrolled through another plan during Obamacare Open Enrollment or chose to continue with your previous plan you are still able to change to Blue Shield or any other provider until February 15, 2015 for a March 1st effective date.
If you have any questions, please call the number above.
If you owe an Obamacare penalty there is a specific formula to calculate exactly what you owe. There’s a few steps to follow to understand what you’ll pay as a tax penalty.
The Obamacare penalty changes from year to year. Your penalty is the higher of the two figures below and maxes out at annual national average premium for a bronze level health plan available through the Marketplace( $2,448 for 2014).
2014: 1% or $95/$285 (indiv/family)
2015: 2% or $325/$975 (indiv/family)
2016: 2.5% or $650/$1,950 (indiv/family)
How do I Calculate My Obamacare Penalty?
There are four steps to figuring out your Obamacare Penalty:
1) ADD Household income: This is your adjusted gross income from your tax return. (Household income also includes the adjusted gross incomes of all of your dependents who are required to file tax returns).2) SUBTRACT Tax return filing threshold : This the minimum amount of gross income an individual must make to be required to file a tax return. ($10,150/$20,300 under 65 indiv/fam for 2014*)3) MULTIPLY total: You will multiply 1% and your household minus tax filing threshold (for 2014)4) DETERMINE Greater amount of % versus flat rate
Obamacare Penalty Example #1
Max is 35, single, and makes $50,000 a year. If he didn’t enroll in a qualifying health plan, this is how his 2014 penalty would break down: $50,000 -$10,150= $39,850. Then multiply $39,850 x 1%=$398.50. Since $398.50 is higher than $95, the penalty would be $398.50.
Obamacare Penalty Example #2
Max and Rita are married with two children. They are both under 50 and make a total of $65,000. If they didn’t enroll in a qualifying health plan, this is how their 2014 penalty would break down: $65,000 -$20,300= $44,700. Then multiply $44,700 x 1%=$447. Since $447 is higher than $385, the penalty would be $477.
For further questions about the Obamacare penalty call the number above.
Anthem Blue Cross of California has extended its off-Exchange deadline until December 31, 2014 for a January 1st start date. There is one caveat, you must enroll through a paper application. If you try to enroll online, you will have a February 1, 2015 start date.
Who Should Use the Anthem Extension?
If you don’t qualify for premium subsidies and/or cost-sharing subsidies, and if Anthem’s network of doctors and hospitals works for you, then you may want to enroll in an Anthem plan.
Anthem Paper Application
If you have decided that an Anthem Blue Cross CA plan is right for you, you can NOT enroll through the online process for a January 1st start date. You MUST enroll through the Anthem paper application. Here are the steps you’ll take go enroll in a paper application:
1) Click here to get an off-Exchange quote (may have trouble accessing quotes in Chrome browser) 2) Choose an AnthemBronze, Silver, Gold, or Platinum plan3) Click on “Apply Now”4) Fill out the online portion on the screen5) Choose the paper application option6) Mail in your application (you can NOT fax it)
Next Steps
For help filling out your application or for help picking a plan please call the number above.
Covered California has extended its Obamacare exchange enrollment deadline to December 21st, for a January 1, 2015 start date.
What Covered Ca’s Extension Means for You
If you want Affordable Care Act (ACA) coverage beginning January 1st you can still enroll on the exchange in one of the Bronze, Silver, Gold, or Platinum plans. You can still qualify for premium subsidies and cost-sharing subsidies to help with your health costs. While the exchange plans have extended their deadline, many off-exchange plans have not.
When Does Open Enrollment End?
Even if you miss the December 21, 2014 deadline, you will still be able to enroll in a health plan in California until February 15, 2014.
Next Steps
If you’re ready to enroll in a health plan call the number above or click here to get an ACA application.
Today, November 15, 2014, is the first day of the Affordable Care Act Open Enrollment for 2015 individual health plans.
ObamaCare Open Enrollment
The Affordable Care Act’s (commonly called ObamaCare) open enrollment runs from today until February 15, 2015. This is the only time, barring special circumstances, that you will be able to enroll in a health plan. If you don’t enroll in a qualifying health plan you may be subject to an ObamaCare penalty.
When you applied for Obamacare premium subsidies for a 2014 plan you estimated what your income would be, but what happens if you underestimated and actually made more than you claimed?
Underestimated Income for ACA Subsidies
The Affordable Care Act, commonly known as Obamacare, offers premium subsidies if your income falls within a certain range, but if you underestimated your income you will owe some or all of your subsidies back. Good news is you may not have to pay it all back because if your income falls below $45,960 the government puts a cap on what you would owe back even if you owe more. The chart below explains what you will owe back if you underestimated your income:
The Affordable Care Act extends coverage under a parents’ plan for eligible adult children until their 26th birthday. Here are some frequently asked questions about Obamacare coverage for young adults.
1) Do I Have to be a Dependent?
No. The new law does not require an adult child to be a tax dependent in order to enroll in their employee sponsored coverage.
2) I am 21 and Married Can I Be Covered by my Parents’ Plan?
Yes. The law allows both married and unmarried children to remain on their parents’ employee sponsored plan until they are 26. However, this will not cover your spouse or children.
3) I Have Employee-Sponsored Coverage. Can I Enroll in my Parents’ Plan?
No. Your parent’s plan only has to cover you if you are NOT offered job-based insurance. So, even if it is more expensive you will not be able to enroll in your parents’ plan.
4) I Used to Have Job-Based Insurance. Will I Be Able to Enroll in my Parent’s Plan?
Yes. You will be able to enroll or reenroll into your parents’ plan if you have lost your job-based insurance.
5) I’m Over 26. Can I Enroll in My Parents’ Plan?
Maybe. Some states have extended coverage past the minimum age stated by the Affordable Care Act. However, there may be restrictions to this type of coverage. If you fall into this group and don’t meet the requirements you may want to apply for an individual health plan.
6) I Live in a Different State than my Parent. Can I be Covered Under Their Plan?
Yes BUT you’ll probably be restricted to a network within your parents’ home state. While you would be covered for emergencies, you more than likely would not have coverage for doctor’s visits while living out of the state the plan was issued in. If this is your situation, you may want to consider one of the Exchange plans available in your state. You may even qualify for premium subsidies to help with your monthly bill, as well as cost-sharing subsidies to limit your out of pocket spending.
If you are under 26 and want to learn more about which plans you qualify for call the number above or contact a Medicoverage agent.
Cedars-Sinai accepts several Obamacare Exchange plans and off-Exchange plans to receive coverage from the world-renowned California hospital and its providers. UPDATED 11/13/2014
Obamacare Exchange Plans Accepted by Cedars
Obamacare Exchange plans are plans sold through your state’s website or through a certified agent and allow for Affordable Care Act subsidies. The following are Obamacare Exchange plans that offer full coverage benefits at Cedars-Sinai:
Off-Exchange plans are sold outside of your state’s website from a certified agent and don’t qualify you for income based subsidies to help with your premium and medical costs. Many people choose to enroll in these plans because the network is larger and you don’t have to share private information. The following are off-Exchange plans that offer full coverage at Cedars-Sinai:
Assurant Health offers a range of PPO plans**
Anthem Blue Cross PPO plans may offer coverage**
Anthem Blue Cross EPO all metal levels
**Check with your agent to learn which off-Exchange PPO plans are available for full coverage at Cedars.
An Obamacare penalty will be assessed for those who do not have health insurance and don’t qualify for an exemption.
How are Penalties Assessed?
Affordable Care Act penalties are assessed by the amount of months that a person is without health insurance. For instance, if you didn’t have health insurance for six months out of twelve a prorated amount will be tacked on when you do your taxes (50%).
How Much is the Obamacare Penalty
The Obamacare penalty for 2015 is $325 or 2% of your income, whichever is higher. For example if your individual income was $60,000, your penalty would be $1,200 for the year. There is also a penalty for each child that is not covered at $162.50 per child, for an out of pocket max for family at $975. To learn what your specific monthly premium under the Affordable Care Act would be call 800.930.7956.
ObamaCare Penalty Exemptions
Some people will not be responsible for an ObamaCare penalty. Here are some examples of Obamacare exemptions:
Being below the poverty line, low enough that you don’t file a tax return
ObamaCare can hold some pretty hefty penalties if you don’t have health insurance. Here’s how to avoid paying the penalty.
