7 things to know about health insurance post ACA.

Doctor and nurse with patient



UnitedHealth leaving all but a ‘handful’ of public health insurance exchanges.


Checklist for Millennials Buying Health Insurance for the First Time.

Reaching the age of 26 is a new benchmark for Millennials, as they mark a new rite of passage of buying health insurance for the first time.

Gen Y-ers lose health insurance coverage under their parents’ plan once they turn 26 and must seek an individual plan, which is mandated by the Affordable Care Act (aka Obamacare).

Becoming 26 years old is counted as a qualifying life event under the ACA, and Millennials have a 60-day time period to research and purchase a health insurance plan. Millennials are required by law to buy their own coverage or face paying the tax penalty of $695 per adult or 2.5% of your taxable income in 2016, whichever is greater.

“Your parents have the option (not the obligation) to keep you enrolled in the family health insurance plan until you turn 26,” said Nate Purpura, vice president of consumer affairs at eHealth.com, an online health insurance exchange based in Mountain View, Calif. “Once you reach that age, however, you’re on your own when it comes to health coverage.”

You can also enroll during the nationwide open enrollment period, which began on November 1 and will continue through January 31, 2016. Millennials who are shopping now for their first health insurance plan should check to see if they qualify for government subsidies and follow these other guidelines.

All Plans Offer Free Preventative Care

One of the mandates of the ACA is that every single plan must include free annual checkups from your doctor, the flu shot and other important vaccines, said Noah Lang, CEO of Stride Health, the San Francisco health insurance exchange company. The preventative care is the same regardless if you buy a bronze, silver or gold plan.

“If you never see the doctor for anything but preventive care, you’re effectively getting the same coverage whether you have a bronze or a gold plan,” said Purpura. “However, if you get sick or need to pick up prescription drugs, you’ll find that your coverage is not the same. That’s where higher metal level plans show their value.”

Qualifying for Subsidies

One major caveat – if you wind up earning more money than what was estimated, save up some money to pay it back next spring when you are filing for taxes.

“Your subsidies will be based on the money you actually earn during the year you’re receiving subsidies, so be careful not to underestimate your income or you could end up paying some of your subsidies back at tax time.


Co-Pay? Deductible? Premium? What Does it all Mean? Health Plan Terms to Know Before you Choose a Plan.

Co-Pay? Deductible? Premium? What Does it all Mean? Health Plan Terms to Know Before you Choose a Plan

Whether you are familiar with health plans or are shopping for one for the first time, deciphering different plans cans be confusing. Understanding the right terms is especially helpful when considering which plan is right for you, as many have cost implications associated with them. Here’s a rundown on the terms you’ll need to know to keep it all straight:

Affordable Care Act (ACA): The federal healthcare reform law passed in March 2010. Also known as Obamacare or healthcare reform.

Allowable charge: Also referred to as an ‘allowable amount’. The negotiated amount for which an in-network provider agrees to provide services. This amount is usually lower than the amount you would pay for the same service if you did not have health coverage.

Coinsurance: Your share of the fee for a service after you’ve met your deductible and before you’ve reached your out-of-pocket maximum. If your plan’s coinsurance share is 20%, you pay 20% of the allowable charge, and your plan pays the other 80% of the allowable charge.

Copay: A flat fee you pay at the time of service, such as an office visit. Copays apply toward out-of-pocket maximum.

Cost shares (or out-of-pocket costs): Costs that you pay for out of your own pocket for medical services, even if you have health coverage. Cost shares include deductibles, copays, and coinsurance.

Covered in full: Services your health plan pays for in full, at 100% of the allowable charges, and not subject to your deductible or coinsurance. For example, most preventive care is covered in full by many health plans.

Deductible: The amount you pay every year before the plan begins to pay for most services. This is similar to the deductible you pay for your car or homeowners insurance.

Exchange or marketplace: Another way to shop for health insurance, with a government (state or federal) website where you can compare plans from multiple companies and find out if you qualify for financial assistance. You can purchase your health coverage through the exchange or directly from Premera.

Formulary: A list of drugs for specific uses that the health plan covers.

Health savings account (HSA): Certain plans with higher deductibles allow you to open a special savings account to pay for many of your health care expenses. The money contributed to your account, by you or your employer, is not subject to federal income taxes when used for allowable healthcare costs, so the accounts offer tax advantages to some people. You generally have higher cost shares with these types of plans, so you should make sure you understand how they work before you consider them.

