October 26, 2020

Time To Chose A Health Insurance Plan Is Now!

November 1, 2015 was the end of daylight saving time, but on that day open enrollment period for Health Insurance started! With all the festivities happening in the last two months of the year, it is wise to look at this important matter as-soon-as possible.

Who?

People that have a job should get the information for enrollment from their employer. Each company that has more than 50 full time workers needs to offer affordable health insurance. If you want to shop for health insurance on the state’s health insurance exchanges you are not eligible for the premium subsidy.

For those persons that are self-employed or do not work, you do need to buy health insurance for 2016. There are 38 states that use the federal online insurance marketplace at HealthCare.gov. The other states have their own website that offer various plans in all 4 tiers. Besides the official marketplace websites, many insurance agents, non-profit organizations and community centers are offering assistance to consumers that want to buy insurance.

Staying Healthy Through Preventive Care!

Staying Healthy Through Preventive Care!

When?

First, here are some important dates to remember:

  • Enrollment between 11/01/2015 and 12/15/2015                          coverage effective 01/01/2016
  • Enrollment between 12/16/2015 and 01/15/2016                         coverage effective 02/01/2016
  • Enrollment between 01/16/2016 and 01/31/2016                         coverage effective 03/01/2016

What?

Quite a few states have re-designed their website to make the process easier and better understandable for consumers. All states and their health insurance marketplace have to offer a basic plan that just covers the necessities. These plans often have the lowest monthly premium. But be aware that the deductible for these plans usually is high. People that are very healthy and do not have medical conditions that require many doctor’s visits or expensive treatment can benefit greatly from this kind of plan.

Many families with children, or persons that have a history of health issues, are better off selecting a plan from the next tier. The premiums are higher, but the deductible and out-of-pocket expenses will be lower. On top of that, the government offers a subsidy for plans in this tier only that is based on your household income, number of persons and the cost of a Silver Plan in your area. Below is a table that shows the income limits for 2016.

Income Levels For Subsidy in 2016.

Income Levels For Subsidy in 2016.

How?

Now, most marketplaces have new tools that will make comparing and shopping easier. Calculators can help in estimating total cost of health plans offered by factoring in premiums, copay and other out-of-pocket expenses and deductibles. It is important to know your family’s health situation and future medical requirements to find the best plan offered. That could mean that you might need to change to a different carrier to get the best deal.

When looking at the different plans keep the following in mind:

  • Check that your medication is covered and find out what the cost will be. You find this information on the insurer’s website or call their customer service.
  • Look at this year’ and last year’s out of pocket expenses to and see what amount is not covered by the insurance. The maximum amount can be more than $6,000 for an individual. Therefore, it is prudent to think of a way how to pay for any medical emergency.
  • Check that your doctor is in the insurer’s network next year. Choosing care and treatment from a doctor and facility from the plan’s list of preferred providers can help save money.
  • Consider contributing to a Health Savings Account (HSA) if the deductible is more than $1,300. For family plans the minimum is $2,600. You can use the savings for medical expenses tax free. All contributions stay with you, even if you change plans. Another benefit is that the contributions are tax deductible when filing your annual income tax return.
  • Under the Affordable Care Act, many preventive health care services are free.  The website healthcare.gov lists all preventive care services by group such as adult, women and children. Visits to certain doctors, screenings for cholesterol, diabetes (type 2) or Hepatitis B are included. Women can get free mammograms and FDA approved contraceptives. Also, many vaccinations for adults and children are free when provided by a doctor or other provider in the plan’s network. This is true even if you have not yet reached the deductible. Check out the information on the website as some services are limited to certain age groups.

You have many options to enroll. Either online through the federal or the state market place, or an insurance agency website. You also can go in person to enroll at a community center, church or insurance agent that offer free assistance. I advise you to not just think about what happened last year when you and your family were healthy. Instead, I urge you to be responsible and to consider “what if I get sick?”

Health Care is a serious matter for you and your family. Especially, if you have children, you can’t afford to have no insurance. You owe it to those that depend on you and cannot make that decision to do what is best for them and you. It is hard to take care of toddlers or children when you are sick yourself.

If you got value from the information in my post and it did help you making a decision on this important matter, l would like to hear from you. Leave a comment below and share the post with others you know that might benefit reading about this subject.

Hurry, only 7 days left to enroll for Health Insurance!

Are you still not sure if you need a Health Care plan for you and your family? You rather pay the high fees for physicians, emergency care and prescription drugs when you or your children have an ailment, disease or accident? And you don’t mind paying a penalty for not complying when you file your income tax return?

The penalty for being uninsured in 2014 is either a flat dollar amount, $95 per adult with a family maximum of $285, or 1 percent of household income, whichever is greater. Penalties in 2015 will be 2 percent of household income, or $325 per person, unless they qualify for an exemption.

But maybe you work for an employer that is considered a small business since it has less than 50 full time employees? Those firms are exempt from the mandate to provide health insurance.  However, if you work in a larger company and your company does not offer this benefit, the penalty that the firm needs to pay for every full time equivalent employee is $2,000. Companies that employ between 50 and 99 full time persons can postpone offering health insurance until 2016. The IRS has specific guidance on how to compute the total number of full time equivalent employees for a firm.

http://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-Questions-and-Answers:-Determining-FTEs-and-Average-Annual-Wages

What can you do to get coverage?

The best strategy is to talk with your boss or human resource department. Show them this video about an affordable health care solution that also gives employees an opportunity to choose a low cost plan. This option can be combined with a Health Savings Account when the deductible is higher than $1,300 for a single person and more than $2,600 for a family plan. See my last post for advantages of a Health Savings Account.