1) Enroll in a Health Plan to Avoid Penalty
First option is to be enrolled in a qualifying health plan. Open enrollment runs from November 15, 2014 and February 15, 2015, during this time you can enroll, drop, or change your health plan. If you are enrolled for 9 or more months you will avoid the ObamaCare penalty. Plans available through the exchange are Bronze, Silver, Gold, and Platinum ObamaCare plans.
2) Qualify to be Exempt from ObamaCare
Most individuals will need to enroll in a health plan, however there are some circumstances in which you do not have to enroll in plan and will not be penalized. A few examples of the ObamaCare exemption is if your income is too low, part of a recognized tribe, religious beliefs, or incarcerated.
ObamaCare Penalty
The ObamaCare 2015 penalty is $325 or 2% of your income (depends on your income). This maxes out at the cost of a Bronze yearly premium -which could be several thousand dollars.
If you don’t fall into one of the exemption categories and want to avoid a penalty, then call 800-930-7956 or click here to get an exchange quote.
ObamaCare health plans offer coverage that stay within certain networks, but does it cover you when you travel? It depends.
What if I Have a Health Emergency in Another Country?
Most ObamaCare health plans do not cover foreign emergency care. When traveling abroad and while cruising you’ll want to get travel insurance.
What if I Have a Health Emergency in Another State?
One of the essential health benefits of ObamaCare is that all emergencies must be covered at in-network costs. So you don’t have to worry if you break your arm in hiking in Utah but your plan is in California.
What if I Travel in the U.S. and Need Non-Emergency Care?
While most Obamacare health plans have a limited network within your area and do not cover you for out of network costs, some plans, like a PPO, allow you to visit out of network doctors. However, just because you may be able to visit out of network doctors for non-emergency care does not always mean you will have coverage outside of your state. You will need to check with your provider or agent to see if you are covered. Click here to see the difference between an HMO, EPO, and PPO.
To learn more about a health plans network call 800-930-7956 or to apply go to HealthApplication.com.
The Affordable Care Act, commonly known as ObamaCare, offers two types of subsidies to help reduce costs. The two types are: 1)Federal Premium Subsidies and 2) Federal Cost-Sharing Subsidies. This article is dedicated to Cost-Sharing Subsidies. To learn about the other form of subsidy, read Do I Qualify for Premium Subsidies?
What is Cost-Sharing?
Cost-sharing is what you pay for copayments (agreed upon dollar amount you pay to pay for a service or drug), coinsurance (% you pay for a service or drug), deductible (amount that you pay out of pocket before your insurance company pays toward your service), and out of pocket maximum. This does NOT include your monthly premium.
Will I Qualify for a Cost-Sharing Subsidy?
Cost-sharing subsidies (sometimes called cost-sharing reductions) are determined by your household income and the state you live in. If you live in of these gold colored states you may qualify for cost-sharing subsidies if your income falls within the perimeters of the chart below.
Household Members
Income Range
1
$16,104 - $29,175
2
$21,707 - $39,325
3
$27,310 - $49,475
4
$32,913 - $59,625
5
$38,515 - $69,775
6
$44,118 - $79,925
If you live in one of the below gold states, you may receive a cost-sharing subsidy if your income falls within the perimeters of the chart below.
Household Members
Income Range
1
$11,670 - $29,175
2
$15,730 - $39,325
3
$19,790 - $49,475
4
$23,850 - $59,625
5
$27,910 - $69,775
6
$31,970 - $79,925
Which Exchange Plans Qualify for Reductions?
The Silver plan is the ONLY exchange plan that qualifies for cost-sharing subsidies.
How do the Cost-Sharing Subsidies Breakdown?
The Silver plan is set up so that 70% of medical costs are covered through the provider. With cost-sharing subsidies the amount listed below is what the provider and the government will approximately pay for your out-of-pocket health services:
If your individual income is up to $17,504*, the actual coverage of a Silver plan is up to 94%
If your individual income is $17,505 - $23,339, the actual coverage of a Silver plan is up to 87%
If your individual income is $23,340 - $29,175, the actual coverage of a Silver plan is up to 73%
*Check charts above to see which income figure would be the lowest your state allows for to qualify for cost-sharing subsidies. If you fall below this amount you may qualify for Medicaid.
The amount you have to pay with cost-sharing is anywhere from 6-27% of out of pocket costs rather than the normal 30%, if you didn’t qualify for cost-sharing. Click here to a health exchange quote.
Article Updated 11/6/2014
Further Questions
If you have any further questions about cost-sharing and whether you qualify please contact Medicoverage. If you know you qualify and are ready to fill out an application go to Healthapplication.com.
The Affordable Care Act, otherwise known as ObamaCare, offers subsidies to help pay a portion of your health insurance under the new law. There are two types of federal subsidies 1) Premium Subsidies, and 2) Cost-sharing Subsidies (coinsurance, copayments, deductibles). This page is dedicated to premium subsidies, click here if you want to learn Am I Eligible for Cost-Sharing Subsidies?
1) What is a Monthly Premium?
A monthly premium is the amount you pay your insurance company for your plan. This may also be called your monthly bill.
2) Do I Qualify for a Premium Subsidy?
If your live in one of these gold states, you may qualify for a premium subsidy to help pay your monthly bill if your income falls within the perimeters of the chart below.
Household Members
Income Range
1
$16,104 - $46,680
2
$21,707 - $62,920
3
$27,310 - $79,160
4
$32,913 - $95,400
5
$38,515 - $111,640
6
$44,118 - $127,880
If you live in one of the gold states, you may receive a premium subsidy if your income falls within the perimeters of the chart below.
Household Members
Income Range
1
$11,670 - $46,680
2
$15,730 - $62,920
3
$19,790 - $79,160
4
$23,850 - $95,400
5
$27,910 - $111,640
6
$31,970 - $127,880
3) How Much Will My Subsidy Be?
The amount of your premium subsidy will depend on a few factors: your age, income, household size, and state. In some states, you may fall just under the 400% mark, but if you are relatively young you may not receive subsidies. It is best to get an exchange quote or call 800-930-7956 to find out exactly how much your subsidy will be.
Article Updated 11/6/2015
If you already know what plan you want go to Healthapplication.com to fill out your Affordable Care Act application. Please call the number above or contact a Medicoverage Health Care Exchange agent for help with any questions you might have.
The federal Health Insurance Marketplace just announced that Obamacare consumers should return to the federal site during open enrollment to renew their plans for 2015. If they don’t, they may find that they are uninsured as of January 1st.
Renew Your Health Plan
All plans for 2014 end on December 31st. Even though some people who don’t do anything will be renewed into either their current health plan or the federal site will enroll them into a similar plan, a large group of people will fall into the group that isn’t renewed or rolled over into a new plan. If you end up in the latter grouping you might find yourself without health insurance on January 1, 2015. Since renewal letters may not be sent out in time, the federal marketplace is suggesting that all consumers are proactive and return to the website to renew or choose a new plan.
If You Switch Plans You May Be Double Charged
If you switch plans to a new a health insurance provider through the federal marketplace they will not inform your former insurer that you have cancelled and you may receive bills for both premiums, or if you sign up for auto-pay you may see two deductions until you cancel one of the plans.
1) Review your coverage because premiums, cost-sharing, and networks may change for 20152) Update your application: address, income, and household information3) Compare your plan to other plans in your area4) Enroll
Too Confusing? There’s Help
Remember that you don’t have to go through all this red tape alone. The federal health insurance marketplace offers navigators at no cost to you to help you understand the different plans and learn if you qualify for premium subsidies and/or cost-sharing subsidies, however navigators are NOT allowed to suggest a plan. Another option is to work with an insurance agent, who, also at no cost to you, can do everything a navigator is able to plus agents are allowed to suggest plans.
Further questions
For further questions about what to do in the federal health insurance marketplace call 800-930-7956 or click here if you are ready to fill out your federal health insurance marketplace application.
Generation Opportunity a conservative group has created a youth campaign telling young persons to take the penalty over enrolling in a health plan. Should you opt out? Well, that’s up to you. Why is this group saying this? It’s a political move. Because the Affordable Care Act needs you, the young, to enroll to make the plans affordable. Generation Opportunity is basically saying you’re young and healthy so you don’t need coverage. They make a point, but let’s break this down so you can make an informed decision.
We aren’t here to tell you what to do, but remember that emergencies happen, you know like a car accident, a fall while hiking, or a snowboarding accident. Just to put this into perspective the average 3-day hospital stay costs $30,000. That’s a lot! But I know what you’re thinking it’s unlikely that you would end up in the hospital for 3 days or any days. Try this on for size: the average cost to set a broken leg is $7,500. Medical costs are expensive. And of course the other reason is most individuals are mandated to have insurance or pay an ACA penalty.
