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2020 Open Enrollment Period is Nov 1st - Dec 15th, 2019
Avoid the glitches of signing up, Agent Express Signup Links: BCBS, UHC, Cigna; The insurance company you choose will interact with Healthcare.gov (or FFM) to determine your official subsidy (if qualified) and then you can complete your enrollment by the deadline of December 15th, 2019. (Agent/Broker...NPN#8771610). To File An Appeal with the Marketplace (pdf)
Health Insurance (Marketplace Plans)
CLICK HERE - Out of protection gap plan
Dental/Vision Insurance
CLICK HERE - PPO Dental/Vision Plans
AGCY
Understanding Healthcare Reform...Rates, Penalties, Subsidies, Premium Rebates
Guaranteed Issue: Insurance companies must sell coverage to everyone regardless of pre-existing conditions and can't charge more because of health or gender.
QUALIFIED HEALTH PLANS (or QHP's) are being offered by BlueCross BlueShield and other carriers. Private Health Insurance Companies involved in the Affordable Care Act "Obamacare" must abide by the Government Rules in order to participate. For increased transparency, insurance carriers must allow review of rates as part of the qualification process. Government experts will monitor and review each carrier's rate hikes.
Example: Insurance Companies are not allowed to charge an older adult over 3 X rate of a 21 year old.
The Penalty
Unknown Status (Individual shared responsibility in 2020 TBD)
Everyone is required by law to have health insurance and must be enrolled in a QUALIFIED HEALTH PLAN (QHP) that includes all the minimum Essential Health Benefits (EHB) in order to avoid the Annual Tax Penalty (based on LINE 37 of IRS Form 1040).
In 2018, individuals owe 1/12th of the Annual Payment for each month they (or their dependents) did not have coverage and were not exempt. Individuals without coverage for less than 3 consecutive months during the year may qualify for the Short Coverage Gap Exemption and will not have to make a payment for those months. The Short Coverage Gap Exemption only applies to the first coverage gap during the year:
The Penalty in 2019 is 2.5% of household income (or $695 per adult and $347.50 per child up to a family maximum of $2085), whichever is GREATER.
After 2016, the tax penalty will increase annually by the cost-of-living adjustment.
Example of the Penalty in 2019: Someone earning $50,000/year who chooses not to obtain health insurance with EHB will be penalized $1,250 not $695 (in 2017); the penalty could be affording several months of coverage instead.
Example #2 of the Penalty in 2019: Someone earning $1,000,000/year who chooses not to obtain health insurance with EHB will be penalized $25,000 not $695 (in 2017).
The Exemptions
If you already have Medicaid, CHIP, Medicare, VA, IHS, TRI-CARE, or Employer Coverage, you're not required to obtain a QHP in order to avoid the annual tax penalty.
Example: In Houston (Harris County), the Community Harris County Hospital District (HCHD) or "Gold Card" is not a QHP and does not exempt anyone from paying the penalty. Doctors working in the HCHD are limited on how much they can provide based on funds available in the county and the severity of health problems. There are no limits with Affordable Healthcare. QHP's are major medical policies.
With the passage of the Healthcare Reform Act into Law, there are major changes within the health insurance industry. It's important to make the right plan selections that best fit your situation. The new changes are in effect and everyone has access to new plans inside the marketplace.
Choosing The Right Plan...We can help!
Licensed Agent/Broker: William Reynolds
FFM User Id (Healthcare.gov): wreynolds
NPN#: 8771610
"On Exchange" Health Plans
4 Metallic Levels of generosity to choose from:
Gold (80%)
Silver (70%)
Dr Office Visits in the Silver Plans (with copays).
Bronze (60%)
Bronze Plans (all 4 metallic levels) provide Preventative Services without fees (or upfront deductible).
Catastrophic Plan
BlueCross BlueShield "On Exchange" Plans
BCBS Agent#: 053501000
Agent Express Signup Link
Blue Advantage HMO Network Plan Benefits
the numbers represent Deductible/Maximum Out-of-pocket see Definitions
BCBS Network Physicians
United Healthcare "On Exchange" Plans
UHC Agent#: 8771610
HMO Plan Benefits
UHC Doctor Network
One of the main purposes of Healthcare Reform is to make healthcare affordable for everyone.
Dependents age 26 or younger can stay on their parents health plan. If you're age 29 or younger and filing your own taxes...or qualify for a hardship exemption, you can save by enrolling into a Catastrophic Metallic Level Plan which is essentially a safety net:
Individuals who purchase health insurance through the new health insurance exchange will be eligible for financial assistance (or Subsidy) if their income is no more than 400% of the federal poverty line. Qualification is based on total household income.
Calculate Your Subsidy (APTC & CSR)
The only reason to buy a plan "On Exchange" through the marketplace is to qualify for a Subsidy; otherwise you can find your plan "Off Exchange". The "Advanced Premium Tax Credit (APTC)" Subsidy assists in paying for the monthly premium and is available on all 4 metallic levels of generosity. Enrolling into a Silver Plan or above can qualify you for a second subsidy - the "Cost Sharing Reduction (CSR)" Subsidy assists in reducing Deductible/Max Out-of-pocket and Co-insurance. Some enrollees will qualify to receive both the APTC and the CSR subsidies.
An individual earning up to $49,960 can qualify for the APTC Subsidy; a family of 4 can earn up to $103,000 and still qualify for the APTC Subsidy. The table shows the maximum amount of household income allowable (based on # household members) to qualify for APTC.
Family Composition
Max Household Income for APTC Subsidy
1
$49,960
2
$67,640
3
$85,320
4
$103,000
5
$120,680
6
$138,360
7
$156,040
8
$173,720
Click Here for a Subsidy Estimate Calculator
Premium Rebates (Medical Loss Ratio)
Healthier Enrollees Could Get A Premium Rebate (this is not a Subsidy) From Their Insurance Company due to the Medical Loss Ratio (MLR) requirements.
80/20 Medical Loss Ratio (MLR) Health Insurance Companies must spend 80% of premiums received on providing healthcare to consumers. Insurance company profits are limited to no more than 20% while 80% of premiums are used on healthcare; the 20% also includes administrative costs, salaries, and expenses.
MLR is not calculated by individual policy, but at the State Level (standard population level). Members enrolling into their health plan could get a Premium Rebate from their insurance company at the end of each year consisting of unused premiums that were not used towards healthcare.
Example: Someone who rarely goes to the doctor gets a bigger rebate check from their insurance company than someone who goes to the doctor often.
Some will qualify to receive both Subsidy and a Premium Rebate from their insurance company depending on their circumstances. Others will qualify for Medicaid based on their total household income according to the federal poverty line. More and more states have been expanding Medicaid due to Healthcare Reform. Click Here to view the State-by-State Medicaid Expansion Map.
Obtaining health insurance is required by law, but more affordable due to the ACA. The cost of your health plan will be based on your age, income, location, and the plan you choose. Everyone will have health insurance, an exemption, or pay an IRS Annual Tax Penalty for not obtaining coverage by December 15th, 2018.
If you need a plan starting...
Buy it...
.
"On Exchange" Open Enrollment ends December 15th, 2019
"Off Exchange" plans available here
CLICK ON THE LOGO TO CHOOSE YOUR PLAN!
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Our Agent Info
Use this info when creating your Marketplace Account on Healthcare.gov
Agent/Broker Name: William P. Reynolds
FFM User ID: wreynolds
Thank You!
*Agent Contracting for CUL's "GAP" & D/V/H