Network: A group of doctors, dentists, hospitals, and other healthcare providers that contract with your health plan to provide healthcare services at negotiated amounts, which are called allowable charges. Your costs are almost always lower when you get care from in-network providers.

Open enrollment period: The annual time period when you can apply for a new individual health plan or make changes to your current health plan. The open enrollment period for 2015 individual coverage is November 15, 2014 through February 15, 2015. If you experience certain life events, such as getting married, having a child, moving, or losing your employer’s health coverage, you can apply for coverage outside these dates.

Out-of-pocket maximum: A preset limit after which your plan pays 100% of the allowable charge.

Preferred provider organization (PPO): A health plan contracts with specific medical providers, such as doctors and hospitals, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use providers outside of the network, but you’ll pay a greater share of the cost.

Premium: The amount you and/or your employer pay (usually each month) for health coverage, regardless of whether you use any medical services.

Primary care physician (PCP): Your main or regular doctor or other healthcare provider. Some plans offer lower office visit copays if you notify them of your designated PCP.

Producer: A person or business that can help you shop for and choose health coverage. Often referred to as a broker or agent.

Tardy tax filers at risk of losing health insurance subsidies.








5 Reasons Your Health Insurance Premium Will Likely Rise in 2016.

If you don’t want to pay more for health insurance, look away now! Here are five reasons why you should be prepared to pay more per month for your health insurance plan in 2016.        The Motely Fool   Sean Williams  May 25, 2015

Cdc Fb
Source: Centers for Disease Control and Prevention via Facebook

It’s been a little over a year since the Patient Protection and Affordable Care Act was officially implemented and U.S. citizens were required to purchase health insurance or face a penalty come tax time.

Obamacare’s two main goals
The goals of this healthcare reform law, which you probably know better as Obamacare, are twofold. First, it’s designed to encourage people to enroll for health insurance and lower the number of uninsured people in the United States. Uninsured people are a strain on the healthcare system, from hospitals to insurers, so getting more people involved helps spread the cost of medical care across a greater percentage of the population. That leads to the second point: controlling medical cost inflation. Obamacare is designed to help increase competition among insurers by making the process of shopping for health insurance more transparent.

Through two full enrollment periods Obamacare appears to be decisively taking care of the first point. Nearly 12 million people enrolled through a state-run exchange or Healthcare.gov for the 2015 calendar year, well ahead of tempered Department of Health and Human Services estimates of 9.1 million by year’s end. Even with some expected attrition throughout the year from non-payees, Obamacare will have notably lowered the uninsured rate in the U.S.

The second point, though, leaves much to be desired still. Although healthcare premiums have been rising at a slower rate over the past five years than at any time over the previous five decades, this has more to do with pricing pressure caused by the Great Recession than Obamacare making the health insurance process more transparent.

Five reasons your health insurance premium may be on the rise
In actuality, it looks as if health insurance premiums could potentially be in for a healthy price hike in 2016. Here are five reasons why.

1. Targeted therapies are pressuring insurers
To begin with, a new trend in targeted therapies, known also as personalized medicine, is hurting insurers. Instead of focusing on one-size-fits-all therapies for chronic diseases, biopharmaceutical companies are aiming their research and development dollars at rare diseases and/or lesser-common diseases that have specific genetic markers.

OpdivoSource: Bristol-Myers Squibb

There are two reasons drug developers have recently seized the opportunity to focus on targeted therapies. First, there’s little competition among rare diseases and gene-targeted therapies. Secondly, it allows these drug developers to set astronomical price tags on these drugs in order to ensure they recoup their development costs — and not just for the approved drug, but for other clinical and preclinical therapies that didn’t make the grade.

For example, recently approved PD-1 checkpoint inhibitors Opdivo from Bristol-Myers Squibb and Keytruda from Merck both work to enhance the immune systems’ ability to recognize and attack cancer cells, which often go undetected. However, both drugs come with an annual wholesale cost of $143,000 and $150,000, respectively. Admittedly, insurers are possibly getting some discount from these levels, but it’s still difficult for insurers to support paying these targeted therapy costs profitably, so they may choose to boost premium pricing across the board.

2. The individual mandate penalty isn’t encouraging enough people to enroll
The primary purpose of the individual mandate, the actionable component of the PPACA, is to encourage healthy young adults (whose premium payments are direly needed for Obamacare to work) to enroll. Having these individuals sitting on the sidelines, especially when they’re less likely to go to the doctor anyway, isn’t helping insurers spread their medical costs around.

ImagesSource: Flickr user Reynemedia.

