Co-op failures adds to speculation about future of ACA: 4 things to know.

Doctors looking at file

Another New Jersey insurance company drops out of Obamacare.


Major Health Insurance Mergers May Leave Consumers “Worse Off”.

Short-term health insurance fills ‘Obamacare’ gaps but has risks.

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, 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.


If You Miss the Obamacare Deadline, Temporary Health Insurance Plans Are Available.

Missing the deadline to purchase health insurance does not mean consumers have to forego coverage for nearly a year until the next open enrollment season starts.

Short-term health insurance plans are one method to manage not having health coverage. After all, one trip to the ER can be an expensive one that can set you back for months or longer since unpaid medical bills is one of the top reasons consumers file for bankruptcy.

Although neither short-term, accident or critical illness insurance will meet the requirement for health insurance coverage under the Affordable Care Act and consumers are still subject to the tax penalty for being uninsured for two consecutive months or longer, these plans will put a cap on your financial liabilities. There are many qualifying life events that could make you eligible for buying health insurance under the special enrollment period such as moving to another state, getting married or divorced or turning 26 and aging out of your parent’s plan.

The short-term plans usually do not include coverage for preventive care like an annual physical or pre-existing medical conditions or prescription drugs. They can be a good option so that your expenses do not wind up insurmountable in case you are injured or wind up sick.

The short-term plans are often “significantly more affordable” than standard health insurance plans, he said. The monthly premiums can range from $50 to $150.

The coverage typically does not last longer than 6 to 12 months, but you can usually apply again at the end of that period. While this option can serve as a backup plan, also ask your doctor for their “cash” value of a visit, which is often affordable if you need a checkup or have a minor illness.

Six states currently do not allow the sale of short-term insurance – Minnesota, New York, Vermont, Massachusetts, Rhode Island, New Jersey and Maryland, said Noah Lang, CEO of Stride Health, the San Francisco health insurance exchange company. Other states such as California limit the length of the policy and consumers can only be covered for up to six months.

Accident insurance is designed to help consumers if they have a qualifying injury. The money is paid directly to consumers rather than to the doctor, which means you can do what you want with the payout such as paying medical bills or for your rent, said Purpura.

Critical illness insurance plans work similar to accident plans because consumers receive a payment if you are diagnosed with a qualifying illness such as cancer or heart disease.

It seems like a no-brainer to simply purchase a temporary plan and use it year-round if you are young and healthy, since you can save money each month, but there are a few catches: you are still liable for the tax penalty, they do not cover any pre-existing conditions and have payout limits of usually $1 million to $2 million, said Jack Hooper, CEO of Take Command Health, an online health insurance exchange based in Dallas.

“In the eyes of Obamacare, temporary insurance counts as being uninsured, meaning you’re liable for penalties and taxes,” he said. The tax penalty for not having health insurance coverage rose for 2016 and now consumers are liable for $695 or 2.5% of their income, whichever is greater.


Payroll Deduction Benefits.

Two more Obamacare health insurance plans collapse.

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.

Individual Health Insurance

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