You Have A Second Chance for ObamaCare Health Insurance

second-chance

The Centers for Medicare and Medicaid Services (CMS) has just announced a special enrollment period beginning on March 15th and continuing through April 30th.  Here is how you qualify:

  • You currently are not enrolled in coverage through the FFM for 2015,
  • You attest that when you filed your 2014 tax return you paid the fee for not having health coverage in 2014, and
  • You attest that you first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing your 2014 taxes.

This is a great opportunity for people who missed the original open enrollment period to obtain health insurance and avoid further IRS penalties.  It is our understanding that health insurance will be offered only through the Marketplace and that Off-Marketplace policies offered directly by the insurance carriers will not be available.  Of course, this is subject to change, and we will update our website as information becomes available.

Last but not least, it’s important for folks to understand that they don’t have to qualify for a subsidy in order to get health insurance on the government Marketplace during this special enrollment period. It also is important to remember that using a licensed, certified broker and agent like ours at Benefits By Design costs you nothing.  Our agents can guide you through the process and help you make an informed decision.  Keep in mind that we are there for you 24/7 after you buy the policy if you have a claims or provider issue, which is far different from trying to purchase health insurance yourself or off of some marketing company’s website.

This is a great opportunity for those who missed the boat on open enrollment the first time, and folks should definitely take advantage of this opportunity beginning March 15th.

Cary Hall

America’s Healthcare Advocate

Open Enrollment For ObamaCare Is Closed—That Means You Can’t Get Health Insurance, Right? WRONG!

open_enrollment_has_closed

So you are on vacation, taking a long winter’s nap or just not paying attention to the fact that you are now required by law to buy health insurance.  And, according to all of your friends and everyone you talked with, now you can’t buy health insurance because open enrollment ended February 15th.  Well, that’s not really true because here are some qualifying events that will allow you to buy health insurance after open enrollment has closed:

  • If you have lost your employer-sponsored health insurance
  • If your employer cancelled health insurance
  • If you’ve moved from one geographic location to another and your old health insurance plan doesn’t offer coverage in your new location
  • If you’re recently married
  • If you lose health insurance through a divorce
  • If you’re adopting a child or have a child born
  • If you’re economic circumstances have changed significantly from last year to this year and you cannot afford your previous health insurance plan

These are all qualifying events that would allow you to qualify for an on-exchange or off-exchange health insurance plan after the open enrollment period has closed.  And, if none of the above apply to you and you really were taking a long winter’s nap or just not paying attention, yes, you still have to pay the penalty but you can buy a short term health insurance policy that will cover you in the event of a catastrophic illness until open enrollment opens next year.  These short term plans are fairly inexpensive and offered by major carriers like Blue Cross and Blue Shield and Assurant as well as others.  They are the proverbial “if I get hit by a bus” policy, which means no doctor office copays or prescription drug coverage but they are real health insurance with real provider networks that can keep you from bankruptcy should you have a major medical expense.

So, if you missed the boat and didn’t get signed up during open enrollment, you still have a way to obtain health insurance either through a qualifying event or through one of these short term policies.

Cary Hall

America’s Healthcare Advocate

Open Enrollment Isn’t Over—You Have Until February 15th To Sign Up For ObamaCare

Marketplace

There’s a lot of confusion with people thinking they can’t purchase health insurance on or off the Exchange after January 1st.  That’s not true.  You can enroll in health insurance through February 15th and avoid the IRS penalties for 2015.  Here are some things you need to know that aren’t on the HealthCare.gov website:

  • Using an exchange certified broker or agent from our agency costs you nothing.  In other words, the price is the same as enrolling for coverage yourself.
  • The penalty for not having a 2015 ACA Compliant health plan in place will be 2% or $325 per adult; 2% or $162.50 per child with a maximum family penalty of $975.
  • How do I qualify for a subsidy?  By supplying us with your approximate 2015 annual income, number of members in your family (including age) and address, our certified agents will tell you immediately what you qualify for.
  • All carriers’ bronze, silver, gold and platinum plans are not the same.  Different plans from different carriers (even though they fall into the same medal category) are not priced the same and, most important, do not have access to the same hospitals and doctors.  It is critically important to know what you’re buying in terms of access to providers before you purchase the policy.  Certain plans have very narrow networks and may limit you to only one or two hospitals in the metro area with a very limited number of doctors.
  • We’re your advocate.  We’re there for you.  Using one of our licensed, exchange-certified brokers or agents guarantees you will have help when you have a claims or a provider issue.  This will not happen if you purchase a policy directly on the exchange or using a navigator, sister or application expert,  In other words, when you have a claim for an ER visit that’s $11,000 and the carrier kicks it back for non-payment, we step in and solve the problem. Otherwise, you get to deal directly with the carrier and try to resolve the issue yourself.
  • I bought a policy last year, and I’m not happy.  If you bought a policy last year on the exchange or off the exchange, this is your opportunity to change policies and move to a policy or carrier that better suits your needs.  You can only make these changes during the open enrollment period (November 15th through February 15th) and you must enroll by December 15 for a January 1 start date.  Policies purchased after that date will have an effective date of February 1 or March 1.
  • Will my pre-existing conditions be covered?  There are no pre-existing conditions on individual policies.  Any medical condition is covered whether purchasing a new policy or moving from an existing policy to a new policy.
  • My group health insurance is too expensive, Employers with small groups (25 employees or less) may find individual health insurance as a viable option from a cost effectiveness standpoint since individual policies oftentimes are now less than group health insurance.  They can still be payroll deducted through the List Bill program, but individual policies do not give employers the tax credit they currently receive when buying group health insurance.  We can help you determine if this is a good fit for your company through a comparison analysis

Cary Hall

America’s Healthcare Advocate

Thoughts For A Christmas Season

Christmas Image

It is the Christmas season, but it’s hard to tell when you turn on the news and see all the discontent, civil unrest and angry people in the streets around this country.  Maybe everyone should take a deep breath and remember this Christmas season is supposed to be about the birth of Jesus Christ, our savior and lord.  I thought this editorial by Carol Dark Ayres summed it up better than anything I could say.

Have a blessed and Merry Christmas,

Cary

Christ Is A Vital Part Of Christmas

Carol Dark Ayres

As we approach another Christmas season, the argument continues as to whether we should call this celebration a winter holiday or Christmas.

Without a doubt the Christ, for whom Christmas is named, has had a larger effect on the world than any other man who ever lived.

The Bible is the story of Christ from the beginning of its first pages in Genesis to its dramatic conclusion in Revelation.

Everything in the Bible points to the Christ, his first coming, which is the story of his birth and amazing ministry and his second coming, which is the story of Armageddon and judgment. Christ is a mysterious figure.

His birth to a human mother and the spiritual God Father, clothes him in a mystery that humans cannot completely understand. But this was the dramatic requirement, which produced the “Godman” who can stand between a perfect God and sinful man and through his death and resurrection open the door that was closed between them.

He was the only sinless man to ever live, and his blood therefore was acceptable to God as atonement for the sins of men. The Christ, named Jesus by his parents as directed by God, was born around 4 B.C. and was crucified around 29 A.D.

He began his ministry when he was 30 years old, and it lasted three years. During that time he healed hundreds, perhaps thousands, as the Bible says he healed all who came to him.

He raised people from the dead and fed 5,000 on five loaves and two fish. His miracles were dynamic demonstrations that he was the Son of God and proof of the veracity of his request to all men to believe on him to receive eternal life.

Jesus fulfills 351 prophecies from the Old Testament made from 400 to 1,450 years before he was born. We have historical proof, through the Dead Sea Scrolls, of the accuracy of the dating of the Old Testament writings.

