Need Individual Health Insurance ?
Health Quotes are Now Available in the new Public & Private
HealthCare Marketplaces.
Please call us at (330) 867-4650 for your FREE Quotes today....
We can help you get Enrolled in your new health plan Today.
We are certified through the Public Marketplace ( HealthCare.gov )
also known as the On-Exchange Marketplace, as well as the Private Marketplace
known as the Off-Exchange Marketplace.
We Represent many of the major Insurance Companies offering plans in
Ohio.
Important Dates you will want to remember.
º Today: Contact us to learn more about health care reform. We will help you with personalized options for the 2017 plan year.
º Open Enrollment for 2016 begins November-1-2015 and ends January-31-2016. Ended January-31-2016
º Open Enrollment for 2017 begins November-1-2016 and ends January-31-2017
º Open Enrollment for 2018 begins November-1-2017 and ends December-15-2017
º March 31, 2014: The government will impose a penalty ( Personal Responsibility Payment ) on those without credible insurance
coverage.
2014
º The annual individual shared responsibility payment is the greater of :
º 1% of the taxpayer's household income that is above the tax return filing threshold for the taxpayer's filing status, or
º The taxpayer's flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285
However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available
through the Marketplaces in 2014
2015
º The annual individual responsibility payment is the greater of :
º 2% of the taxpayer's household income that is above the tax return filing threshold for the taxpayer's filing status, or:
º The taxpayer's flat dollar amount, which is $325 per adult and $162.50 per child, limited to a family maximum of $975
However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available
through the Marketplaces in 2015
2016
º The annual individual shared responsibility payment is the greater of :
º 2.5% of the taxpayer's household income that is above the tax return filing threshold for the taxpayer's filing status or:
º The taxpayers flat dollar amount, which is $695 per adult and $347.50 per child, limited to a family maximum of $2,085.00
What Happens if I Missed the Deadline for Obamacare?
If you missed the deadline for ObamaCare you still may have options for obtaining health insurance.
If you missed the ObamaCare enrollment you may qualify for a Special Enrollment Period SEP.pdf, which can extend the time
you can use the marketplace.
If you don't qualify for a special enrollment you may still qualify for Medicaid and CHIP or some types of temporary private
health insurance outside of the marketplace through an agent, broker or provider.
You can contact the appropriate government office ( Medicare ) ( CHIP ) or your local agent or broker for further details.
Health Care Reform means you can look forward to new and expanded health benefits in 2014.
Health Care Reform mandates that all new 2014 plans & thereafter include 10 Essential Health Benefits.
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care now automatically covered
5. Increased benefits for mental health and substance use disorder services including behavioral health treatment
6. Prescription Drugs
7. Rehabilitative and habilitative services and devises
8. Laboratory Services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
Also, all new health care compliant plans will have an annual cap on out-of-pocket expenses.
Metal Tiers of health Insurance Plans under the ACA:
Beginning January-1, 2014, plans both on and off the Exchange must take the shape of one of 4 levels of coverage
based on the tiered metal system, Bronze, Silver, Gold and Platimum
Bronze- Bronze plans have an actuarial value of 60%, which means that at an overall plan level, the member ( you ) will pay for
40% of the medical costs through a combination of deductibles, copays and coinsurance.
Silver- A silver plan has an actuarial value of 70%, so members will be responsible at an overall plan level for 30% of medical
costs through a combination of deductibles, copays and coinsurance
Gold - A gold plan has an actuarial value of 80%; therefore, under this plan, people will be responsible for 20% of the medical
costs through a combination of deductibles, copays and coinsurance
Platinum- Under a platinum plan with an actuarial value of 90%, people will be responsible for only 10% of medical costs
through a combination of deductibles, copays and coinsurance.
These tiers were set into place for three reasons:
1. To set the minimum standard of coverage expected by the ACA
2. To determine when a person will be fined for refusing to purchase health insurance
3. As benchmarks for premiums and cost-sharing subsidies provided by the federal government for low-income people purchasing
health plans on the Exchange
Health Care Reform will affect everyone differently: Key Points:
º You can get health insurance coverage even if you have a pre-existing medical condition
º There will be no limits on how much will be paid toward certain essential benefits, such as hospital stays and prescription drugs.
º Individuals under the age of 26 can be insured through their parents plan
º Consumers will receive a response within 72 hours of an appeal in urgent medical situations
º Preventative care and annual checkups have no out-of-pocket costs
º Part of your health insurance cost may be covered by premium tax credits based on your income level and family size.
For example, a family of four that makes less than $94,200 a year may be eligible for help.
Maximum income levels for 2014 Obamacare Insurance subsidies, and premium maximums:
Household Size 400% FPL Premium Cap
1. ( Single ) $45,960 $4,366
2. ( Couple ) $62,040 $5,893
3 $78,120 $7,421
4 $94,200 $8,949
2015
Exchanges: ( Individuals )
Generally there will be two types of Exchanges:
1. Public Exchanges ( Government Exchange ) which will offer plans to both Subsidy and Non-Subsidy eligible individuals.
These plans will generally be known as ON- EXCHANGE plans.
If an individual qualifies for a subsidy they will be required to purchase and enroll through the Federal Marketplace Exchange.
Premium rates will be the same if the individual goes directly to the Government site, uses a Navigator,
or uses an Agent or Broker. Agents and Brokers offer the expertise and ability to review and explain
plan and benefit details and make recommendations based on their clients needs, which a Navigator is generally not licensed to do.
2. Private Exchanges : Generally these exchanges will be utilized by individuals who do not qualify for a subsidy or help
paying their premiums. These plans will generally be known as Off-EXCHANGE plans. Enrollment for these plans will be done outside
the federal public exchange and directly with the insurance carriers.
Both exchanges will be similar as far as the medal plans offered. There will be no pre-existing condition clauses in either
exchange.
Both exchanges will be required to offer the 10 Essential Health Benefits in their plans and medal structures.
Our Agency can help you enroll through the Government Exchange www.HealthCare.gov or directly through the
insurance companies and their established enrollment sites.
We represent most of the insurance companies offering coverage through the Public and Private Exchanges in Northern Ohio.
We will also be able to assist you in finding a plan either ON-EXCHANGE or OFF-EXCHANGE that best fits your needs
and budget.
Health Reform Subsidy Calculator:
Source ( HENRY J KAISER Family Foundation ) http://kff.org/interactive/subsidy-calculator
Health Reform Questions & Answers http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/
Source ( HENRY J KAISER Family Foundation )
OSCAR-Cleveland Clinic ( Get a Quote ) https://www.hioscar.com/get-quote/?broker_npn=2442863
Small Business Owners
If you have less than 50 Employees and do not provide group health insurance, your employees will be able to consult with us and get insured!
You may be eligible for tax credits beginning in 2014 for employers who provide insurance to their employees
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