Watch Stephen Colbert talk about health insurance:
How Much is the Penalty?
The penalty ranges from $325 to thousands of dollars. It all depends on how much money you make.
Should I Choose the Penalty or a Plan?
Again up to you. But if you go for the penalty you pay out of pocket and still will have to pay if you have any medical issues. If you choose insurance you can go with an on or off-Exchange plan. But if you qualify for premium subsidies to help with the monthly cost and/or cost-sharing subsidies to help with deductibles, coinsurance, and copays you should choose one of the metal plans. These plans can be as low as $0 a month. That is not a typo. But the average US premium for a 26 year old purchasing a Bronze plan costs $179.33 a month -of course this is without any subsidies.
If you decided that applying is your best option, go to Healthapplication.com to fill out your paper Obamacare Health Exchange Application.
To learn what your monthly premium would be call 800-930-7956 or contact Medicoverage.
Many Americans are going to be surprised that they don’t qualify for subsidies even though their income falls within federal eligibility standards. The reason for this is subsidies are not just based off of income, but rather age and region act as qualifying factors as well.
What are the Eligibility Requirements for ACA Subsidies
You may qualify for premium subsidies if you make between $11,490 and $45,960 per year. To qualify for cost-sharing subsidies you must make between $11,490 and $28,725. These are the basic perimeters of the qualifications, but there are other factors in play as well, as stated above: age and region.
Why You Won’t Qualify for Premium Subsidies
Covered California has released its plans and what the premium and cost-sharing subsidies would be available for individuals. For instance if you live in Los Angeles, are 26 and make $30,000 a year or 35 and make $35,000, you will not receive any premium subsidy help even though you fall under the “eligibility” set out by the Affordable Care Act.
Why is this? According to Covered CA, “For your income, age, and location, the cost of health insurance is below the “fair share” amount called for under the Affordable Care Act. This means you will pay less for coverage than people living in areas with higher insurance costs or people who have higher costs due to their age.”
Don’t Qualify for Subsidies? Buy an Off-Exchange Plan
Many people don’t realize that on-Exchange plans aren’t the only plans in play. Insurance providers may offer identical plans off the Exchange or providers may offer plans that have added benefits. Remember all plans after 2014 (with the exclusion of grandfathered plans) must include the ObamaCare essential health benefits which include $0 preventive care, mental health, ambulatory services, and pediatric dental and vision. So you won’t be exchanging quality when choosing an off-Exchange plan.
Why to Choose an Off-Exchange Plan
If you qualify for subsidies, don’t purchase off the Exchange, but if you don’t qualify, purchasing off-Exchange plans saves you time and protects your privacy by not having to reveal personal financial information such as assets, alimony, and child support. Remember agents can help you learn if you qualify for subsidies and help you sign up for on or off-Exchange plans.
For further questions about whether you qualify for subsidies call 800-930-7956 or contact Medicoverage.
With the immediate expansion of same-sex marriage in Indiana, a special open enrollment period for same-sex spouses runs from now until November 30, 2014. Here is what this means for same-sex married couples.
Same-Sex Spouse Special Enrollment
Up until now same-sex married couples did not legally have to be included on their spouses’ health plans. Here are the two new factors for currently married and/or couples who plan to marry prior to November 30, 2014:
A same-sex spouse in Indiana is eligible to be added to their spouse’s health policy
Self-funded group plan sponsors may refer to their own eligibility criteria regarding spouses to determine whether to offer coverage to same-sex spouses.
If You Miss the Special Enrollment Period
If for some reason you did not take advantage of your special enrollment period you can enroll in an on or off-Exchange plan, generally a Bronze, Silver, Gold, or Platinum plan, until your spouse’s company’s health insurance offers open enrollment. Or if you aren’t married prior to November 30, 2014, but plan to marry after you will be allowed a special enrollment period at that time to join your spouse’s plan.
The Affordable Care Act, also known as ObamaCare, offers one time a year to enroll in or change your individual health plan for 2015.
ObamaCare Open Enrollment
The ObamaCare open enrollment runs November 15, 2014 -February 15, 2015. For most people this is the only time to enroll to avoid an ObamaCare penalty.
For help enrolling in an ObamaCare health plan you can enroll through the directly through your state’s platform or work with an agent for free. If you choose to work with an agent to enroll in an Obamacare health plan you will still qualify for ACA subsidies, be able to purchase on and off the exchange, and most people will find that it saves time.
If you’re unhappy with your current health plan you can switch as of November 15th for 2015 coverage. ObamaCare offers an Open Enrollment each year that allows you to either enroll in or change your health plan.
Switch Your Health Plan Nov 15th
Each year you can switch your health plan regardless of a preexisting condition to one of the new individual plans: Bronze, Silver, Gold, or Platinum plans. These may be purchased on or off the Exchange. At this time you qualify for ACA 2015 subsidies, choose your plan, and enroll for a January 1st start date.
To learn more about individual health plans available call 800-930-7956 above or contact Medicoverage.
Affordable Care Act Off-Exchange plans explained: why you would want them and how they work.
What’s an Off-Exchange Plan?
Off-Exchange plans are Bronze, Silver, Gold, or Platinum plans purchased outside of the Exchange. They can either be the exact same coverage offered or they may offer a larger network and more benefits. Off-Exchange plans are purchased directly through the insurance companies’ brokers and agents.
Why an Off-Exchange Plan?
If you know you don’t qualify for ObamaCare subsidies then an off-Exchange plan can save you (a lot of) time, while at the same time keeping your information private because you aren’t required to report your income and other personal information.
Covered California announced as of today, August 4, 2014, all participants in the healthcare plans through the Exchange are required to prove their identity.
CA Identity Proofing
Covered California now requires that all applicants show proof of their identity. This can be done through an insurance agent or broker. Once you do it, you don’t have to show proof of identity again.
There are certain circumstances that qualify you for a CA Special Enrollment Period: divorce, adoption, graduated from college, loss of job-based insurance, and other circumstances. If you think you qualify call 800-930-7956 or click here to fill out a CA health plan application.
ObamaCare offers two types of enrollment periods each year: Open Enrollment and a Special Enrollment Period. Here is the difference between the two Affordable Care Act’s enrollment periods.
ACA Open Enrollment Period
The ACA offers an Open Enrollment period each year in which anyone can enroll or change their health plan regardless of preexisting conditions. For 2015, the proposed open enrollment period is November 15, 2014 to February 15, 2015. By enrolling during this period in one of the Bronze, Silver, Gold, or Platinum plans you will avoid the ACA penalty as long as you make your payment each month.
You may enroll through a broker, agent, insurance company, or through the federal or state exchange (whichever is offered in your state). Eligibility for premium subsidies and cost-sharing subsidies are determined based on financial qualifications and you are able to get this help through your agent or broker, not just directly through the Exchange.
People who qualify for Medicaid or CHIP may enroll at anytime during the year.
ACA Special Enrollment Period
Obamacare offers a 30-day Special Enrollment Period (SEP) that extends outside of the open enrollment period for those who have a Qualifying Life Event. The following are examples of a Qualifying Life Event:
Marriage
Divorce
Moving out of state
Birth of a child
Loss of job-based insurance
Miss Open Enrollment? Don’t Qualify for SEP
If you miss the ACA’s Open Enrollment, and don’t qualify for a Special Enrollment Period, there is another option called short-term insurance. Short-term insurance is peace of mind insurance generally for 18-85 year olds, that you can have for up to 6 months. It generally has a deductible that ranges from $1000 to $7500, you pay coinsurance and copays, and most plans max out at $2 million in coverage. This is just in case you get hit by a bus insurance so you don’t go bankrupt.
Short-term insurance does not cover preexisting conditions, substance abuse, normal maternity, and preventive and wellness visits. This temporary insurance does not meet the minimum requirements under the Affordable Care Act, therefore even if enrolled in a short-term insurance policy you may be subject to an ACA penalty.
If you’re ready to enroll in a short-term insurance plan call 800-930-7956 or contact Medicoverage for assistance.
Covered California, California’s ObamaCare Exchange, announced that it has created a Special Enrollment Period for those covered by COBRA. Starting May 15, 2014 and running for 60 days, people who have coverage through COBRA can enroll in a Bronze, Silver, Gold, or Platinum plan.
