THIS JUST IN!
HEALTHNET to offer new PPO plan in many CA areas!
This will give many areas of CA two (2) PPO choices again.
Check here for updates. We’ll post them as we learn more about their network of providers.
Review the entire document of Covered CA’s 2018 plans and pricing here
ANTHEM pulling out of the individual market in most of CA
Not sure if your plan will be affected? Click here to download Anthem’s FAQ.
So What Is The Affordable Care Act Anyway (Obamacare, HEALTHCARE.GOV, Covered CA, etc.)
The Affordable Care Act, affectionately known as Obamacare is a new health care reform law in America. It was signed into federal law by President Obama on March 23, 2010. No matter what you call it, or what political side of the fence you are on, it’s important that you know what it can do for you!
…it originally was put into place to provide more Americans with access to affordable quality health insurance. Although, if your MAGI (Modified Adjusted Gross Income) is too much for help with the premium, rates have gone through the roof. We can help minimize the blow as much as possible with a personalized insurance design. We also work with your CPA to make sure you’re minimizing your MAGI to maximize your subsidy! BE AWARE…many Doctors either do not accept the new individual plans or they have aligned with one or two insurance companies only. Work with an experienced independent broker that can make sure your Doc is in the plan you choose!
***IMPORTANT NEWS!! The government has just released the 2017 FEDERAL POVERTY LIMIT CHART. That means that if your income on the Exchanges is below these amounts, you may be pushed into MediCal. Your agent should be proactive notifying you. If they aren’t, change to us and we’ll take care of the making the changes for you. It doesn’t cost you an extra to have an advocate on your side 🙂 Click on the link above to download the new chart.
I’M SURE YOU HAVE A LOT MORE QUESTIONS!
- Have a child turing 26?
- When and how do I apply?
- Do I go on or off the exchange?
- Will I be penalized for not obtaining health insurance?
- What do I do if I can’t afford my companies insurance?
- Can I get help with my premium?
- Who can assist me with all of this?
That is where I come in…so let’s get started!!
Compliments of Healthcare.gov…
Q. What is the deadline to enroll in health insurance coverage for 2017?
A. Open enrollment for 2017 coverage will begin on November 1, 2016, and will continue until January 31, 2017 (that’s the same schedule that was used for 2016 coverage, and it will also be used for 2018 coverage. But starting with 2019 coverage, the open enrollment window will be different).
The open enrollment window applies in the exchanges, and it also applies to plans purchased outside the exchange—with the exception of Nevada (in Nevada, off-exchange plans—with no subsidies—can be purchased year-round, but the carriers can impose a three month waiting period before coverage takes effect).
2017 penalty for being uninsured
The penalty for being uninsured doesn’t apply to people who have one short gap in coverage of less than three months time (note that the penalty does apply if you’re uninsured for three months or longer). If you enroll in coverage by the end of January 2017, you’ll have coverage in place no later than March 1, 2017. As long as you maintain it for the remainder of the year, you won’t face a penalty for 2017.
For people who remain uninsured, the penalty for not having coverage grew significantly in 2016. It will remain at the 2016 rate going forward, but the flat-rate amount will be adjusted annually for inflation (there are several circumstances under which you can get an exemption from the penalty).
After January 31, enrollment only available with a qualifying event
Once open enrollment ends, you’ll only be able to purchase coverage for 2017 if you experience a qualifying event. In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods. They also began conducting audits to ensure that special enrollment period regulations were being properly enforced, and that enrollees were providing proof of their qualifying events when they sign up.
In short, the rules are being followed much more closely than they were in 2014. If you want health insurance for 2017, make sure you enroll by January 31 at the latest.
Special rule for loss of coverage
If you have a health plan that’s being terminated on December 31, or if your insurer is exiting the market at the end of 2016, you will be eligible for a special enrollment period, as loss of coverage is a qualifying event.
This will be the case for people in numerous states—for example, CO-OP enrollees in Connecticut, UnitedHealthcare enrollees in most of the states where United currently offers individual market coverage, Oregon residents whose plan will no longer be available due to shrinking coverage areas for existing carriers, etc.
If your plan is ending altogether (which is not the same thing as simply being mapped to a modified plan) and renewal is not available, you’ll have 60 days after your coverage ends to enroll in a new plan (this is true anytime a plan ends, even if it happens in the middle of the year, and the special enrollment period also extends for 60 days prior to the loss of coverage). If your coverage is terminating on December 31, your special enrollment period will continue until February 29.