The individual mandate institutes a penalty on U.S. citizens come tax time if they were without health insurance for more than three months during a calendar year. In 2014, this penalty was the greater of $95 or 1% of a taxpayer’s modified-adjusted gross income. In 2015, the penalty soared to the greater of $325 or 2% of modified-AGI.

However, based on data from H&R Block, the median penalty during 2014 for those without insurance was just $178. This works out to less than one month’s payment if an individual had purchased the lowest level of insurance on an Obamacare exchange, known as a bronze plan. In other words, unless the penalty for not having insurance approaches the cost of purchasing insurance for the full year, it’s cheaper for non-purchasers to continue to simply pay the penalty.

Not to mention, the IRS’ hands are tied when it comes to penalty collection. The IRS can’t garnish wages or seize property, thus its only means to get you to pay is to take money out of your refund if you’re owed one, or to ask nicely.

3. Risk corridor funding gaps are hurting insurers
According to a recent report from Standard & Poor’s, and as reported by FierceHealthPayer, the risk corridor payments designed to protect insurers who simply aren’t doing as well as others may wind up hurting rather than helping insurers.

Cdc FbSource: Centers for Disease Control and Prevention via Facebook

The risk corridor is a program put in place to collect funds from some of Obamacare’s best-performing insurers and funnel it to insurers who are losing significant amounts of money on enrollments. If you’re wondering how an insurer can lose money after more than 11 million people enrolled over the past two enrollment periods, it pretty much comes down to the makeup of their new members. Too many sick enrollees and the scales tips toward higher medical costs and losses for the insurer. With a new state-level adjustment risk added last year by the Department of Health and Human Services, the risk corridors budget is now neutral, and many insurers who are due payments from the program aren’t collecting or getting paid.

More than half of insurers included in S&P’s report neither made a payment to the risk corridor program nor received one. Some insurers didn’t even post receivable payments on their financial statements because they frankly don’t expect to be able to collect money from the program.

It’s believed that struggling insurers that aren’t receiving these payments, especially smaller insurers, could be forced to propose hefty premium increases just to make up the difference.

4. Insurers still maintain some degree of pricing power
Fourth, it’s important to realize that despite becoming part of a transparent marketplace exchange, insurers still maintain some degree of power when it comes to setting the pricing of their plans.

Cdc FbSource: Centers for Disease Control and Prevention via Facebook

Prior to Obamacare, the checks and balances on premium increases simply weren’t there. It wasn’t uncommon for insurers to hit consumers with a double-digit percentage increase in their health insurance premium rates within a state or region if its costs were higher than expected.

Under Obamacare, insurers are required to submit their premium rate proposals to their states’ Office of the Insurance Commissioner for review. From there some “bargaining” between both sides ensues and a rate is often set that’s between what the Office of the Insurance Commissioner would like, and what the insurer would prefer.

But, insurers still control what states they operate in, thus they maintain the upper hand on overall insurance plan “supply.” In states where there is little competition among insurers, it’s not out of the question that insurers could propose hefty increases, even with the new Obamacare checks and balances in place. While insurers may have given up some of their power when transitioning to Obamacare, they are far from helpless. Expect them to use their clout to help health insurance rates move higher in 2016.

5. Inflation is taking its toll
Finally, don’t forget that inflation plays a role too. Regardless of targeted therapies increasing insurers’ medical costs, the average cost of most healthcare goods is on the rise — be it expensive diagnostic services or the needles used in IVs.

Generally speaking, as long as the Consumer Price Index, one of the more common gauges of inflation, is rising, there’s a good chance that health insurance premiums will need to rise as well, at least to match inflation. If there’s one piece of solace that readers can take here, it’s that overall inflation levels have been pacing well below their historic average since the Great Recession.

Keep your eyes peeled
Consumers will also want to keep their eyes peeled for the upcoming King vs. Burwell ruling from the Supreme Court next month, which could have a definitive effect on premium pricing in 2016. Obviously we’ll have to watch and wait to see whether prices do indeed rise in 2016 — insurers just submitted their 2016 pricing this past week — but my personal belief is we can expect a noticeable uptick in health insurance premiums in 2016, so prepare accordingly.

The Motley Fool  Sean Williams  May 25, 2015

7 Rules For Deducting Medical And Dental.

In past years, if you itemized your deductions, you could deduct qualified medical and dental expenses to the extent they exceeded 7.5% of your adjusted gross income (AGI). However, beginning January 1, 2013, this threshold was raised to 10%. In this article, we’ll discuss what you need to know to claim a federal income tax deduction for medical and dental expenses.