Exchange Plans Could Save You Money
Most of the time an Exchange plan’s premium will be less expensive than a COBRA premium, as well as Exchange plans offer premium subsidies and cost-sharing subsidies that can significantly lower what you pay per month and your out of pocket costs, respectively.
In a statement from Covered California Executive Director Peter V. Lee, “For some people who have COBRA coverage, purchasing a plan in the Covered California marketplace during this special-enrollment period could save thousands of dollars a year.”
How to Enroll in an Exchange Plan
If you have Federal COBRA or Cal-COBRA you can enroll in one of the new Affordable Care Act plans until July 15, 2014.
For help enrolling through an agent (remember in CA and most states an agent doesn’t cost you anymore money than enrolling on your own) call the 800-930-7956 or fill out an application at HealthApplication.com.
All Affordable Care Act plans must be enrolled in by March 31, 2014 to avoid a penalty*. However, Covered California is concerned that there will be such an influx of last minute applications that it has made an exception for online applicants. Paper applications MUST be postmarked by March 31, 2014, however, Covered California stresses to avoid a penalty individuals should only use the online application at this point.
Covered CA announced yesterday, if an individual starts their ObamaCare application by March 31, 2014 they will be able to complete their application by April 15, 2014 to avoid the ACA penalty. This is to enroll in the Bronze, Silver, Gold, or Platinum ACA plans. The enrollee must do the following to qualify:
Create an online account.
Fill out all required information on the “Apply for Benefits” page and hit “Continue.”
After hitting “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit.”
They must return to their online account no later than April 15 to complete the application and select a plan.
Covered California reminds consumers that they must make their first premium payment to the health insurance company by the due date to avoid the tax penalty.
California ObamaCare Help
To enroll in an ACA plan call 800-930-7956 to have an agent enroll you and answer your questions.
*Remember if you’re 65 or over and qualify for Medicare you don’t enroll in ObamaCare plans. Click here for Medicare help.
Covered California just announced that Californian’s who signed up for a CA ObamaCare plan with a January 1st start date now have until January 15, 2014 to pay for their premiums. The ACA plans are known as the Bronze, Silver, Gold, and Platinum plans.
CA Payment Extended: What About Coverage?
Don’t worry, if you are enrolled in a plan with a January 1, 2014 start date you can seek medical treatment or get prescription drugs before you make your monthly premium payment. Just know that you will have to pay out-of-pocket for all services but will be reimbursed by your insurance company (if it applies with your plan) after you make your premium payment.
Payment must be received by January 15, 2014, it cannot be in transit or post-marked on that date.
Need to Enroll in a Covered CA Plan
For February 1st coverage you will need to enroll by January 15, 2014. Go to HealthApplication.com to find a Covered Ca quote, application, and guidance.
Remember you make your payment directly to the insurance company. For further questions call 800-930-7956 or contact Medicoverage.
ObamaCare plans have been given another extension due to issues with the CMS site. This time enrollees in the federal exchange may pay their premium as late as January 10, 2014 for a January 1st start date. However, enrollees must still choose one of the new Bronze, Silver, Gold, or Platinum plans by December 23, 2013, it is only the payment that has been extended.
To enroll in one of the new Affordable Care Act exchange plans call 800-930-7956 or go to HealthApplication.com.
Tonik health plans, which are popular with the younger crowd due to their relatively low monthly premiums, are seeing their final enrollment dates in Colorado, Georgia, and Nevada. The final day to enroll is December 30, 2013. For all other states enrollment for Tonik is closed.
Choosing a Tonik plan will provide coverage through 2014. Some people are opting to take off-Exchange plans, like Tonik, because of the larger network of doctors and hospitals rather than choosing one of the new ACA plans: Bronze, Silver, Gold, or Platinum.
When looking at ObamaCare plans, a Catastrophic plan may be the most cost effective if you’re under 30. But not always. Let me explain.
Breaking Down the Catastrophic Plan
Basically in some states the Bronze plans and Catastrophic plans may have you pay similar out-of-pocket costs (within a few hundred dollars) before your insurance pays toward your healthcare, BUT the Catastrophic plan generally will cost less each month.
However, if you qualify for monthly premium subsidies your Bronze plan’s monthly cost could be less. As well as, in some states, including California, your Bronze plan insurance provider may start paying towards your medical care costs way before the Catastrophic plan would.
This may seem counter-intuitive, however if you qualify for cost-sharing subsidies ONLY the Silver plan offers tax credits to help reduce costs when you seek medical care. At that point, the Silver plan may be the right choice for you.
Conclusion
Just because something looks less expensive, like the Catastrophic plan, it may not be. Remember to choose a plan based off your medical needs, budget, and network of doctors and hospitals. For further questions about plans call 800-930-7956 or contact Medicoverage.
Connect for Health Colorado announced today that the Obamacare individual and family plans have been extended to December 23, 2013 for a January 1, 2014 start date. This 8 day extension gives Colorado residents more time to decide on the new Bronze, Silver, Gold, and Platinum plans.
For individuals and families looking for plans go to the ACA HealthApplication.com to find a paper application in your state. For any questions call 800-930-7956 or contact Medicoverage.
Covered California’s ACA SHOP* plans are still not functioning properly, even though an email sent out today claimed they were. The enrollment and quote tool for small business is down. However, small businesses have another option than using the websites: ACA paper enrollment through agents is available for all individuals, families, and small businesses. Small businesses will still be eligible if they apply through an agent for ACA business tax credits if they are eligible.
*SHOP stands for small business health option.
When I spoke with our contact at Covered Ca, they said it would take some time for that tool to be function as it is supposed to. This comes on the heels of CMS’ announcement last week that the federally run SHOP exchanges will not be launched until April, leaving agents the only option for enrollment in over 30 states.
To make sure you and your employees are enrolled by January 1, 2014 in a new Affordable Care Act plan call 800-930-7956 or contact Medicoverage.
With the Affordable Care Act plans you might be seeing this term “EPO” as an option. You’ve probably heard of HMOs and PPOs, but EPO is not as widely used until now. The new Bronze, Silver, Gold, and Platinum plans in many states will offer EPOs. To make it easier, we decided to explain the difference between all three so you know which type of plan is best for you.
What is an HMO?
HMO is short for Health Maintenance Organization. Here’s the basics of an HMO: you MUST use network providers. This means your doctors, hospitals, and other health care providers must be in your network or you will pay out of pocket for all costs. There is one exception: emergency care. If you have an emergency your HMO plan must cover you at the same cost whether that hospital is in-network or out of your network.
You will also have to choose a Primary Care Physician (PCP), typically all referrals to see a specialist come from your PCP.
What is an EPO?
EPO is short for Exclusive Provider Organization. EPOs are similar to HMOs, in that you must stay within your network (emergency care is an exception), however with an EPO you generally do not need to select a Primary Care Physician nor receive a referral to see a specialist. This type of plan gives you a little more freedom than an HMO plan.
What is a PPO?
PPO is short for Preferred Provider Organization. PPOs do not require you to choose a PCP nor stay within network, however if you choose to go outside of your network your cost-sharing will be higher and not as many benefits will be covered (emergency services exempted). Due to PPOs having a larger network, they usually have a higher monthly premium. These plans have the most freedom.
Should You Choose an EPO, HMO or a PPO?
That’s up to you. You have to weigh your budget and if you have specific doctors and/or hospitals that you prefer to use, as well as if you want the freedom to use a specialist without a referral. Best advice before choosing any plan is to learn what your network is (even if it is a PPO plan). You don’t want to be surprised by a bill because you didn’t know your doctor or hospital wasn’t in your network.
All new qualified health plans will include the essential health benefits, such as maternity, $0 preventive care, and emergency services.
ACA Deadline
The ACA deadline for the federal exchange is December 23, 2013, other states may have earlier deadlines. However, don’t wait to the last minute to apply because your paperwork still needs to be processed. To get an Affordable Care Act application go to HealthApplication.com.
For further help deciding which plan is right for you call 800-930-7956 or contact Medicoverage.
Maryland announced that it is delaying its SHOP enrollment launch until April 1, 2014. Small businesses may still receive SHOP tax credits and enroll through an agent or broker for health insurance that begins January 1, 2014.
Don’t Wait to Enroll in SHOP in April
Employers and employees need to know that if you enroll in a SHOP (Small Business Health Option) plan after April 1, you will still owe an ACA penalty (tax) for the months you were without insurance. If you are a business owner and want to enroll your business into SHOP contact an agent at 800-930-7956. If you are employee who will not receive job-based insurance go to Healthapplication.com to fill out your paper Obamacare Health Exchange Application.
For further questions about SHOP plans or individual/family plans contact Medicoverage.
Healthcare.gov delayed the Affordable Care Act federal SHOP* exchanges purchased through their site till 2015. However, small businesses, if they qualify, may still receive SHOP tax credits when they enroll through insurance agents or brokers for the new ObamaCare small business plans.
*SHOP stands for Small Business Health Option.
This is just one of many delays, including the employer requirement that employers with 50 or more full-time equivalent employees must offer insurance or face a penalty. This was also delayed until 2015.
SHOP Employers Enroll Through Agents
Agents, like the team at Medicoverage, will be able to help employers find a plan(s) and enroll them, even though they cannot use the federal website. For employers to get an idea of plans click here to see the individual and family ACA Bronze, Silver, Gold, and Platinum plans available. Employers will need to contact their agent directly at 800-930-7956 to find out what works best for them.
If Your Employer Chooses Not to Enroll in SHOP
If you are an employee who will not receive job-based health insurance you are still mandated to have health insurance or pay an ACA penalty (tax). If you need your own health insurance go to HealthApplication.com to fill out your individual or family application. Once you send in this application your agent will inform whether you are eligible for federal subsidies and explain the plans to you.
Remember before you do anything, check with your employer to see if they enroll you in a plan. If your employer offers you qualifying insurance you cannot receive subsidies. For further questions contact Medicoverage.
Anthem Blue Cross of Indiana just released that they are extending renewals for individual and family health plans until December 15, 2013. This announcement comes after the Indiana Department of Insurance decided to reject President Obama’s offer to reinstate cancelled insurance policies.
In a statement released by Anthem, “We also realize that some customers want to keep their present health plans and benefits into 2014. That’s why back in the fall, we began offering our small group and individual members the choice to renew their current plans early. In doing so, they can keep their current benefits through most of next year.”
The federal website, Healthcare.gov, “will not work perfectly on Dec. 1,” per CMS spokesperson, Julie Bataille. The spokesperson went on to say, “periods of suboptimal performance” will still be present due to high traffic and technical difficulties, according to The John and Rusty Report.
The website has been plagued with long wait times and the system timing out when people try to apply for one the new ACA plans: Bronze, Silver, Gold, and Platinum. Bataille’s announcement came after the federal website had an unexpected one hour outage on Monday, November 25, 2013.
How to Avoid the Federal Website
Many people may not realize that they do not have to use the federal website to be insured and receive federal subsidies on January 1, 2014. Agents and brokers are able to help people enroll in plans without the consumer having to go onto the fed’s site. All federal applications should be in as early as possible to have coverage on January 1, 2014. Below you will find the application:
Go to Healthapplication.com to fill out your paper Obamacare Health Exchange Application.
At anytime if you have a question while filling out your application or to learn about which plan is right for you call 800-930-7956 or contact Medicoverage.
Are part-time employees better or worse off with the new Affordable Care Act plans? That really depends on who you ask which answer you’ll get.
Part-Time Employee Plans Cancelled
There are these plans called “mini-meds” that cover part-time retail and restaurant employees, which are no longer allowed due ACA rules. Most of these plans offer limited coverage and may cap at a few thousand dollars per year. On the plus side, these plans were very inexpensive for part-time workers. So, employees may find they paid less for these plans than plans available through the Exchange.
ACA Plans Available to Part-Time Workers
Plans available on the ACA Exchange are Bronze, Silver, Gold, and Platinum plans. The ACA plans may cost more or part-time employees may find they pay less with the ACA plans if they qualify for one or both of the following: premium subsidies to help with the monthly cost and/or cost-sharing subsidies to help with copays, deductibles, and coinsurance (basically all the payments you make when you seek medical care).
As well as subsidies, the new plans must offer the essential health benefits which include $0 preventive care, maternity, and children’s dental and vision.
Conclusion
Overall, employees will fair better with benefits, but we’ll have to wait and see if they save money on their premiums. For further questions about the Affordable Care act plans call 800-930-7956 or contact Medicoverage.
The federally run Obamacare plans have received an extension till December 23, 2013 for a January 1, 2014 start date. This gives consumers in those states an extra 8 days to decide on one of the new Bronze, Silver, Gold, or Platinum plans.
ACA Applications
Go to Healthapplication.com to get your paper application. Once you fill out the application and send it in, you will be contacted to discuss plans and informed if you qualify for subsidies. Remember to fax, scan and email, or snail mail your application in as soon as possible.
To learn if your state has extended its deadline call 800-930-7956 or contact Medicoverage.
Many Seniors 65 and over are very independent and are living their lives with little to no assistance. As November is National Medicare Family Caregiver’s Month, we decided to write an article about what you and family can do now to ensure you maintain your best healthcare as you get older.
1) Talk to Family Today
Seniors need to sit down and talk with their family about their future healthcare needs in advance. Right now, you may not foresee any complications with your health in the near future but when accidents happen, you may not be in a position to communicate your wishes. Craig Fukishama, a consultant at the Fox Group, says, “Don’t wait to plan.” He goes on to say, “It is too late when something serious happens.”
The following is a quick list of questions that you should discuss with your family member is advance. Some of the questions should be part of a formal Living Will that you can develop with legal assistance.
Who is the emergency contact?
Which doctors are your currently working with?
What drugs are you currently taking?
Do you qualify for Medicaid?
What additional insurance you have purchased? (See number 2 below)
Do you want to be resuscitated, etc?
2) Consider Senior Insurance
Medicare will not cover all your medical costs should you be sick or injured. As the New York Times states, “The average married couple retiring this year at age 65 need $220,000 to cover health costs throughout retirement.” You should consider getting additional coverage to keep the high cost of medical bills in check. Here is a list of insurance you may want:
Many seniors don’t understand what is exactly covered under Medicare and don’t know the protocol to follow to to get reimbursed for expenses. Adria Gross, of Med Wise Billing, says that seniors and their families don’t understand that you need a 72 hour qualifying hospital stay to have Medicare cover their share of Skilled Nursing care.
“Someone was out in California at the hospital for three weeks and they were not covered by Part A [Medicare] for the Medicare bill,” Gross states because this patient was being held under “observation,” not considered admitted. Gross goes on to say, “You’ve got to really ask, because they think because they are at the hospital they are considered an in-patient, but many times they will still be considered as an out-patient.”
Gross stresses that patients should ask after a few hours at the hospital what there in or out-patient status is. Asking the right questions can save thousands of dollars, but if you are not familiar with how medicare works you will not be able to ask the right questions.
4) Be Smart About Drugs
Seniors should be vigilant about how they take their drugs and how they will be paid for. Jen Wolfe, a pharmacist in the DC area started her own consulting firm ( Mymedicationexpert.com) after a client of hers had a heart attack in her pharmacy because he was not taking his drugs as prescribed. She suggests the following steps for seniors to be smart about drugs:
Talk to their doctors and pharmacists about all the drugs they are taking to make sure there isn’t an adverse reaction from a combination of drugs
Have Medicare Part B, because it covers cancer drugs, injectibles, nebulizers, and anti-nausea drugs
Put extra money aside each month for possible drug cost increases
Go to the Medicare website and look up all the their current drugs to help decide which drug plan to enroll in
5) Use Medicare Preventive Services
Senior healthcare is not just about worrying about the financial end of things, it’s also about making sure that you use all of Medicare’s or your Medicare Insurance’s preventive services. With many of the Medicare Supplemental plans (Medigap plans) and MA plans including gym memberships, seniors should utilize this benefit to improve balance and prevent disease. Also the ACA has included $0 charge for Medicare preventive care beneficiaries that include tobacco cessation counseling, vaccinations, and mammograms.
6) Avoid Falls (not the Niagara type)
Fukishama says that one of the main reasons seniors are at Long Term Care facilities is due to a fall, and many times it is because their vision had diminished. Get an annual vision checkup to make sure you peepers are in order.
As well as, according to Centers for Disease Control and Prevention, 1 in 3 seniors has a fall every year. Falls are leading cause of both non-fatal and fatal injuries among seniors. “In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized,” according to the CDC. And the CDC explains how costly falls are for American seniors, “In 2010, the direct medical costs of falls [adjusted for inflation] was $30 billion.”
Conclusion:
Family members often become the default caregivers when seniors become ill or injured. If you plan ahead and make smart decisions you can give them the tools to really assist you and maybe even postpone needing their help with some preventive planning.
The Maryland Health Benefit Exchange announced today that they extended their ObamaCare enrollment to December 23, 2013 for a January 1, 2014 start date. Carriers will accept payment from consumers through January 15, 2014. The extension is 8 days past the federal enrollment date. This is for the ACA Bronze, Silver, Gold, and Platinum plans sold on the Maryland health insurance marketplace.
For questions about plans and deadlines in your state call 800-930-7956 or contact Medicoverage.
California’s health insurance marketplace board voted unanimously not to extend health insurance plans that are not ACA compliant. The state rejected President Obama’s offer of extending over 1 million California health plans that have been cancelled. The board chose to only enroll CA residents into plans that are Obamacare compliant by including the essential health benefits.
Due to the state’s ruling, California has extended its enrollment date by 8 days to Dec 23, 2013 for a January 1, 2014 start date. It also has extended the deadline for the first payment till January 5, 2014.
CA Grandfathered Plans Still Okay
If you enrolled in a plan prior to March 23, 2010, not to worry you can keep your current plan -the ruling by the exchange board does not affect your plan in any way. However, if you are eligible for federal subsidies they would not apply to your grandfathered plan.
To learn about plans available in California call 800-930-7956 or contact Medicoverage.
According to Cover Oregon, Oregonian’s who want Obamacare coverage to start January 1, 2014, must submit applications for health insurance and financial savings by December 4, 2013. Applications must be postmarked, faxed or submitted online by this date. Oregon’s enrollment date is eleven days prior to the federal deadline of December 15, 2013 for the new ACA plans: Bronze, Silver, Gold, and Platinum plans.
To learn more about plans available in your state call 800-930-7956 or contact Medicoverage.
Anthem Blue Cross is the only provider offering ACA exchange plan coverage to UCLA Medical Center and other UC research hospitals, according to the LA Times. The ObamaCare plans known as Bronze, Silver, Gold, and Platinum have limited networks.
Make sure that you check your plans network of doctors and hospitals before signing up for the new plans. Call 800-930-7956 or contact Medicoverage to learn about the new plans.
Cedar-Sinai is only offered on two lower priced Health Net plans in the California ObamaCare exchange, according to the LA Times. It was previously thought that none of the California Bronze, Silver, Gold, or Platinum plans would include the world-renowned hospital.
Make sure to check a plan’s network before signing up. For questions about the new plans call 800-930-7956 or contact Medicoverage.
Covered California just announced their site will shut down enrollment from November 22nd to November 25th. Medicoverage has you covered during this time. Agents will be able to help with questions and enrolling in the new ACA Bronze, Silver, Gold, and Platinum plans.
Agents Can Help During Covered Ca’s Enrollment Blackout
Covered Ca says that although the enrollment part of the site will be down, Californians will still be able to browse the site for other information.
Get Your California ACA Application Here
Federal tax credits are available if you qualify, no matter if you go directly through the site or purchase from an agent. It is important to remember that an agent doesn’t cost anymore than purchasing directly from a provider or from Covered Ca.
While you are applying call 800-930-7956 or contact Medicoverage to answer any of your questions. After filling out the application, fax or mail it to contact info on the cover page.
Step One: See if You Qualify for Premium Subsidies
Before deciding on a plan you want to first check if you are eligible for premium subsidies.
People in Household
Monthly Premium Tax Credit Eligibility Per Income**
1
$45,960 or less*
2
$62,040 or less*
3
$78,120 or less*
4
$94,200 or less*
5
$110,280 or less*
6
$126,360 or less*
Step Two: See if You Qualify for Cost-Sharing Subsidies
After you find out if you qualify for premium subsidies, now you want to learn if you qualify for cost-sharing subsidies for help with your deductible, coinsurance, and copays.
People in Household
Cost-Sharing Tax Credit Eligibility**
1
$28,725 or less*
2
$38,775 or less*
3
$48,825 or less*
4
$58,875 or less*
5
$68,925 or less*
6
$78,975 or less*
*The less refers to the minimum you have to make to qualify. For states that didn’t expand Medicaid for a single person it is: $11,490. In states that expanded Medicaid, the minimum income for subsidies is $15,856. Both figures are for 2014.
After you learn where you fall on the subsidy chart, now learn your cost by calling 800-930-7956. If you qualify for a subsidy, you’ll want to purchase an on-Exchange known as the ACA Bronze, Silver, Gold, and Platinum plans.
In the future we will have an online quote button (as you know the online systems are not working so well), for now call 800-930-7956 to get your quote.
Step Four: Apply Today for ACA Plans
If you’re ready to apply, click to access ObamaCare Application in your state. For any questions call the number above.
It probably won’t come as surprise that there is a shortage of doctors, but with the Affordable Care Act going into full effect January 1, 2014, doctors may be pushed to the limit. The patients will either be enrolled in the newly expanded Medicaid, Catastrophic plans, or Bronze, Silver, Gold, and Platinum plans.
How Doctors are Planning for ObamaCare
Because of the shortage doctors are hiring physician assistants. According to CBS News, Christopher Timm, president of Metro Immediate, said, “Because there’s such a shortage of physicians, and this many people are becoming part of the insured population that the (physician’s assistant) is going to be their primary mode of contact.”
Medicaid Patients May Be the Sickest
Patients that are newly receiving health care may not have taken care of health issues before. It is expected that Medicaid patients will have higher occurrences of undiagnosed hypertension, diabetes, and other chronic problems than patients that are currently seeking healthcare. This can make a doctors job more difficult, as these patients will require more attention and time. According to CBS News, Dr. Brigit Britton says,“They may be more difficult to manage to begin with, and to get their chronic conditions under control, but as we go forward, they’re going to be easier - less hospital visits, less hospital stays, more savings, so it’s going to be easier for us.”
Money is a Big Concern for Doctors
With doctors’ offices having to increase their staff, there is concern that payment from the new ACA plans and Medicaid will not sufficiently cover costs. This could also mean, less time with each patient, as doctors are trying to fit more people in.
We’ll have to wait and see how all of this pans out after the New Year. For any questions about subsidies or the ACA plans call 800-930-7956 or contact Medicoverage.
This will affect 1 in 4 Americans who suffer from mental illness or substance abuse. Previously insurance companies were not required to include these services. In a quote from WSJ, Kathleen Sebelius, United States Secretary of Health and Human Services, stated “For way too long, the health insurance industry has openly discriminated against people with mental health and substance abused disorders. We are finally closing the gaps in coverage.”
New Mental Health Coverage
A previous law required large groups to charge the same copay and deductible for mental health services as it does for other medical services, and now the ACA builds upon that law. The following are a few of the new coverage benefits of the ACA plans for mental health:
All individual and small-group plans sold through the health insurance marketplace must include mental-health benefits
Must cover psychiatric day programs and rehab
If a patient is refused treatment they have the right to see why in writing within 30 days and appeal
According to Politico, DC HealthLink’s Richard Sorian says that saying only 5 residents have enrolled is “not an accurate depiction of the strong level of interest in the District of Columbia in obtaining quality, affordable health insurance.” 747 individuals and small businesses have selected a health plan but have not paid for them. The deadline for DC individuals to pay for a January 1st start date is December 15, 2013 and for small businesses it is December 12, 2013.
According to CMS, a law in place before the Affordable Care Act was passed, known as the Health Insurance Portability and Accountability Act (HIPAA) states that all individual health plans are considered “guaranteed renewable” at the end of the 12-month contract, although they can increase premiums, increase cost-sharing, and/or reduce the scope of benefits covered. This affects all health plans including the Bronze, Silver, Gold, and Platinum ObamaCare plans.
What Providers Must Do to Cancel Your Insurance
A health insurance provider must do the following things in order to cancel your health plan:
Provide at least 90 days’ notice in writing to each covered individual
Offer each covered individual the option to buy any other individual plan it offers to individuals in that market
If an insurer decides to pull all coverage out of a state’s individual market, the provider may cancel an individual plan without offering you the chance to purchase a new plan. If an insurer chooses to do so, they are prohibited from offering coverage in the state’s individual market for 5 years. And this provider must offer 180 days notice to the policyholder and the state before stopping coverage.
Special Enrollment Period for ObamaCare Plans
You’ve probably heard by now that there is one open enrollment period for the new ObamaCare plans, however there is also an ACA special enrollment period. At this time you can enroll in an individual plan on or off the Exchange. It is usually a 60 day period that comes after a life changing event, such as losing your job or a divorce (if you insurance was provided through your spouse).