Professor Peter W. Stoner the author of “Science Speaks” stated that the probability of just eight particular prophecies being fulfilled in one person is 1 in 1017, or 1 in 100,000,000,000,000,000. The probability number of 351 prophecies fulfilled would be so large that the strength of its argument could not be comprehended.

The Bible is the foundation of our nation as confirmed through the Declaration of Independence: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Our laws are built on the moral laws of the Bible.

The value of individuals and equal rights came from the Bible and was the bedrock that produced the greatest nation on the earth and guided our tremendous growth and success as a democracy. One could say that we owe our very nation to the teachings of Christ.

C.S. Lewis, the great scholar and Christian writer, put it so well: “Either Jesus was telling the truth or he wasn’t. If he wasn’t then he must have been a liar or a lunatic. If he was, then He is the Lord.”

One must question if a liar or a lunatic would have had an effect on the world that has lasted more than 2,000 years. For all of these reasons and many more, we should call this holiday Christmas and celebrate Christ’s life as the greatest gift ever given to mankind.

Here Comes Open Enrollment for ObamaCare

Marketplace

November 15th marks the second open enrollment period for ObamaCare on and off the health insurance exchanges.  Here are some things you need to know that aren’t on the HealthCare.gov website:

  • Using an exchange certified broker or agent from our agency costs you nothing.  In other words, the price is the same as enrolling for coverage yourself.
  • The penalty for not having a 2015 ACA Compliant health plan in place will be 2% or $325 per adult; 2% or $162.50 per child with a maximum family penalty of $975.
  • How do I qualify for a subsidy?  By supplying us with your approximate 2015 annual income, number of members in your family (including age) and address, our certified agents will tell you immediately what you qualify for.
  • All carriers’ bronze, silver, gold and platinum plans are not the same.  Different plans from different carriers (even though they fall into the same medal category) are not priced the same and, most important, do not have access to the same hospitals and doctors.  It is critically important to know what you’re buying in terms of access to providers before you purchase the policy.  Certain plans have very narrow networks and may limit you to only one or two hospitals in the metro area with a very limited number of doctors.
  • We’re your advocate.  We’re there for you.  Using one of our licensed, exchange-certified brokers or agents guarantees you will have help when you have a claims or a provider issue.  This will not happen if you purchase a policy directly on the exchange or using a navigator, sister or application expert,  In other words, when you have a claim for an ER visit that’s $11,000 and the carrier kicks it back for non-payment, we step in and solve the problem. Otherwise, you get to deal directly with the carrier and try to resolve the issue yourself.
  • I bought a policy last year, and I’m not happy.  If you bought a policy last year on the exchange or off the exchange, this is your opportunity to change policies and move to a policy or carrier that better suits your needs.  You can only make these changes during the open enrollment period (November 15th through February 15th) and you must enroll by December 15 for a January 1 start date.  Policies purchased after that date will have an effective date of February 1 or March 1.
  • Will my pre-existing conditions be covered?  There are no pre-existing conditions on individual policies.  Any medical condition is covered whether purchasing a new policy or moving from an existing policy to a new policy.
  • My group health insurance is too expensive, Employers with small groups (25 employees or less) may find individual health insurance as a viable option from a cost effectiveness standpoint since individual policies oftentimes are now less than group health insurance.  They can still be payroll deducted through the List Bill program, but individual policies do not give employers the tax credit they currently receive when buying group health insurance.  We can help you determine if this is a good fit for your company through a comparison analysis

Cary Hall

America’s Healthcare Advocate

Open Enrollment For Medicare Is Just Around The Corner

October 15

October 15th marks the beginning of Medicare’s open enrollment process for Medicare Advantage plans like Coventry Advantra, Humana and UnitedHealthcare AARP.  This open enrollment period also applies to Part D stand-alone prescription drug programs.

Open enrollment lasts from October 15th through December 7th and is the only time you can enroll in these programs or make a change between Medicare Advantage plans or Part D insurance carriers unless you have a qualifying event.  In order to be eligible for enrollment to any of the plans, you must have your Part B Medicare enrollment completed.

Many of the Medicare Advantage plans are low cost or zero premium plans, but they do operate under the network provider system and may not be suitable for all Medicare recipients.  For example, if you live in the Midwest but spend your winters in Arizona or Florida, you may not have network access to providers when you are out of your provider network.  In this case, a MediGap or Medicare Supplement plan like Blue Cross and Blue Shield, Stonebridge or Mutual of Omaha may be a better choice, providing you access to doctors, hospitals and clinics anywhere in the country that accept Medicare.

Choosing a Medicare Advantage or Medicare Supplement plan should be done with the help of a licensed, certified broker or agent so you know (before you make your choice) what your options are, what the restrictions are and what monetary obligations you will have for out-of-pocket expenses.

It is important to note that using a broker when choosing a plan does not cost you anything and does not change the price of that Medicare Advantage or Supplement plan.  Additionally, if you have claims problems or provider problems after the policy is written, it is the agent or broker’s responsibility to interact with the carrier on your behalf as your advocate.

Plan ahead, choose wisely and you will probably find the Medicare products much more affordable than conventional healthcare policies while still providing the same level of benefits.

Cary Hall

America’s Healthcare Advocate

Father of the Bride

Elizabeth and Shawn

I had the honor and the privilege on Saturday, September 27th, of walking my daughter Elizabeth down the aisle to an outstanding young man, Shawn Peterson.  The wedding was held in Pasco, Washington (Shawn’s home), and it was a wonderful event.

Shawn and Elizabeth live in Los Angeles but have friends all over the country.  There were guests in attendance from New York, Washington DC, Los Angeles, Miami, Kansas City and many other locales across the country.  Besides being a very proud father, I was very happy for this newly-wed young couple.

My most memorable take away from this four day event was the opportunity to interact with this large group of young people commonly labeled the Millennial Generation.  They were a very diverse group including active duty military, Wall Street stock brokers, medical professionals, a restaurant chef, farmers, mechanics and not-for-profit employees.  While their political views were wide ranging, they were generally reflective of our overall population.  And what I found most encouraging was the common sense and clear direction in life they shared during our conversations.

There’s a lot of cynicism in this country about where we’re headed, but I can assure you, after my weekend surrounded by these wonderful young people, we are not going to hell in a handbasket like so many claim.  In many ways I think these people are better equipped to move forward in their lives than my generation was at their age, and I’m convinced that, as they assume the mantle of leadership in this country, we can look forward to a bright future for all of us.

Cary Hall

America’s Healthcare Advocate

Open Enrollment For Medicare Is Just Around The Corner

October 15

October 15th marks the beginning of Medicare’s open enrollment process for Medicare Advantage plans like Coventry Advantra, Humana and UnitedHealthcare AARP.  This open enrollment period also applies to Part D stand-alone prescription drug programs.

Open enrollment lasts from October 15th through December 7th and is the only time you can enroll in these programs or make a change between Medicare Advantage plans or Part D insurance carriers unless you have a qualifying event.  In order to be eligible for enrollment to any of the plans, you must have your Part B Medicare enrollment completed.

Many of the Medicare Advantage plans are low cost or zero premium plans, but they do operate under the network provider system and may not be suitable for all Medicare recipients.  For example, if you live in the Midwest but spend your winters in Arizona or Florida, you may not have network access to providers when you are out of your provider network.  In this case, a MediGap or Medicare Supplement plan like Blue Cross and Blue Shield, Stonebridge or Mutual of Omaha may be a better choice, providing you access to doctors, hospitals and clinics anywhere in the country that accept Medicare.

Choosing a Medicare Advantage or Medicare Supplement plan should be done with the help of a licensed, certified broker or agent so you know (before you make your choice) what your options are, what the restrictions are and what monetary obligations you will have for out-of-pocket expenses.

It is important to note that using a broker when choosing a plan does not cost you anything and does not change the price of that Medicare Advantage or Supplement plan.  Additionally, if you have claims problems or provider problems after the policy is written, it is the agent or broker’s responsibility to interact with the carrier on your behalf as your advocate.

Plan ahead, choose wisely and you will probably find the Medicare products much more affordable than conventional healthcare policies while still providing the same level of benefits.

Cary Hall

America’s Healthcare Advocate

New ObamaCare Insured Not Understanding Health Insurance: Who’s On First?

A recent article in The New York Times states Americans who signed up for ObamaCare find their policies complicated and have difficulty understanding them.

To quote Resources for Human Development program coordinator Rebecca Cashman, “It’s not like you enroll and, voila, you immediately know how to use it.”  Actually, if Ms. Cashman’s program members had used an exchange-certified broker or agent, then, voila, they would have understood how to use their policies.  Ms. Cashman went on to say, “There are a lot of people who really have some big questions about ‘what now?’”

Exchange certified agents go through more than ten hours of training and testing in an effort to make sure they understand the exchange rules, subsidies and policies.   The National Association of Health Underwriters certifies agents and has an Agent Finder tool on its website to help consumers in finding qualified brokers and agents to assist them in qualifying for subsidies and purchasing health insurance.

Ms. Salwa Shabazz who is epileptic stated she didn’t understand the plan when she chose it and that her doctors were not in her plan.  She states, “None of that was explained when I signed up.”   Once again, had Ms. Shabazz been counseled by a certified broker or agent, she would have clearly understood that she had purchased a plan with a narrow provider network and would have known that her doctors were not included.

To solve this problem, the Centers for Medicare and Medicaid Services is launching a new project named “From Coverage to Care.”  What’s fascinating about this effort along with The New York Times article is that not once are brokers or agents referred to anywhere as a free resource for consumers who would solve 90 percent of the problems people face in understanding the health insurance process.

We don’t need another government program.  We do need the government to stop stonewalling brokers and agents and to recommend us as a resource for assisting consumers in the purchase of health insurance as we have done in my agency for the last 16 years.

Cary Hall

America’s Healthcare Advocate

Could A Lawyer in Greenville, South Carolina Have the Silver Bullet That Kills ObamaCare?

A bearded, be speckled avid gardener and father of three grown children is the relatively obscure figure behind the litigation of Halbig v. BurwellThe attorney, Mr. Christina, with the law firm Ogletree Deakins was the catalyst behind the lawsuit that latched onto the wording which caused the DC Circuit Court of Appeals to rule that only state funded exchanges could have subsidies.

In another ruling in the Fourth Circuit Court of Appeals, King v. Burwell, this appeals court ruled that the subsidies are indeed legal for people purchasing insurance on the federal exchange and are not limited to state run exchanges.

Although the wording in the Patient Protection and Affordable Care Act explicitly says only state run exchange participants can receive federal tax credits for their health insurance, we now see two different opinions (one for and one against) by the federal appeals courts.

Since the Obama administration has requested an en banc review by the DC Circuit (meaning all 11 members would have to rule on this case and its wording vs. the 3 who originally ruled), the Obama administration may find itself going back to the Supreme Court as a result of these two opposing decisions and the en banc ruling request.  The losing lead litigator in the 4th Circuit decision, Michael Garvin of Jones Day can now petition the Supreme Court for an expedited appeal which would throw the whole case back to the Supremes for a second ruling, meaning Chief Justice Roberts would have a second bite at the apple on whether or not he will uphold ObamaCare again as he did in his first ruling.

While all of this makes for great theater and speculation, it leaves the insurance industry in turmoil and one wonders what would happen if the Supreme Court ruled like the DC Circuit regarding the language striking down subsidies on the federal exchange.

Just when you thought it was safe to go back in the water again, it appears the sharks could be circling for one last bite that could be fatal to ObamaCare.

Cary Hall,

America’s Healthcare Advocate