INDIVIDUAL and FAMILY HEALTH PLAN DEADLINES

Open enrollment begins on November 1st and continues until December 31st.  (some states, CA, NY and Wash DC, etc., tend to extend past deadlines to 1/31…check with your individual State).

***After Open Enrollment ends (January 31st), you can only obtain an ACA compliant plan with a qualfying event.

If you need a health plan and you missed Open Enrollment, there are MANY qualifying events that will allow you to obtain a plan. Here are some of the events (click the link for the current events):

– Turning 26
– Losing current insurance
– Move to a new area
– Getting married
– Birth of a baby
– Getting divorced
– Death in the family
– Becoming a citizen

WHAT’S A QUALIFYING EVENT?

What is The Exchange?

The exchange is an online marketplace for health insurance. This is where you can go to find and apply for coverage from competing private health care providers.  You have the option of buying a plan ON the Exchange or OFF the Exchange (direct with the carrier). Many States have Health Exchanges. If your State does not, you can buy through Healthcare.gov.

1) Your MAGI (Modified Adjusted Gross Income). If your MAGI is within certain parameters, you are eligible for a ‘subsidy’ (the government helps to pay for some or most of your insurance premium).

2) Some plans have a wider network of Providers ‘OFF’ the Exchanges (direct to the insurance company). Always check to see if your Drs, medications, and hospitals are ‘in-network’.

Working with an INDEPENDENT Insurance Agent (LIKE US😉) that is certified with the Exchange, will be able to figure out:

1) If you can receive a subsidy
2) Maximize the subsidy
3) Ensure your Providers are in-network
4) Educate you
5) Guide you to the right plan FOR YOU!

And the cherry on top of the already delicious ice cream? At HIR Insurance, you won’t pay any more for our services than if you did this yourself!

What is the Metal-Tier System?

This is a way to compare health plans and figure out which is best for you and gives you the most Bang for your Buck! It’s all about how much you’re willing to pay in premiums and how much coverage you need.
Just remember the METALS:

1. BRONZE – Insurance pays 60% you pay 40%
2. SILVER – Insurance pays 70% you pay 30%
3. GOLD – Insurance pays 80% you pay 20%
4. PLATINUM – Insurance pays 90% you pay 10%

MAGI – you won’t find anything labeled MAGI on your tax form.  For most people, MAGI will be:

• Line 7 on your tax form (Adjusted Gross Income)
• Plus lots of things but the two main additions are ‘un-taxed’ Social Security and tax-exempt income

Check with your tax professional if you want to be 100% sure of your MAGI

Whether you can get help with your insurance premiums from the government (subsidy) and how much it will be, depends on a few factors:

1) What is your MAGI (Modified Adjusted Gross Income)? It’s basically your AGI (Line 7 on your taxes) plus a few extra things (tax-exempt interest and untaxed Social Security benefits) but always best to contact your tax accountant.

2) Your location. Yes, your zip code matters and it can be a dramatic difference.

3) Whether your Providers are ‘in-network’ with the Health Exchanges. Yes, the network can be vastly different if you get your plan ‘on’ the Health Exchange or ‘off’ the Exchange (direct to the insurance companies).

All in all, contact an independent insurance agent that is certified with the Exchange you will use. With HIR Insurance agents, you’ll always receive non-biased guidance and will NEVER cost you any more than if you did it yourself!

FEDERAL POVERTY LIMIT (FPL):  This is the barometer that the government uses to see if you qualify for help with your premiums and/or benefits.  The issue is, if your income falls below certain amounts, you may be pushed into MediCaid (MediCal in CA).  Now, if you are ok on Medicaid, then it’s no issue.  If you don’t want to be on MediCaid however, you’ll want to be on top of this because it’s easier to get ON to MediCaid than it is to get OFF.  We’ve had to go through the ‘appeals’ process for many of our clients to get them off of MediCaid.  It’s no problem for us to do this, it’s just part of our customer service.  However, many times it takes months to get you completely out of the States’ computer systems.  To avoid this mess,  your insurance agent should be keeping an eye on this for you.  If they aren’t, change the Broker of Record to us and we’ll take care of the making the changes for you!  Remember, it doesn’t cost you one extra penny to have us as your advocate  🙂

TIP:  If you Doctor doesn’t accept any IFP plans, consider a high-deductible, Bronze, Health Savings Account (HSA) plan.  They used to be more affordable than they are now but it’s not what it is, it’s what it does.  It allows you to put money away in an account (tax-deductible going in and tax-free coming out when used for qualified medical expenses).  You can then use the HSA to pay for those Doctors’ bills.

In CA, the penalty applies if you are without an ACA Compliant plan for more than three months and will be assessed on your State income tax return.

Starting in 2020, California residents will be penalized unless you have an ‘Exemption’. Call us and we’ll discuss whether you will be exempt and what you will have to do to prove it.

NOTE:  There are many exemptions from the penalty available.  However, you must apply and be approved in advance for the exemption. Click here for more info: https://www.coveredca.com/learning-center/tax-penalty-details-and-exemptions/exemptions/

HINT -Remember, it is ok to reduce your MAGI by legal means so if you’re close to a plan being unaffordable, consider putting more money into your retirement account. We’ve seen where putting $500 in an IRA has saved our clients $2,000 because they were able to get a higher subsidy or get their MAGI so that they are in the ‘unaffordable’ area and not pay the penalty. Of course, check with your tax professional to see what else you can do to reduce your MAGI.

What are the exemptions from the CA health insurance penalty?

Click here for a full list:  CoveredCA Penaties and exemptions

The Affordable Care Act increased the age that children can stay on your health plan from 21 to 26. Then it’s time to move them to their own health insurance plan. If your child is disabled and you claim them on your taxes, they can stay on your plan.

Call your health plan and ask when the child will be terminated off the parents’ plan. Look for options a couple of months before they that date and apply for a new plan the month before it is terminated.

HIR Insurance agents are well versed in finding the right plan for young adults turning 26. And we won’t charge any more than if you had to search for yourself!

This is all just the…
TIP OF THE ICEBERG when it comes to Obamacare!

All pretty confusing, right?  We’re sure you have a lot more questions like…

• Have a child turning 26?
• When and how do I apply?
• Do I go On or Off the exchange?
• Will I be penalized for not obtaining health insurance?
• What do I do if I can’t afford my employers’ insurance?
• Can I get help with my premium?
• What happens if my premiums cost too much?  What are my options?
• Who can assist me with all of this?
• What is the penalty for not being insured?

That is where we come in!

You know that ole’ saying, “we just don’t know what we don’t know”.  The biggest issue nowadays?  Most people have no idea what questions to ask.  We will help easily guide you to the strategy and plan that is right for you.  Or if your current plan is the right one, we’ll let you know that too!

For more information please give us a call at:
323-455-4961

Also keep up to date with valuable Obamacare hints, tips and deadlines:
“Like” our FACEBOOK page!

Check out some of the reviews posted by our clients on Yelp and Google.  You may see yourself in those stories!

For more information on Obamacare visit this helpful resource:
https://www.healthcare.gov

FROM OBAMACARE TO MEDICARE…WE REALLY DO CARE!