If your insurer has cancelled your plan call 800-930-7956 or contact Medicoverage to learn which plans are available in your area.
24 states have decided not to expand Medicaid to about 5.4 Million eligible residents. The Affordable Care Act presented a plan to the states that 100% of the cost of Medicaid would be covered by the federal government for the first three years, after that the states would pay 10% of the cost in the fourth year. However, some states did not think was advantageous to its citizens. Individuals are still able to purchase the Bronze, Silver, Gold, or Platinum plans, but they would not be eligible for subsidies if they fall below 100% of the poverty line ($11,490 for 2013).
The following states have chosen not to expand Medicaid: Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin, and Wyoming.
We will do some more research and update this information as it comes in. Call 800-930-7956 or contact Medicoverage for the most up to date information for your state.
Washington Healthplanfinder announced yesterday that more than 55,000 residents have enrolled ObamaCare health coverage known as the Bronze, Silver, Gold, Platinum plans, and Catastrophic and Medicaid coverage.
However this last week has had issues due to outages on the federal level. These outages stopped WA Healthplanfinder from determining eligibility. For help learning if you are eligible for subsidies call 800-930-7956 or contact Medicoverage.
ObamaCare enrollment numbers down this week due to outages at the Federal Data Services Hub. This system is managed by the federal government and allows state-based markets to verify enrollee’s identity and subsidy eligibility. Therefore states were not able to give accurate figures to persons trying to enroll.
This information was sent out by Washington Healthplanfinder, Washington State’s online health insurance marketplace, however this impacted all state-based markets. According to their email the issue is currently resolved for the Bronze, Silver, Gold, and Platinum plans.
According to Covered California’s press release today, approximately 2.6 million people are eligible for federal subsidies to help with the new Affordable Care Act plans, known as the Bronze, Silver, Gold, and Platinum plans. As well as, more than 1 million additional Californians are newly eligible to receive no-cost or low-cost Medi-Cal.
Covered California’s Executive Director Peter V. Lee is optimistic that Alameda Alliance will be back on the Obamacare exchange in the future. Lee said, “Alameda Alliance has a solid provider network and is a valuable asset to the community.We look forward to the company getting its commercial license, so we can welcome its plans back to the exchange.”
Covered California learned that the company was not approved to sell commercial insurance plans through the Department of Managed Health Care. However, Alameda Alliance will continue to provide Medi-Cal to the California’s residents.
Call 800-930-7956 or contact Medicoverage to learn of other provider available in your area.
Due to glitches with the website, the Obama Administration has extended the Affordable Care Act enrollment deadline to March 31, 2014. Wait, you might be thinking, wasn’t that already the deadline? Let us explain, that was the previous deadline for the open enrollment, but if you had waited till the tail end you would have still owed a penalty for the months you went uninsured.
The Affordable Care Act penalty is $95 according to many sources, but that won’t be accurate for many people who choose to forego insurance in 2014.
How the ACA Penalties Work
The minimum penalty (tax) for someone who chooses to go without insurance is $95 BUT the maximum penalty is 1% of your income. And that 1% penalty is way more likely the penalty you will pay, than a measly $95. But here’s the big news: that penalty maxes out at the cost of the average yearly Bronze premium -projected at $249 per month for the 48 contiguous states. It is unclear if your penalty will be based on the federal, state, or region average. But if your penalty is based of the U.S. average for all ages and counties, you could pay up to $2,988 for 2014.
Anthem is allowing residents of Colorado, Georgia, Nevada, and possibly Virginia to enroll in non-Obamacare plans until November 15th. This means that all current clients can renew their current plan for another year, as well as anyone can apply for a December 1, 2014 policy end date.
Anthem Facts for those who want to Enroll in non-ACA plans
There are few things you should know when applying for these plans:
All Anthem Blue Cross Blue Shield of Connecticut’s grandfathered plans will be cancelled and will be enrolled into an Affordable Care Act compliant plan. There have been some articles written that say “some” plans, but according to our individual broker contact at Anthem Connecticut ALL grandfathered plans will be cancelled.
What are ACA Compliant Plans?
An ACA compliant plan is one that includes the essential health benefits such as $0 preventive care, maternity, and child dental and vision. These plans will have a maximum out-of-pocket cost ($6,350 for 2014), Anthem must cover a minimum of 60% when you seek in-network medical care, guaranteed issuance regardless of preexisting conditions, and there are no lifetime limits on what Anthem will have to cover.
If you have a grandfathered plan don’t worry they will enroll you in one of the new plans, but remember you have options. So if you want to check out your options call 800-930-7956 or contact Medicoverage.
Per a Washington Healthplanfinder email, over 8,000 applicants were offered higher tax credits than should have been allowed based off their income and members of their household for the new Bronze, Silver, Gold, and Platinum plans.
WA Website Glitch
From the email released by Washington Healthplanfinder, “Working with the federal government, our IT team traced the issue to inconsistent file formats being shared between Washington Healthplanfinder and the Federal Data Services Hub.The investigation revealed that the two systems were using different parameters to establish estimated household income. As a result, some Washington Healthplanfinder applicants did not receive the correct tax credit information related to their premiums.”
WA Residents Who are Affected by the Under-Quote
This problem, according to the email, only affects those who qualify for subsidies. The WA Healthplanfinder assures that this does not affect those that are buying plans that do not qualify for premium subsidies or cost-sharing subsidies, and it doesn’t affect the 40,000 Medicaid eligible applicants.
Washington State Late Enrollment
Most U.S. residents can apply for a plan until Dec 15th for a Jan 1st start date, but Washington State allows its residents to apply until December 23rd for the first of the year start date.
Wait to Enroll in ACA Plans
Even though, Washington claims that this problem was fixed as of October 23rd, we suggest waiting to enroll in any plan until glitches in all the exchanges are repaired. As the federal website also is under-quoting premiums, but in fed’s case, it affects applicants regardless if they qualified for subsidies. Remember an agent is able to help you enroll in any of the ACA plans and they will be able to help you understand how all the plans work. To learn more call 800-930-7956 or contact Medicoverage.
The Centers for Medicare and Medicaid’s (CMS) Health Insurance Marketplace website has been drastically under quoting Affordable Care Act (ACA) health insurance prices. According to CBSNews, the federal exchange website doesn’t correctly calculate the date of birth of Bronze, Silver, Gold, and Platinum plan premium rates. Let us explain.
Quote Problems with the Federal Exchange Website
The inability to quickly get a health insurance quote without first proving your identity is a large complaint of the new Federal Exchange website. To address this, the CMS team has now added a way to get a quick quote without first entering your personal information or social security number. Unfortunately this new method may be inaccurate. Currently the quote tool only asks if you are “49 and younger or over 50.” According to CBSNews, “the 49-or-under group (rates) are based on what a 27-year-old would pay. In the 50-or-older group, prices are based on what a 50-year-old would pay.” This is not how the plans are really priced, however, and this could make a difference of more than $200 a month. After CBSNews compared exchange quote prices with the actual prices from insurance providers, they determined that “in some cases, people could end up paying double of what they see on the website.”
General Problems with Exchange Website
In addition to inaccurate quotes, the federal website is still creating frequent error messages after nearly one month in operation. We confirmed this today when we tried 5 times to set up an account. We had to use several different email addresses and still couldn’t get into the system. The federal website isn’t alone in it’s struggle to get it right, apparently the state of Washington’s own exchange under quoted 8000 applicants.
How to Learn Your Actual Monthly Premium
As the exchange sites are still unreliable, the best way to get a quote is to contact an authorized agent who is able to get the direct prices from the insurance provider. Don’t worry, authorized agents can still make sure you receive premium subsidies and cost-sharing subsidies, if you qualify. Regardless of who you work with, we are stressing to all considering a new ACA insurance plan, wait until the dust settles. You do not need to rush into a plan right now, as ObamaCare enrollment runs until December 15th for a January 1st start date.
To learn more about the new plans or to speak with an authorized agent, call 800-930-7956 or contact Medicoverage online.
The University of Kentucky Hospital and their physicians have announced that they will join Anthem Blue Cross Blue Shield of Kentucky’s Pathway (off-Exchange) and Pathway X (on-Exchange) networks. Anthem KY’s new Affordable Care Act qualified health plans have compiled a list of all doctor/hospital networks.
Kentucky is one of a few states that has their doctor/hospital networks available. Remember to always check a plan’s network before deciding to enroll. To learn about networks and plans available in your state call 800-930-7956 or contact Medicoverage.
