After you have completed a Health Insurance application and provide household income information, you will find out if you qualify for a Premium Tax Credit subsidy that lowers your monthly health insurance bill.
You will also find out if, in addition, your income qualifies you for Cost-Sharing-Reductions (CSR). If you qualify, you can save money a second way: By paying less out of your own pocket each time you secure medical services. This can significantly reduce your total health care costs for the year.
IMPORTANT: If you qualify for these extra savings on out-of-pocket costs, you get them only if you enroll in a plan in the Silver category. There are four different metal catagories: Platinum, Gold, Silver, and Bronze. You may use a Premium Tax Credit for any plan in any metal category, but you will get CSR only if you enroll in a Silver plan.
HOW YOU WILL SAVE ON OUT-OF-POCKET COSTS
- You will have a lower deductible. This means the insurance plan starts to pay its share of your medical costs sooner. For example, if a particular Silver plan has a $6,100 deductible, you have to pay the first $6,100 of the Florida Blue medical charges yourself before the insurance company pays anything (other than co-pays and free preventative services). But if you qualify for CSR your deductible for a Silver plan could range from $0 to $4,300,
depending on your income.
- You will have both lower copayments and coinsurance. These are the payments you make each time you secure care: like $65 for a doctor visit. If a silver plan’s co-pay is $65 for a doctor’s visit, if you enroll in a qualified Silver plan and you qualify for the CSR you may pay as little as $1 for your primary care doctors visit.
- You will have a lower “out-of-pocket maximum.” This is the absolute amount that you would be liable for in a calendar year. For example, if you used a lot of care, because you became seriously ill or had an accident, your absolute maximum could be significantly lower. Instead of being as much as $6,850, your out-of-pocket maximum for a particular Silver plan, if you qualify for CSR, could be as little as $950.
IMPORTANT: Plans in all categories have a wide range of deductibles, co-pays/coinsurance, and out-of-pocket maximums. You will know exactly how much you can save on out-of-pocket costs only when you contact your local insurance agency and schedule an appointment with a health insurance agent. THE SERVICES PROVIDED BY YOUR LOCAL INSURANCE AGENT WILL ALWAYS BE OF NO COST TO YOU.
Military veterans that are enrolled in either TRICARE or a Veterans’ Affairs (VA) Healthcare Program are in compliance with the Affordable Care Act (ACA), and do not have to make any changes to their health insurance coverage. If you are not covered through TRICARE or the VA, federal law requires you to enroll in a qualified health insurance plan or pay a penalty.
LIST OF VETERANS’ PROGRAMS THAT MEET ACA GUIDELINES:
1) Veterans Health Care Program
2) VA Civilian Health and Medical Program (CHAMPVA)
3) Spina Bifida Health Care Benefits Program
- If you are enrolled in, or a beneficiary of, any of the aforementioned programs: you’re considered to have Minimum Essential Coverage under the ACA and do not need additional coverage.
IF ARE NOT ENROLLED IN A VETERANS’ PROGRAM:
You are able to enroll into a health insurance plan, either directly through the insurance company, or the Marketplace. The most efficient way to sign up is by directly contacting your local insurance agency, and scheduling an appointment with an agent. Your health insurance agent will be able to navigate you through the health insurance system and into the coverage that fits your needs. All agents perform this service at NO COST TO YOU.
Depending on your household size and income, you may be eligible to get lower costs on monthly premiums and out-of-pocket costs on private insurance. Or you may qualify for free or low-cost coverage through Medicaid or Children’s Health Insurance Program (CHIP).
If you neglect to enroll in a qualified ACA plan, you may be subject to a substantial penalty.
IF YOUR DEPENDENTS ARE NOT COVERED:
If you are a veteran enrolled in, or are a beneficiary of, a VA health care program, you may have dependents who are not eligible for a VA health care program. In this case, a local health insurance agent will be able to enroll them into qualified health insurance program.
Depending on household size and income, they may get lower costs on monthly premiums or out-of-pocket costs. Or they could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
Like everyone else, if they do not have health insurance coverage, they may be subject to substantial penalty fees.
IMPORTANT: TRICARE’s young adult coverage rules are different from the ACA’s version… Eligibility ages, benefits, and other details differ; you will need to confer with a TRICARE representative who is able to provide you the detailed set of procedures.
The health insurance marketplace provides four tiers of health coverage known as “metal” levels: bronze, silver, gold, and platinum.
Generally, bronze plans have the lowest monthly premiums (your monthly insurance bill), but they have also have high deductibles and out-of-pocket costs. In most cases, bronze plans do not include co-pays for doctor visits or any other form of co-payment.
In contrast, platinum plans have the highest monthly premiums but provide low deductibles, co-payments, and significantly mitigate out-of-pocket costs.
The cost sharing between metal plans and the insurance company
Insurance Company’s Cost Share Your Cost Share
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%
In order to reduce your monthly premium you may apply for a tax credit (government subsidy). In order to qualify for a subsidy, your household income must be within the parameter of 100-400% of the Federal Poverty Level (FPL). Individuals earning less than 100% of the FPL are ineligible for subsidized health coverage through the marketplace, and must enroll in Medicaid. Applicants with a household income above 400% of the FPL do not qualify for subsidized healthcare.
Many people are aware of the subsidies being offered by the government, but very few know that the government offers an additional benefit known as Cost-Share-Reduction (CSR). In order to qualify for CSR benefits, your household income must fall between 100-250% of the FPL. Consequently, people that go online and sign up by themselves are failing to take advantage of the benefits our new healthcare system provides. The Health Insurance Marketplace is a difficult website for any layman to navigate. Even if you’ve managed to enroll in a healthcare plan via healthcare.gov it is highly likely that you did not elect the coverage that would best suit your needs. Unless you’re a licensed health insurance agent; your failure to identify the multiple nuances throughout the application consequently prohibit enrolling in optimal coverage that is personalized to fit your needs.
**ADVICE TO STRONGLY CONSIDER**
Do not settle for lackluster coverage by enrolling yourself through healthcare.gov. Find your local agency and have an agent take you through the process… A good agent will be familiar with the many facets of the enrollment process and present you with the best coverage available… REMEMBER – allowing an insurance agent to write your insurance policy is absolutely free… Take this unbiased advice and utilize the expertise of your local agents.
For further information contact Simerly-Ayers Insurance Group at 850.244.3472.
Medicare what about it?
The Medicare program is designed to not only provide medical treatment to heal injuries and diseases but also to provide preventive care. Medicare provides a free-no cost – physical exam within the first 12 months after enrolling in Part B. After the first year the medigap policy (Medicare supplement) and Medicare advantage plan (Part C) provide a cost free wellness exam once each calendar year. Note there is government assistance to pay or help pay the premium for a medigap policy for those with limited incomes. This also applies to Part D, the prescription drug plan, to be discussed later.
Many seniors are concerned that the Federal Government will reduce the fees paid to the doctors and hospitals. If this were to occur as rumored in 2014, many doctors would have refused to treat Medicare patients. It did not happen and it appears that we Medicare recipients are safe for now.
Congress is taking some action to implement “Means Testing” in the future – maybe in 2018. Means testing merely means that the wealthier among us will pay more for their treatments. Means testing is already applied to the Part B premium and Part D (RX plan) premium.
Whether you agree with means testing or not, it is the Federal Governments way to reduce the increasing cost of Medicare. By doing so the Medicare program can continue to provide care for those who need it most.
To summarize: Medicare as we know it now is not real cause for worry and should be with us and for us and for those turning 65 for years to come. There will probably be with some increase in cost to those who are determined to be able to pay more.
Obamacare – March 15th 2015 there will begin an special enrollment period for certain eligible persons
Health insurance can be very tricky to figure out nowadays. Luckily Simerly Ayers Insurance Group offers health insurance in Ft Walton Beach and the surrounding areas. Our team of insurance professionals gives you the opportunity to speak to a person regarding all of your health insurance needs. We assist numerous businesses as well with their group health insurance needs. If you have questions about obtaining health insurance please do not hesitate to call our team.
When choosing health insurance plans during ACA open enrollment there are several mistakes that can be made.
1. Choosing the wrong NETWORK OF PROVIDERS – Health insurance companies’ contract with different groups of hospitals and doctors. They agree to certain payments for services rendered to insured / patients. It is imperative to know that your providers are in the network servicing the plan you chose. The health insurance company’s website should have an up to date list of providers. Search their listing and when you find the providers you like then we recommend you call to confirm they are taking patients in that network. In short, do your research before you choose a plan – it could save a lot of unhappiness.
2. Annual max out of pocket – it is risk management 101 to know what the limits are for any insurance coverage you own. A health insurance annual max out of pocket tells you what your annual cost will be in a calendar year before your insurance carrier will pay 100% of your expenses. Not all health insurance policies meet their annual max out of pocket the same way. Learn how yours work.
3. Deductible – does your deductible have to be met before co-payments kick in? Are your doctor and / or drug co-pays added to meet your deductible and / or max? These are just 2 examples of the different ways deductibles can be meet. Not knowing how your deductible is meet can bring unpleasant surprises.
A knowledgeable health insurance agent can guide you through the process.
The 2015 ACA (Obamacare) enrollment is happening now and the deadline is approaching. The Open Enrollment Period for 2015 coverage is November 15, 2014 to February 15, 2015. If you haven’t enrolled in 2015 coverage by February 15, 2015, you generally can’t buy Marketplace health coverage for 2015 unless you qualify for a Special Enrollment Period. Once again, the deadline for enrollment is February 15, 2015! Make sure to get covered immediately to avoid serious tax penalties. Open enrollment for Health Insurance for an employer’s group is usually only a one or two month period per year. During this short time, eligible employees may exercise options to change plans if they are already covered, or employees may sign up for coverage if they are not currently covered. If you do not sign up for health insurance during open enrollment period – and the deadline is approaching fast! – you most likely will NOT be allowed to sign up until next year’s open enrollment. While there are exceptions that might allow employees to enroll during times other than the annual open enrollment period, these exceptions are not common. Don’t risk missing out on health insurance AND ALSO paying a hefty tax penalty. Open enrollment coverage right now is guaranteed and there is no underwriting for qualified, timely persons. In addition to employer’s group health insurance, open enrollments are available for ACA Health Insurance through Simerly-Ayers Insurance Group who will help you with signing up via the exchanges in the marketplace, for ACA Health Insurance through carriers directly, and for Medicare coverage. Make sure to enroll today and take advantage of having an insurance agent assist you at no additional cost!