Do we not need uninsured motorist since we have medical insurance?

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Health Insurance: It’s Not Too Late To Get Covered.

Health Insurance: It’s Not Too Late to Get Covered – Special Enrollment Period Now Open

(Fremont County, Wyo.) – Up to six million Americans are expected to pay a tax penalty this year for not having health insurance coverage in 2014. To help families avoid future penalties, a special enrollment period for the Health Insurance Marketplace opened on March 15 and will close April 30.

This special enrollment period is an additional time outside of open enrollment during which you and your family can sign up for health coverage. This will be your last chance this year to receive health coverage through the Health Insurance Marketplace and avoid a tax penalty for next year.

Why is health coverage important?

Health coverage helps cover the cost of medical services, tests and treatments that assist you in getting and staying healthy. The required basic level of coverage includes preventive care, health screenings, well woman and prenatal care, immunizations for adults and children, treatment for pre-existing conditions, and the cost of some prescription medications.

What fees might I owe if I’m not covered?

Surveys have shown that nearly half of uninsured adults are unaware of the penalty associated with not having health coverage. In 2014, the penalty for not having the required minimum level of health coverage was up to $95 per uninsured person or 1% of a household’s income. For 2015, this amount will more than double, with the penalty per uninsured person reaching $325 or 2% of a household’s income.

There are exemptions available to those who cannot afford coverage or who have experienced hardship. Consult Healthcare.gov or a certified application counselor to see if you qualify for an exemption.

Who’s eligible for the special enrollment session?

The special enrollment period is designed for the following:

  • Those who don’t currently have health coverage for 2015;
  • Those who paid a penalty as part of their 2014 federal income tax returns for not having health insurance in 2014; and
  • Those who became aware of the individual mandate penalty after the regular 2015 enrollment window closed.

Open enrollment: Tips for selecting health insurance.

Open enrollment is the time each fall when most Americans select or change their health benefits for the following year.

Choosing health-care coverage is one of the most important decisions people make. Therefore, it’s essential that consumers fully understand their options during open enrollment so they can choose a plan that will help them enhance their health and possibly save money.

Even with health insurance coverage now available in many states through government exchanges, the vast majority of Americans, nearly 158 million, will continue to obtain health benefits through their employer. Many companies set aside a two-week period between October and December for when their employees can select health benefits, so now is the time to start getting prepared.

Here are three important tips for a successful open-enrollment season:

• Tip 1. Review your options. It may sound simple, but taking the time to review your options is very important. Ask questions. In many cases, people who review their health plan options may find ways to save money on their health-care costs — whether it’s through selecting a plan that will cover more of their expected health costs for a major event (such as having a baby or surgery), evaluating prescription drug coverage, or having the opportunity to enroll in an incentive-based wellness program.

Some insurers offer wellness programs or incentive programs that may help you lower your cholesterol, quit smoking or lose weight. These incentives may include gym membership discounts, lower premium costs or merchant gift cards.

• Tip 2. Make sure your doctor is in-network — it can usually save you money on out-of-pocket costs. Even if you don’t plan to make any changes to your health insurance this year, it’s always good to ensure that any doctor you see, or plan to visit in the coming year, is in your plan’s care provider network.

Many insurers offer a broad choice of local in-network health-care professionals, and these in-network care providers agree in advance to what they’ll charge for specific procedures. You should also call before your procedure to verify the care providers are in-network. If you plan to visit a doctor or hospital outside the network, be sure to understand how your costs will differ from those of an in-network care provider.

• Tip 3. Don’t forget about specialty benefits. Specialty benefits like dental and vision plans are often available at a minimal cost and cover annual teeth cleanings and eye exams. Many vision plans also offer reduced pricing on frames and lenses. Research suggests that there is a connection between oral health and overall health, so adding a dental plan may help prevent more serious medical problems.

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.

Grandfathered Health Plans

The Affordable Care Act created a new set of minimum requirements for health insurance plans. These minimum requirements are known as the Essential Health Benefits a plan must have in order to be sold in the United States. However, there were exemptions given to health plans that were in existence on or prior to March 23, 2010. Plans that have these exemptions on meeting the requirements of the Affordable Care Act are known as “grandfathered health plans.”

Retiree health plans (i.e. plans whose membership are limited to retired employees of the sponsor with no active employees enrolled in the plan) are also exempt to the requirements of the Affordable Care Act. Dental plans, Medicare Supplement plans, and Long Term Care plans are also exempted from the requirements of the Affordable Care Act.

If My Plan Is Grandfathered, Are All Benefits Grandfathered?

Not necessarily. Determinations are made at the benefit level within a plan, not at the plan level. This means that some benefits within your health plan may be grandfathered while others may not and, as a consequence, meet the new standards of the Affordable Care Act. For example, even grandfathered health plans must comply with the following benefits regardless of their benefits at the time of grandfathering:

  • Must not apply lifetime dollar limits to key health benefits
  • Cannot cancel your coverage because of an honest mistake made on your insurance application
  • Must provide dependent coverage to your children until age 26

Can I Stay In My Current Health Plan?

Many consumers are concerned that there current health plan may be discontinued. The first step in determining whether you can stay in your plan is to contact your insurer and ask if your plan is grandfathered. If it is grandfathered, ask if the insurer expects the plan to remain grandfathered in 2014.

How Long Will My Plan Stay Grandfathered?

There is no clear answer to that question. Since grandfathered status is determined by the plan’s adherence to government regulations, the plan’s grandfathered status can be lost due to noncompliance. There is no official limit to how long a plan may remain grandfathered. The chart to the right illustrates a decrease in employees covered by grandfathered health plans between 2011 and 2012.

How Can A Plan Lose Its Grandfathered Status?

A health plan can lose its grandfather status for a variety of reasons. For example, grandfathered status will be lost if the insurance company:

  • Significantly increases beneficiary cost sharing (e.g. copayments, coinsurance, deductible) beyond the levels used by the plan on March 23, 2010
  • Cannot add an annual limit on benefits or reduce an existing annual limit on benefits
  • Eliminates substantially all benefits used in the diagnosis and treatment of a particular medical condition (e.g. muscular dystrophy)
  • Forces consumers to switch to another grandfathered plan that has lower benefits than the existing grandfathered plan
  • Merges with, or is bought by, another plan just so the plans can avoid the requirements of the Affordable Care Act

Additionally, a plan can also lose its grandfathered status if its sponsor (i.e. an employer or employee organization):

  • Switches to a new insurer
  • Decreases its contribution rate to the plan more than 5% below the sponsor’s contribution rate on March 23, 2010

What Happens If My Plan Loses “Grandfathered” Status?

If your plan loses its grandfathered status, you will need to enroll in a qualified health plan during the next applicable enrollment period.

Can I Enroll in a Grandfathered Health Plan?

New enrollment in a grandfathered group health plan is limited to family members of existing enrollees and new employees of the grandfathered plan’s sponsor. New enrollment in a grandfathered individual health plan is limited to family members of existing enrollees

Health Insurance Options for Part-Time Employees

The Affordable Care Act (ACA), also referred to as Obamacare, does not require employers to offer health insurance to part-time employees Part-time employees are defined as those who work less than 30 hours a week, and employers without healthcare coverage for part-timers will not be penalized.

The Individual Shared Responsibility Provision of the ACA that goes into effect in January 2014 requires that all individuals, including part-time workers, must either have creditable health coverage or qualify for an exemption. Individuals that do not meet either requirement will be assessed a penalty on their income tax return for the year. Part-time workers without access to job-based coverage will be responsible for obtaining their own healthcare if they do not wish to pay the tax penalty.

Individuals and families will have several options for purchasing their own health insurance. Individual plans may be purchased directly from private insurance companies. Beginning in January 2014, insurers will not be able to deny applicants that have a pre-existing condition, which may be beneficial to those individuals that are not able to work fulltime due to illness.

Part-time workers may be able to purchase health insurance via their state’s Health Insurance Marketplace, also known as the state exchange. Individuals and families may qualify for lower costs on monthly premiums based on household size and annual income. Part-time workers can also purchase insurance from a private exchange, particularly those that include on-exchange and off-exchange health plans for maximum consumer choice.

Monthly premiums for health plans purchased via a state exchange may be partially subsidized via premium tax credits. Generally these credits will be extended to non- elderly families with annual incomes of 100 to 400 percent of the federal poverty line. About half of the non-elderly population has an annual income in that range, but this varies depending on geographical location and family size.

Premium credits will only be extended to consumers who are not offered health insurance through an employer. Since about 95% of all companies that employ over 50 full-time workers already provide healthcare to those workers, subsidies will not be available to most of those who do full-time work. Full-time employees would be eligible for lower costs via subsidies only if their job-based coverage isn’t considered affordable or doesn’t meet certain minimum standards of care.

Healthcare coverage is generally considered to be affordable according to ACA standards if an employee’s premium cost is less than 9.5% of their yearly household income. The minimum standards of care are called the Essential Health Benefits, which cover 10 medical coverage categories that must be offered by every insurance plan.

Part-time workers may qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Eligibility guidelines for these programs vary by state, but are usually determined by annual income and household size.

Individuals and families that use their state exchange sites can explore their coverage options and learn whether they qualify for premium tax credits, Medicaid, or CHIP. Many states offer a free-to-use Navigator program that provides assistance in comparing and applying for healthcare. Small businesses that employ less than 50 full-time workers can use the Small Business Health Options Program (SHOP) to explore their options for employee coverage.

The benefits and pitfalls of buying insurance on health-care exchanges.

The benefits and pitfalls of buying insurance on health-care exchanges. 

As the state health insurance marketplaces, also called exchanges, get set to launch in October, many people have questions about the coverage that will be offered there. Here are a few that were posed to me recently:

Q. Are there unintended consequences of shopping through an exchange? For example, are the benefits of a plan with a lower monthly premium less comprehensive than the benefits of an expensive plan? And are there plans available only to people who qualify for subsidies, so that once income increases, the consumer must switch to a different plan?

A. All plans sold on the exchanges must cover 10 so-called essential health benefits, including prescription drugs, emergency and hospital care, and maternity and newborn care.

For the most part, the plans will differ not in which benefits they cover but in the proportion of costs that consumers will be responsible for paying.

There will be four basic types of plans: Platinum plans will pay 90 percent of the cost of covered medical services, on average; gold plans will pay 80 percent; silver plans will pay 70 percent; and bronze plans, 60 percent. Premiums will vary based on those percentages, so platinum plans generally will be pricier than bronze ones.

Individuals and families with incomes up to 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013) may be eligible for federal tax credits to help pay premiums.

Consumers “can use the premium subsidy to purchase any plan,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

If your income increases during the year, you may no longer qualify for the same level of assistance, but you won’t have to switch plans. However, you may have to repay any overpayments that were made to insurers if your projected income turns out to be higher than your actual income. On the other hand, if your income falls, you may be eligible for a larger tax credit. That’s why it’s important to report any income changes to the exchange promptly.

A second type of subsidy available on the exchanges will reduce the amount that people owe in co-payments, deductibles and other out-of-pocket costs. The cost-sharing subsidy is available to individuals and families with incomes up to 250 percent of the poverty level ($28,725 for an individual and $58,875 for a family of four in 2013). To qualify for this subsidy, you must buy a silver plan, Park says. If your income changes, however, you won’t be responsible for any overpayments.

 

Once the exchanges open, how much will an insurer be allowed to increase premiums annually? And are those increases based on claims?

Premium increases are driven by many factors, including medical costs and the health of the people covered by a particular plan.

The Affordable Care Act discourages insurers from imposing unreasonable premium increases in a couple of ways. Insurers in the small-group and individual markets that want to raise premiums by 10 percent or more must submit data, projections and other information to justify the increase to state or federal regulators, who review the requests and make the information available to the public at. Asking insurers to justify why they want to increase rates should act as a deterrent to unreasonable increases, experts say.

But the law doesn’t give regulators new authority to refuse rate increases, says Timothy Jost, a law professor at Washington and Lee University in Lexington, Va. It does, however, provide funding for states to beef up their rate-review processes.

The Department of Health and Human Services says that increased scrutiny of insurance rates has led to a decrease in rate increases, says Jost, “and that’s probably true.”

In addition, the law requires insurers to spend at least 80 percent of the money they collect in premiums on medical claims and quality improvements rather than on administrative activities such as marketing. If they exceed that limit, they must rebate the excess to consumers. Insurers will return $500 million to 8.5 million consumers — about $100 per eligible family — by mid-August of this year for overcharges in 2012, according to the Obama administration. Rebates may come in various ways, including a check or a reduction in the following year’s premium.

 

My parents are legal immigrants over 65 but not yet eligible to buy into Medicare because they haven’t lived in the United States for five years. Will they be able to buy health insurance on the federal exchange?

Yes, legal immigrants will be able to shop for coverage on the exchanges, where they may be eligible for premium tax credits if their income is no more than 400 percent of the federal poverty level ($62,040 for a couple in 2013). Immigrants living in the United States illegally, on the other hand, are not permitted to buy coverage on the exchanges even if they wish to pay the entire premium out of pocket.

New California Health Insurance Exchange Marketplace.

In the next few months you will be hearing about “Exchanges” for businesses & individuals on TV
and radio.  The California health insurance exchange will begin to offer plans and enrollment after October 1st. with coverage taking effect January 1, 2014.  The new marketplace will offer California Exchange and Off-Exchange health plans in addition to existing private plans.   All new health plans will be offered on a guaranteed acceptance basis with all pre-existing conditions covered.   More Exchange & Off-Exchange benefit details and rates should be available by August .   It usually will only make sense for you to move to a health plan in the State Exchange if you are eligible for a tax subsidy.  The Cal State exchange premium assistance offered is only for those who fall between 133% to 400% of the Federal Poverty Level based upon household income.
You can count on us!  We’re your key health reform and exchange resource.  We are ready to assist you every day–on the phone and in person providing you with time and cost saving programs.  Please call us before  you do anything with your current coverage and I will advise you on the best course of action that will provide quality coverage and save you money.

You may be better off keeping your existing health plan or alternatively consider the Off-Exchange and California Health Insurance exchange plans which may save you money and provide enhanced benefits.  Our services will assist you in applying for a possible tax subsidy, selecting the best health plan, and enrollment process.

Thank you again for the pleasure of being of service and for your business!

Kind Regards,
Frank West

For fast online quotes, benefit details, & applications for health,
group health, medicare supplement, dental, and life insurance
please visit: https://frankwestinsurance.com

Frank West Insurance Services, LLC     Ca Lic. # OG23770
“Service You Can Count On Since 1982”
P.O. Box 721090 San Diego, Ca  92172

800-726-9525 858-484-1894    Fax: 858-484-1668 

Check Out The Following Informative Summaries: 
Health Care Reform: What is a health insurance
exchange?

https://frankwestinsurance.com/health-care-reform-what-is-a-health-insurance-exchange/#comments

Individual Health Care Mandate Q&A
https://frankwestinsurance.com/individual-health-care-mandate-qa/#comments

Administration quietly announces another PPACA delay.

For a year, consumers will be on the honor system for subsidies under the Patient Protection and Affordable Care Act.

That’s what the Obama administration quietly announced Friday, days after unexpectedly announcing they would delay the employer mandate penalty for another year.

In a new 606-page rule published Friday, the administration said they would significantly scale back on the law’s requirements that the new exchanges verify consumers’ income and health insurance status until 2015, when stronger verification systems are in place.

In the meantime, the government will rely on consumers’ self-reported information.

Health insurance exchanges set up under PPACA are set to begin open enrollment Oct. 1. Enrollees with incomes ranging from 100 percent to 400 percent of the federal poverty line are eligible to receive tax subsidies to help them buy insurance. They also must not have access to insurance through their employer to qualify.

“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan . . . without further verification,” according to the final rule.

The administration has said they would conduct random checks to verify whether new applicants receive employer-sponsored insurance benefits, while also verifying income status.

But the new regulations from the Department of Health and Human Services said the 17 state-based exchanges would have until 2015 to do random checks, citing “legislative and operational barriers.”

In all 50 states, though, the federal government will scale back oversight of what applicants say they earn.

That move, some critics say, could lead some consumers to under report their income in order to qualify for federal tax subsidies, at least in states that are not expanding Medicaid coverage.

In the same rule, the government said it would give states until 2015 to roll out electronic notices because “states are at different places in the development of their eligibility and enrollment systems,” HHS said.

The rule is the latest setback in the health care overhaul law.

Last week, the administration announced it would not require employers with 50 workers or more to provide insurance benefits until 2015, a move business groups applauded but Republicans slammed as confirmation that “Obamacare costs too much and it isn’t working the way the administration promised.”

The administration has said the exchanges and other parts of the law are on target, and they are making delays and changes to better suit the public and employers.

Troy Underwood, CEO of Benefits Connect in Rancho Cordova, Calif. said, though, that he expects to see more PPACA delays and missed deadlines as the months go by.

“Platitudes, political favors and hope never replace a solid and realistic plan,” Underwood said. “As an expert in the processing and administration of employee benefits I can tell you the government’s efforts, even if well-intentioned, are grossly inefficient.

Health insurance carriers fear many young people will opt to go without coverage.

 Youth weighing a $100 fine against the cost of insurance.

Dan Lopez rarely gets sick and hasn’t been to a doctor in 10 years, so buying  health insurance feels like a waste of money.

Even after the federal health overhaul takes full effect next year, the  24-year-old said he will probably decide to pay the $100 penalty for those who  skirt the law’s requirement that all Americans purchase coverage.

“I don’t feel I should pay for something I don’t use,” said the Milwaukee  resident, who makes about $48,000 a year working two part-time jobs.

Because he makes too much to qualify for government subsidies, Lopez would  pay a premium of about $3,000 a year if he chose to buy health insurance.

“I shouldn’t be penalized for having good health,” he said.

Persuading young, healthy adults such as Lopez to buy insurance under the  Affordable Care Act is becoming a major concern for insurance companies as they  scramble to comply with the law, which prohibits them from denying coverage  because of pre-existing conditions and limits what they can charge to older  policyholders.

Experts warn that a lot of these so-called “young invincibles” could opt to  pay the fine instead of spending hundreds or thousands of dollars each year on  insurance premiums. If enough young adults avoid the new insurance marketplace,  it could throw off the entire equilibrium of the Affordable Care Act. Insurers  are betting on the business of that group to offset the higher costs they will  incur for older, sicker beneficiaries.

The nonpartisan Congressional Budget Office estimates that about 6 million  people of various ages will pay the tax penalty for not having insurance in  2014, the first year the law championed by President Barack Obama will be fully  implemented.

It’s hard to estimate how many of those will be the young and healthy adults  that insurers are trying to reach, but that subgroup makes up a very small  portion of the overall market. Even though it’s small, experts say it could be  enough to throw the system’s financing off-kilter.

About 3 million 18-to-24-year-olds in the U.S. currently purchase their own  insurance. Many pay high prices for scant benefits, with high deductibles and  co-pays because they make too much to qualify for Medicaid and have no coverage  options from their employers or parents. The Urban Institute estimates that the  majority of adults in their 20s will qualify for government subsidies under the  Affordable Care Act.

Premium hikes could be a disincentive for young people weighing their  options. Premiums for people aged 21 to 29 with single coverage who are not  eligible for government subsidies would increase by 42 percent under the law,  according to an analysis by actuaries at the consulting firm Oliver Wyman. By  comparison, an adult in his or her early 60s  would see about a 1 percent  average increase in premiums under new federal health rules.

“The key to keeping health care affordable is you really want to balance the  pool, where you have enough young and healthy people to balance off the care of  the older, sicker people who are likely to utilize much more health care  services,” said Justine Handelman, the Blue Cross and Blue Shield Association’s  vice president for legislative and regulatory policy.

She said younger people use about a fifth of the services that older  beneficiaries do.

Jonathan Gruber, an economics professor at the Massachusetts Institute of  Technology who helped craft that state’s law, said he thinks the first-year  federal penalty should be higher.

The penalty under the Massachusetts law, which served as the model for  Obama’s overhaul, was $218 the first year in 2007. Gruber said that amount  proved effective.

“People hate paying money and getting nothing for it,” he said.

Francois Louis, a 20-year-old college student in South Florida who works  part-time, can’t remember the last time he went to the doctor and gets by on  over-the-counter medication whenever he’s sick. He’d love to get a checkup, but  says it’s too expensive on his income of less than $15,000 a year.

“I probably would do the $100 fine because it’s just cheaper and you don’t  have to worry about paying off monthly costs,” said Louis, a student at Broward  Community College near Fort Lauderdale.

By Kelli Kennedy
The Associated Press

 

Individual Health Insurance

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