Premiums are available in all states for ObamaCare plans. This page is dedicated to Wisconsin’s health care plans. The Affordable Care Act rates listed are for the new Bronze, Silver, Gold, and Platinum plans.
Wisconsin ACA Rates
The following information is Wisconsin’s 2014 ObamaCare plans. In the chart, only a few ages are represented, as well as subsidies are not included. So, you’ll want to reach out to to learn your specific premium or to learn if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
The 2014 West Virginia table represents a few demographics and leaves out the subsidies. So, learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
Exchange premiums for all the states that defaulted to the federal Exchange have been released. This page is dedicated to Tennessee’s premiums. The ObamaCare rates listed are for the new Bronze, Silver, Gold, and Platinum plans.
Tennessee ACA Rates
The chart below shows the 2014 rates for Tennessee ObamaCare plans. Note that only a few ages are represented, as well as subsidies are not included. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
South Dakota is one of more than 30 states who decided to let the feds set up their Exchange. The premium rates released by the Health Insurance Marketplace for South Dakota are for the Catastrophic plan and the Bronze, Silver, Gold, and Platinum plans.
South Dakota ACA Rates
While going over the table below, please note that only a small handful of ages are represented, as well as subsidies are not included in these SD plans. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
The table below shows the 2014 rates for Texas plans. Take note that not all ages are represented, as well as subsidies are not included. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
The 2014 Wyoming table only displays a few ages and leaves out the subsidies. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
South Dakota is one of more than 30 states who decided to let the feds set up their Exchange. The premium rates released by the Health Insurance Marketplace for South Dakota are for the Catastrophic plan and the Bronze, Silver, Gold, and Platinum plans.
South Dakota ACA Rates
While going over the table below, please note that only a small handful of ages are represented, as well as subsidies are not included in these SD plans. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
In the past fourteen days the Health Insurance Marketplace has been up and running there have been a lot of glitches. One of the big problems is many of the Exchange do not include networks of doctors and hospitals. How does someone choose a health insurance plan without all the details? We say, wait. Let us explain.
ObamaCare Exchange Problems
The following are a few of the problems that have occurred in the past 14 days:
Doctors and hospitals not included in lists for consumers in some states.
California’s Doctor Finder Removed
The doctor and hospital finder on Covered California’s website went up a week after enrollment began, and was almost immediately taken down. We know that CA residents will find a smaller network, however consumers were finding that hospitals were not available within 100 miles, because Covered Ca had not updated all the networks not because they wouldn’t be available, according to San Jose Mercury News.
Senior and the ACA
Officials are concerned that seniors might become targets of ObamaCare scammers. So we are stressing to our clients: seniors who are on Medicare do not sign up for ACA plans. If you are over 65 and do not qualify you can sign up for the new ACA plans. This message is extremely important as there is a lot of confusion with the federal and state sites not fully up-to-date.
UPDATE 11/27/13: there is an easy way to fill out your Affordable Care Act application. First you go to Healthapplication.com and fill out the application send it in, and an agent will contact you about plans in your area, answer questions about doctors and hospitals, and tell you if you qualify for subsidies.
Millions have attempted to use Healthcare.gov to research plans available in their state. However, many are receiving “busy” messages from the website and long delays on the phone. One way to avoid this is to work with an agent.
Agents: Go through a rigorous training period to become certified by the state, the Exchange, and appointed by the provider (ie. Blue Cross, Humana). This process is continuous, as agents and brokers must continue their studies to maintain their license. The way an agent is chosen depends on the state, but per California’s Insurance regulations an agent must pass a background check and must not have “demonstrated a willful attempt to derive a personal financial benefit through the nonpayment or underpayment of taxes.”
Navigators: Navigators are hired by the state and feds to help educate the public about health care options. According to CMS.org, navigators undergo extensive training, however they are not required by federal law to pass a background check
Difference Between Navigator and Agent Help
Navigators are paid through federal and state grants (up to $50K per year). They are unable to suggest one plan over the other and are not allowed to help with off-Exchange plans that may have a lower monthly premium.
Agents don’t cost anymore money to use than if you were to purchase directly from your provider. Agents are also able to suggest plans based off what might be best for you and your family, as well as enroll you in an off-Exchange plans.
Both navigators and agents are able to help you sign up for Exchange plans and help you learn if you qualify for premium subsidies (to help with monthly payments) and/or cost-sharing subsidies (lowers your cost for out-of-pocket costs when you seek medical care).
A story published today, by the Daily Caller in Kansas, raises concerns about the navigator program. The article discusses how the lack of background checks in Kansas allowed the only full-time navigator in Douglas County, who deals with personal financial information, to be hired regardless of her financial history: “which includes a bankruptcy in 2003, a 2007 civil charge from a local check cashing business called Midwest Checkrite for writing a bad check, being more than $1700 behind on her state tax bill, and having an outstanding arrest warrant in nearby Shawnee County.”
UPDATE 11/27/13: Paper applications are an easy way to apply for the Affordable Care Act. Go to ObamaCare Exchange Healthapplication.com. Remember to fill it out and send it in as soon as possible to ensure the earliest enrollment date.
Conclusion
At this point you’ll need to contact your agent directly to work with them for plans sold through the federal exchange. As Healthcare.gov is not totally ready, the complete list of agents will be added shortly. However, to speak with an agent now about on and off-Exchange plans call 800-930-7956 or contact Medicoverage for assistance.
Below is the 2014 Pennsylvania Exchange chart. It is important to note that only a few ages are represented below, as well as the monthly premiums do not include subsidies. Call 800-930-7956 or contact Medicoverage to learn if you qualify for premium subsidies or cost-sharing subsidies and to get your specific monthly premium. Scroll to the right to see prices.
The Health Insurance Marketplace rates for Oklahoma are now available for viewing. Oklahoma, and 35 other states, decided to let the federal government set up its Exchange, which allows for two ways for residents to enroll in a new plan: through state navigators or an insurance broker. The OK rates released are for the new Affordable Care Act Bronze, Silver, Gold, and Platinum plans.
Oklahoma Exchange Rates
The table below shows the 2014 Oklahoma ACA rates. As you scroll through, note that only a few ages are represented below, as well as the monthly premiums do not include subsidies. Call 800-930-7956 or contact Medicoverage to learn if you qualify for premium subsidies or cost-sharing subsidies and to get your specific monthly premium. Scroll to the right to see prices.
The following table shows the 2014 ACA plans for Louisiana. When looking over the chart, remember that only a small handful of ages are represented, as well as the monthly costs do include subsidies. Prices are available for all ages, so to learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
The chart below shows the 2014 ACA plans for Utah. Keep in mind that only a small handful of ages are represented, as well as the monthly costs do include subsidies. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
New Jersey’s ObamaCare rates are now available. New Jersey decided to allow the federal government to set up its Exchange, which allows for two ways for residents to enroll in a new plan: through newly established state navigators or an insurance broker. The NJ rates released are for the new Affordable Care Act Bronze, Silver, Gold, and Platinum plans.
New Jersey Exchange Rates
The 2014 plans and prices displayed in the chart below are for the state of New Jersey. Take note that only a few ages are represented below, as well as the monthly premiums do not include subsidies. Call 800-930-7956 or contact Medicoverage to learn if you qualify for premium subsidies or cost-sharing subsidies and your specific monthly premium. Scroll to the right to see prices.
New Hampshire’s Affordable Care Act premium rates have been released. The state of New Hampshire is handling the Health Insurance Marketplace plans differently than most states by doing these two things: only offering a single provider (Blue Cross Blue Shield) and only offering three tiers of the metal plans: Bronze Health Plan, Silver Health Plan, and Gold Health Plan. The plan left out is the Platinum Health Plan, which offers the most comprehensive coverage.
New Hampshire Exchange Rates
The chart below displays the 2014 New Hampshire ACA plans. Keep in mind that only a handful of ages are represented, as well as the monthly costs do include subsidies. To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
The chart below displays North Carolina’s premium rates for 2014. The prices included are for specific ages, and do not include subsidies. Prices are available for all ages, so to learn your specific premium or to learn if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
When looking over the following Montana ACA 2014 table, take note that only a few ages are represented to give you an idea of how much your monthly premium would be. Also, note that subsidies are not included.To learn your specific premium or if you qualify for premium subsidies or cost-sharing subsidies call 800-930-7956 or contact Medicoverage. Scroll to the right to see prices.
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