But in order to have seamless coverage—with your new plan effective January 1—you’ll need to enroll no later than December 31 (although December 15 is the last day you can enroll for a January 1 effective date in most states under normal open enrollment rules, the special enrollment period triggered by loss of coverage allows for an effective date the first of the following month, even if you enroll on the final day of the month in which your old plan ends; in order to take advantage of this provision between December 16 and December 31, you’ll need to make sure you’re using your special enrollment period, even though it will coincide with general open enrollment). If you enroll in January or February, your new plan will take effect sometime between February and April, which means you’ll have a gap in coverage in the early part of 2017.
And a few facts that you should know:
- Those who make less, pay less: 2017 Federal Poverty Limit Chart
- Health plans must cover maternity, pediatric dental/vision and birth control pills
- There are NO lifetime limits on your coverage
- All new plans sold on or off the Exchange must include a wide range of new benefits including wellness visits and preventative tests and treatments at NO additional out-of-pocket costs
But wait a minute…does ObamaCare replace Medicare?
NO! This is important for you to know. While The Affordable Care Act DOES make some changes to Medicare it does NOT replace Medicare. So, if you have Medicare…you can keep it.
Okay, so now you’ve heard some of the POSITIVES about The Affordable Care Act, I need to let y’all in on a few of the GOTCHAS. Yes, there are some.
Before we talk about these landmines, you must understand ‘Affordable’ Coverage!
It will make a BIG difference if you work and are offered health coverage through the group.
‘Affordable’ coverage’ is if the employee’s required contribution to the Plan does not exceed 9.5% of the employee’s HOUSEHOLD income for the year.
So that means if your spouse and kids work, their income is counted as HOUSEHOLD income however, the premium you would pay for dependent coverage at work DOES NOT COUNT as the employee’s required contribution! I know, it doesn’t make much sense.
We affectionately call it the ‘FAMILY GLITCH’!
Here are a few ‘Family Glitches’:
- Situation: Employer offers you ‘affordable’ health insurance (see definition above).
- You will NOT be able to obtain subsidies through the Exchange.
- Situation: Many lower-income employees decline ‘affordable’ coverage at work because they have been on MediCal for many years and it’s much less expensive.
- Business is off the hook
- But the individual will NOT be eligible for MediCaid (MediCal in CA).
- Situation: Employer plan offers dependent coverage but does not offer to pay for it so you turn it down.
- Dependent will NOT qualify for premium assistance through the Exchange.
- If the employer purchases a group plan through CoveredCA SHOP, they CAN exclude dependents which opens up the door for your dependents to receive a subsidy. Call us for more info!
- Situation: You receive a premium subsidy and file your taxes for the upcoming year. Your income is $1.00 over the limit.
- Be prepared to pay a nice size bill. It doesn’t work like your tax bracket that increases incrementally. If you’re Modified Adjusted Gross Income (MAGI) is one penny over the limit, you’ll pay the difference when you file your taxes.
All pretty confusing, right?
Stick with me!
I’ve got the answers and the help you need to make the right, informed choices!
NEW PLAN IN TOWN! OSCAR is an EPO and available in CA, TX and NY. They are proactive on promoting wellness and using technology. Need to Skpye a Doctor in the middle of the night? No problem and no charge with OSCAR!
Click here to learn more about OSCAR!
What is The Exchange?
The exchange is an online marketplace for health insurance. This is where you can go to find and apply for coverage from competing private health care providers.
What is the Metal-Tier System?
This is a way to compare health plans and figure out which is best for you and gives you the most Bang for your Buck! It’s all about how much you’re willing to pay in premiums and how much coverage you need.
Just remember the METALS:
- BRONZE – Insurance pays 60% you pay 40%
- SILVER – Insurance pays 70% you pay 30%
- GOLD – Insurance pays 80% you pay 20%
- PLATINUM – Insurance pays 90% you pay 10%
This is all just the…
TIP OF THE ICEBERG when it comes to Obamacare!
Most times…you don’t even know the questions to ask! I will help easily guide you to the plan that is right for you. Or if your current plan is the right one, I’ll let you know that too.
For more information please give me a call at:
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For more information on Obamacare visit this helpful resource: