10 Things You Must Know Before Enrolling In Obama-Care for 2015

#10: Affordable Care Act Health Plans must cover essential health benefits, pre-

existing medical conditions and preventative care.

Essential benefits are as follows:

Ambulatory patient services; emergency services; hospitalization; maternity and

newborn care; mental health and substance use disorder services, including

behavioral health treatment; prescription drugs; rehabilitative and habilitative

services and devices; laboratory services; preventive and wellness services and

chronic disease management; and pediatric services, including oral and vision

care.

#9: Many that apply for health coverage qualify for a premium tax subsidy.

Approximately 84% of those who applied for health coverage on the Federal

Marketplace received a federal tax subsidy to pay some or their entire monthly

health plan premium. An insurance agent can help you find the best plan with

your choice of doctors and hospitals.

A premium is what you pay the insurance company each month for your health

insurance plan. Again Uncle Sam is helping singles and families to get coverage

by issuing premium tax credits to make the plans affordable.

#8: Your family may be eligible for both a premium tax subsidy and cost-sharing

reductions for Marketplace plans.

See the chart below for your eligibility for a tax subsidy and cost-sharing

reductions for Marketplace plans.

#7: If you are currently enrolled in a Marketplace, “Obama-Care” plan your

current plan could be changed, discontinued, or have a rate increase!

You will, if currently enrolled in a plan, be receiving a letter from the insurance

company telling you of the changes.

If you do nothing you will be “re-enrolled” in your current plan if it still exists.

This could cause you to have a higher rate to pay each month and possibly

cause you to lose your current doctors and hospitals.

Each person needs to contact their current insurance agent, one who is

certified by the Federal Government to assist you in the Marketplace; to be sure

that you are selecting the best plan for you and that you’re Federal Subsidy

won’t be lost or change.

In each state plans will be changing with your current insurance carrier and also

new insurance companies will be entering the market to offer plans to you.

It is the duty of your insurance agent to help you choose the correct plan for

yourself or your family.

There are a lot of moving parts to the Affordable Care Act, “Obama-Care” and

you don’t want any surprises when you go to the doctor or hospital.

#6: You must have a health insurance plan that meets the standard of “credible

coverage” or pay a tax penalty each year to the IRS.

What is credible coverage?

Credible Coverage is any public or private health insurance or health benefit plan, whether insured or self-insured. The following types of health care

coverage are Creditable Coverage:

To avoid the penalty for being uncovered you must have insurance that qualifies

as minimum essential coverage.

Health plans that qualify as minimum essential coverage:

If you're covered by any of the following types of plans, you're considered

covered under the health care law and don't have to pay a penalty.

Any Marketplace plan, or any individual insurance plan you already have

Any employer plan (including COBRA plans, with or without

“grandfathered” status.

Retiree health plans

Medicare

Medicaid

The Children's Health Insurance Program (CHIP)

TRICARE (for current service members and military retirees, their families,

and survivors)

Veterans health care programs (including the Veterans Health Care

Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina

Bifida Health Care Benefits Program)

Peace Corps Volunteer plans

Self-funded health coverage offered to students by universities for plan or

policy years that begin on or before Dec. 31, 2014

Other plans may qualify. Ask your health coverage provider.

Health plans that don't count as coverage

Health plans that don't qualify as minimum essential coverage don't count as

coverage under the health care law. If you have only these types of coverage,

you may have to pay the fee. Examples include:

Workers' compensation

Coverage only for a specific disease or condition

Plans that offer only discounts on medical services

#5: How much is the tax penalty or fine?

The fee for not having health coverage is calculated one of 2 ways. If you or your

dependents don’t have insurance that qualifies as minimum essential coverage

you'll pay either a percentage of your household income or a flat fee --

whichever is higher.

The fee in 2015

If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

2% of your yearly household income. (Only the amount of income above

the tax filing threshold, about $10,000 for an individual, is used to calculate

the penalty.) The maximum penalty is the national average premium for a

bronze plan.

$325 per person for the year ($162.50 per child under 18). The maximum

penalty per family using this method is $975.

The fee for not having coverage in 2014

If you didn’t have coverage in 2014, you’ll pay one of these two amounts when

you file your 2014 federal tax return:

1% of your yearly household income. (Only the amount of income above

the tax filing threshold, about $10,000 for an individual, is used to calculate

the penalty.) The maximum penalty is the national average premium for a

bronze plan.

$95 per person for the year ($47.50 per child under 18). The maximum

penalty per family using this method is $285.

The fee after 2015

The penalty increases every year. In 2016 it’s 2.5% of income or $695 per

person. After that it's adjusted for inflation.

How you pay the fee

You’ll pay the fee on the federal income tax return you file for the year you don’t

have coverage. Most people will file their 2014 returns in early 2015 and their

2015 returns in early 2016.

#4: What types of health and dental plans are available in 2015?

In 2015 you will find five levels of coverage available on and off the Marketplace.

The health plan category you choose determines how you and your plan share

the costs of care. These categories have nothing to do with the quality or

amount of care you get.

There are 5 categories or “metal levels” of coverage in the Marketplace. Plans in

each category pay different amounts of the total costs of an average person’s

care. This takes into account the plans’ monthly premiums, deductibles,

copayments, coinsurance, and out-of-pocket maximums. The actual percentage

you’ll pay in total or per service will depend on the services you use during the

year.

Bronze: Your health plan pays 60% on average. You pay about 40%.

Silver: Your health plan pays 70% on average. You pay about 30%.

Gold: Your health plan pays 80% on average. You pay about 20%.

Platinum: Your health plan pays 90% on average. You pay about 10%.

Catastrophic: Catastrophic coverage plans pay less than 60% of the total

average cost of care on average. They’re available only to people who are

under 30 years old or have a hardship exemption.

What to consider when choosing a plan category

Think about your health care needs when choosing a category of Marketplace

plan.

If you expect a lot of doctor visits or need regular prescriptions: You may

want a Gold plan or Platinum plan. These plans generally have higher

monthly premiums but pay more of your costs when you need care.

If you don’t expect to use regular medical services and don’t take regular

prescriptions: You may want a Silver, Bronze, or Catastrophic plan. These

plans cost you less per month, but pay less of your costs when you need

care.

If you qualify to save on out-of-pocket costs: Silver plans may offer the best

value. You may qualify for lower out-of-pocket costs based on your

household size and income. If you do, you can get these out-of-pocket

savings only if you enroll a Silver plan. If you make this choice you'll

basically get the lower out-of-pocket costs of a Gold or Platinum plan while

paying a Silver plan premium.

If you’re under 30 or have a hardship exemption and want low monthly

premiums: You may want to choose a catastrophic plan designed to

protect you from worst-case scenarios, like serious accidents or diseases.

Of course, it’s impossible to predict all your health care needs for the year

ahead. Pick a plan that fits your budget and meets your and your family’s

expected needs.

#3: What is the Health Insurance Marketplace?

Here’s a quick rundown on the most important things to know about the Health

Insurance Marketplace, sometimes known as the health insurance “exchange.”

Important. Before November 15, 2014, you can enroll in a Marketplace health

plan only if you qualify for a Special Enrollment Period. Any plan you enroll in

before November 15, 2014 ends December 31, 2014. You can apply for Medicaid

and CHIP any time. Find out if you qualify for a Special Enrollment Period or view

plans and prices for coverage ending December 31, 2014.

Use the Marketplace to get covered

The Health Insurance Marketplace helps uninsured people enroll in health

coverage. Fill out a Marketplace application and we’ll tell you if you qualify for:

Private health insurance with savings based on your income. Plans cover

essential health benefits, pre-existing conditions, and preventive care.

Most people who apply through the Marketplace qualify for premium tax

credits and savings on out-of-pocket costs based on household size and

income.

Medicaid and the Children’s Health Insurance Program (CHIP). These

programs provide free or low-cost coverage to millions of families with

limited income. Many states are expanding Medicaid to cover more people.

Find out what Medicaid expansion means for you.

Fees, exemptions, and qualifying coverage

Most people must have health coverage or pay a fee. If you don’t have

coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325

per adult ($162.50 per child) — whichever is higher.

You’re considered covered under the health care law if you have any job-

based plan, any plan you bought yourself, Medicare, Medicaid, CHIP, and

many other kinds of coverage. See a full list of plans and programs that

meet the health law’s coverage requirement.

Some people qualify for an exemption from the fee based on income or

other situations.

3 more things to know

If you’re eligible for job-based insurance, you can consider switching to a

Marketplace plan. But you’ll qualify for premium tax credits and other

savings based on your income only if the job-based insurance isn't

considered affordable or doesn’t meet minimum value requirements.

If you have Medicare, you’re considered covered and don’t have to make

any changes. If you have Medicare, you can’t use the Marketplace to buy a

supplemental plan or dental plan.

You can buy a plan outside the Marketplace and still meet the health care

law’s coverage requirements. But if you buy outside the Marketplace, you

won’t be eligible for premium tax credits or other savings based on your

income.

#2: The deductibles for some of these health care plans seem to be a large

amount $6.300 for a single person and $12,600 for a family. Is there a way to

reduce that out-of-pocket expense?

Yes there is some relief for individuals and families in the Marketplace. First if

you qualify for Cost Sharing Reductions in the Silver plans then you will see your

out-of-pocket costs reduced.

A discount that lowers the amount you have to pay out-of-pocket for deductibles,

coinsurance, and copayments. You can get this reduction if you get health

insurance through the Marketplace, your income is below a certain level, and

you choose a health plan from the Silver plan category (See Health Plan

Categories). If you're a member of a federally recognized tribe, you may qualify

for additional cost-sharing benefits

Another way you can reduce your out-of-pocket costs is to purchase a Qualified

Health Plan Supplement Plan. With that type of plan the insurance company will

pay you a set benefit amount for such items as doctor’s visits, hospital stays and

such items as x-rays and imaging.

Ask your agent about Supplement Plans including Accident and Cancer Care

and Hospital Indemnity plans which pay you for each day you are confined in a

hospital.

#1: What do I do next?

It’s all a little confusing for the average American to grasp the 2,000 pages of

the Affordable Care Act and the more than 10.000 pages of regulations that

affect how you buy healthcare now and into the future.

With the IRS and other agencies of the Federal Government watching how your

purchase and use your healthcare it’s important that you make the right choices

each and every time for yourself and your family.

That is why you should turn to an insurance agent who has training in the health

care market and who has to certify each year to assist you in finding the best

coverage for your family.

There are a lot of agents out there but only a few have taken the time to certify

on the government website and have taken the tests and have the necessary

skills to help you.

To apply online click here: https://health.acaexpress.com?npn=239960 or better yet

just give my office a call at: 816-224-9466.

You’ll be glad you called.

Best regards,

Duaine Owings-President

Plan To Win Insurance Agency

Blue Springs, Mo

www.GetAHealthPlan.com