1) AGI Threshold Increase

The total of your qualified medical and dental expenses must exceed 10% of your AGI to claim a deduction. There’s one exception which we’ll discuss in the next section.

2) Temporary Exception to the 10% AGI Threshold

If married, and one spouse is at least age 65, the threshold remains at 7.5% of AGI until December 31, 2016. Beginning January 1, 2017 the threshold will be 10% for all taxpayers.

3) You Must Itemize

You must itemize your deductions (i.e.; Schedule A) in order to qualify. You cannot use the standard deduction and claim medical and dental expenses.

4) When Are Medical Expenses Considered Paid?

You must have paid medical expenses during the calendar year. If you paid by check, the date you mailed or delivered the check is usually the qualifying date of payment.

5) Qualified Costs And Expenses

You may use any medical or dental costs you paid for yourself, your spouse, and your dependents. However, if you were reimbursed by insurance or another source, your deduction will be reduced by the amount of the reimbursement. In general, any legitimate medical expenses will qualify, including the costs of diagnosing, treating, easing, or preventing disease. This also includes the cost of health and dental insurance premiums and possibly long-term care insurance premiums. Also on the list are eye exams, eye glasses, contact lenses, and eye surgery. The list of qualified expenses is quite extensive. To find everything you’ll need to know about deducting medical and dental expenses, click the following link which will take you to the IRS website and to the specific publication on this subject. To learn more, click: IRS Publication 502.

6) Travel Costs

You may be able to claim the cost of travel for medical care. This includes public transportation, ambulance, tolls, parking fees, etc. If you used your personal automobile, you may be able to deduct 24 cents per mile for 2013.

7) No Double Benefits

If you participate in a Health Savings Account or Flexible Spending Arrangement and you used either to pay for medical expenses, you cannot claim a tax deduction as these funds are usually withdrawn on a tax-free basis.

Health Insurance Coverage for Children (Minors & Young Adults)

The Affordable Healthcare Act (ACA) includes provisions specifically designed to address the medical insurance needs of children and young adults. These changes extend health coverage to millions of previously uninsured young Americans and also guarantee insurance to children with pre-existing conditions. Several other changes are scheduled to take effect in 2014 that will expand coverage to those over 26 years of age.

Up to 17 million children under 18 may have some sort of pre-existing condition that could have prevented them from obtaining health insurance before the ACA took effect. Now insurance companies may not deny, exclude, or limit coverage to children with a pre-existing condition. This protection also extends to all individual and job-related policies that are grandfathered. In 2014, the prohibition against rejecting a health insurance application on the basis of a pre-existing condition will cover Americans of all ages.

The new insurance requirements created by the ACA also affect The Children’s Health Insurance Program (CHIP), which is the component of the Medicaid program that provides low-cost or free health insurance to children. The current eligibility standards for CHIP will remain in place through 2019 and financial funding for CHIP is now guaranteed through 2015. However, given health insurance subsidies from the government along with an expansion of Medicare eligibility, there are questions regarding how the CHIP program may need to evolve in the future.

Additional ACA changes increase the age at which young adults can be removed from their parents’ insurance plan. It is estimated that this policy has already enabled up to 3 million Americans between 19-25 that were previously uninsured to gain health coverage. Previously, insurance companies could require families to remove children from their plans at age 19. This limit is now raised to age 26 and applies to young adults across the board even if they are not living at home or are currently married.

This increased coverage for young adults also provides for those children in the foster care system over age 19 to remain eligible for the Medicaid program through age 26. There is one exception to the age limit increase. If a young adult is eligible for coverage through his or her employer and their parents’ plan is grandfathered, the parents’ insurance provider is not required to observe the new age limit increase. This exception will expire in 2014.

These age limit changes include tax benefits for those parents whose employer-provided health coverage includes their adult child in their insurance plan. Generally, healthcare coverage for adult children up to age 27 is now tax-free in most cases. These tax benefits currently extend to various workplace and retiree health plans and some self-employed consumers.

Employees with cafeteria plans, or plans that allow consumers to pick from a menu of tax-free benefit options and cash or taxable benefits, may now begin to make pre-tax payments for the health coverage of their young adult children. Since insurance plans usually expire at the end of the calendar year and coverage for adult children expires on their 26th birthday, these benefits are designed to ease the financial necessity of continuing to pay for a plan for which the adult child can no longer use.

Individual Health Insurance

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