Take a tour of the Health Care Market Place here.

 

Take a Tour of the Health Care Market Place.

Since January 22, 2015 the IRS accepts individual income tax returns. Many CPA firms, tax service providers and the volunteers of the AARP or Volunteer Income Tax Assistance program sponsored by the IRS are busy preparing Tax Forms. Individuals that purchased their own health insurance this year’s filing needs 2 additional forms. Form 1095-A is a statement that shows your coverage and will be mailed out in February by the Health Insurance Market Place. This information is need to complete form 8962 to reconcile the subsidy if you got this at time of purchase or get tax credit now.

With open enrollment closing in just one week there is not much time left to contemplate. Feel free to contact me on any matter discussed in the post regarding taxes or health insurance.

Thank you for reading my post. If you like the information let me know through a comment or by clicking the follow button on this page.

Only 28 Days to Chose A Health Insurance Plan

Are you ready for filing your income taxes this year? Have you all your papers together? Did you get health insurance or will you pay the penalty when you file your tax return?

You still have 28 days to get health insurance as open enrollment period is till February 15th, 2015. The Affordable health Care Act (or Obamacare) requires everybody to have health insurance for 2015.  At the moment there are 40 million Americans that have not yet enrolled.

Many people do not have the financial means to purchase health insurance. In the past, they just did not buy it, and when they were sick they often could not pay for the treatment in the emergency room or hospital. Fair enough, many people that did not have insurance paid their doctor’s visit, medication and any surgery or clinic stay.

Either way how you think about this law, health insurance is required, just like having car insurance and home insurance.  So what is it about?

 

Employer Sponsored Insurance

The ACA law requires employers that have more than 50 full time employees to offer health insurance. Luckily, many companies fall in this group. People that work for these employers usually have an option out of two or more plans. Depending on their family situation they can choose the one that best fits their needs. However, if  an employee does opt out of any plan offered, and would get a health plan on the open market, they will not be able to get a subsidy, even if they would qualify.

 

Health Insurance Exchange

If you work for an employer with less staff or who has cut your hours to make you a part time employee, you need to look on the federal, state or private market place to find affordable health insurance. You can either go to an insurance agent or to a local community organization that has counselors to assist in navigating the websites and pick a plan. But you need to be mindful that these might advise you to purchase a plan that is offered by the sponsoring insurance provider.

All states and the Federal Government have their own websites where you find all plans offered. This can be a daunting task if you are not well informed. There are different plan tiers, deductibles and benefits that vary and numerous insurance companies to choose from. Depending on your family situation you may qualify for a subsidy, but how much would you get? And if your income is below a certain amount, you could also get assistance in out-of-pocket expenses. Let me help you get a better understanding on how to determine what plan you need.

 

How to get the best plan?

You need to consider a few things when choosing a health insurance plan.

–        First, get your total family income for 2014 by either taking the details from your W-2 or the last paycheck of the year.

–        Next, how many people are in your family that need to be covered.

–        Then, you need birth dates of every one.

–        Lastly, I would look at my healthcare expenses for the years 2013 and 2014, so I can estimate the amount that I have to budget.

The number of people that need insurance and your total income control if you get a subsidy. Below is a chart that gives the income limits for a lower premium.

 

2015 wage limits for subsidy

2015 wage limits for subsidy

Plans in the market are grouped into 4 categories: Bronze, Silver, Gold and Platinum. In order to qualify for a subsidy, you have to purchase a Silver health insurance plan. Usually, these plans have a lower deductible that the Bronze plans.

 

The question now is:

how much health care expenses will I have in 2015 that warrant to take a Silver Plan with a higher premium, but a lower deductible and maybe qualify for a subsidy?

 

High Deductible?

When you are a healthy person and you do not have children, then you probably could choose a plan with a high deductible. However, when you have children, your health care expenses could be quite different. Looking back at the total cost for health care in 2013 and 2014 will give you an idea of how much you will spend in 2015. If it is less than the deductible in the Silver plan you could take a Bronze plan with a lower premium and save money that you can use towards out-of-pocket expenses. But if it is not substantially more then you could compute the savings of a bronze plan for the year and see if you are better off purchasing a Silver plan.

As I mentioned before, every person’s situation is different and you definitely should look ahead on what is happening in 2015. If you plan to get pregnant, or have a surgery that is necessary for your health, then you need to take this into consideration.

All plans cover the same preventive care that is free of charge even if you have not yet met the deductible. Vaccinations, screenings for cholesterol and high blood pressure, mammograms and other tests are free. See the full list here. Only caveat is that these services need to be performed in-network.

 

High Expenses?

For those that do not qualify for Silver plan with lower out-of-pocket expenses, you can reduce cost by taking a supplemental plan that gives you access to a nurse 24/7/365 by phone or you can talk with a doctor for just $5. This will save on high unnecessary emergency room visits or long wait times to get a doctor’s appointment. Reports from the Centers for Disease Control and Prevention find that more than 50 % of ER visits do not need treatment within an hour. And according to another report 76% could have been treated better at other outpatient care facilities.

 

My recommendation:

If you are ready to purchase health insurance now I recommend that you check out this private members only market place, which has dedicated licensed brokers to help you navigate the insurance choice options.

If you are an owner of a small business that is looking into offering health insurance, please contact me for any assistance.

I realize while writing, that there is so much more that influences a thorough decision for choosing a health insurance plan. I do not want to make this one lengthy post, thus I will talk about the benefits of a high deductible plan in my post next Sunday. Stay tuned for Health Insurance – Part 2.

Feel free to get in touch with me about this post or to leave a comment below. Let me know if this information was helpful for you.

 

 

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