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Category Archives: Obamacare

Hit with a Penalty for 2014? Then the Extra Enrollment Period is for YOU!

EEP_signOn February 20, 2015, The Washington Post and countless other news outlets reported that Americans hit with the new federal tax penalty for not having health insurance coverage will have more time to purchase a health plan for this year.

The Obama administration announced that up to six million Americans are expected to face the Affordable Care Act penalty for not having health insurance in 2014. Those living in 37 states relying on the HealthCare.gov enrollment portal who would have to pay the 2014 and 2015 penalty will now be able to purchase coverage between March 15 and April 30, 2015. Read More…

Seven Tips to Navigate Health Reform

CMS Announces Special Enrollment Period for Tax Season

Eligible consumers have from March 15 through April 30 to enroll in coverage


The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30.  If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:

  • Currently are not enrolled in coverage through the FFM for 2015,
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they 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 their 2014 taxes.

The special enrollment period announced today will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015.  If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Here are seven vital tips to navigate health reform for 2015 and beyond. Be sure to download the PDF flier with this information to print and share.

ONE:  As of January 1, 2014—All new plans on or off the federal exchange marketplace are guaranteed issue with no exclusion of pre-existing conditions—which means the insurance company cannot deny you for coverage and they can’t exclude any of your medical conditions. Read More…

DEC Presents: Affordable Care Act 101 (Live Event from Sept 19, 9-11am)

DEC Presents: Affordable Healthcare Act 101

Join us on Thursday, September 19 from 9:00am – 11:00am in the 1st Floor Training Conference Rm.


“Health Reform – Navigating the Changes in Healthcare”


Learn about The Affordable Care Act

The newly enacted federal Patient Protection and Affordable Care Act makes sweeping and dramatic changes to how employers manage their employee benefits. It is crucial that employers stay abreast of changes that will immediately impact their businesses as well as begin preparation for future requirements that will have financial and administrative impact. Join us as we map out how reform affects businesses and individuals alike. The seminar will inform business owners, employers and human resource professionals on the latest information about health reform and how it will directly impact businesses.


Topics Covered:

· Employer Mandates

· Individual Mandates

· Coverage Expansion to Dependents

· Small Business Health Insurance Tax Credit

· Exchanges

· Medical Loss Ratio (MLR)

· Grandfathering

· How to stay in touch with new developments

· Early retiree reinsurance program

This Presentation will provide:

1. Deconstruction of the Bill and Its Provisions

2. A Timeline of Provisions and Employer Responsibilities

3. Practical Steps to Comply with the Law

4. Anticipated Changes to Benefit Plan Design, and the Role of Wellness Programs

This seminar will examine these impacts, analyze the options and opportunities and present what this means to you, your employees and your company. This conference will be useful for business owners, human resources professionals who are responsible for managing their employee benefit programs, health care providers and others involved in the health care industry.

Presenters: Matt Byrne & Barry Darryl Peel

Barry Darryl Peel is an Economic Development Specialist, Veteran Representative and Affordable Care Act Specialist with the U.S. Small Business Administration, Columbus District Office. Barry is responsible for creating and maintaining relationships with banks, chambers, economic development agencies, small businesses and small business assistance agencies. Barry brings over 15 years’ experience working with small businesses, especially Minority, Women and Immigrant owned.

Matt Byrne is President of MyHealthQuoter.com, a division of Spiralight Group, a health insurance brokerage specializing in affordable solutions for individuals, families and employer sponsored plans. Matt has a Bachelor of Arts degree from Boston University and holds a life and health insurance license.

He serves on the board of Central Ohio Professional Education Council (COPEC) and the Foundation Board of Trustees for First Community Church.


The Dublin Entrepreneurial Center is located at 565 Metro Place South, Suite 300, Dublin, Ohio 43017. For more information visit our website or even better join the conversation on twitter, facebook, or LinkedIn.

10 Tips You Need to Know About Health Reform (federal exchange marketplace)

You have questions and we have answers.  Because we value your time, we’ve quickly summarized the 10 things we believe you need to know to help you navigate health reform. For those who want a deeper look, access to a recording of our hour long webinar, a link is provided at the end of this post.

#1) On January 1, 2014 – All plans on or off the federal exchange marketplace will be guarantee issue with no exclusion of pre-existing conditions which means the insurance company cannot deny you for coverage and they can’t exclude any of your medical conditions.

#2) If you want a 01/01/2014 effective date, your broker will help you enroll in a plan between October 1-December 14, 2013.  Applications submitted on 12/15/2013-01/14/2014 will be effective 02/01/2014.

Marketplace subsidies available to those under 400 FPL

Marketplace subsidies available to those under 400 FPL

#3) The deadline to enroll in a 2014 health reform compliant plan, be it on the federal exchange or through the private market is 03/31/2014. If you miss this window, you will not be able to enter the system until 01/01/2015, unless you qualify for a special enrollment.

#4) Anyone making under 45,960 (single), $62,050 (couple) or $94,200 (family of 4) will receive federal subsidy to help you pay for your health insurance. If you are eligible for a subsidy, your broker will assists you in purchasing your health plan on the exchange marketplace and you will receive an immediate premium discount at the time of purchase, no extra forms, no waiting.

#5) If you are eligible for subsidy, you will buy your insurance on the federal exchange marketplace, with help from your broker.

#6) If you are NOT eligible for subsidy you will buy your insurance, with the help of your broker, OFF the federal exchange marketplace.

#7) All Americans will be required to purchase health insurance or pay a fine.

#8) You may keep your current plan but upon its renewal in 2014, it will be converted to a more costly Health Reform compliant plan.  Speak with your broker to determine if early renewal is right for you.

Community Rating Changes How We Are Charged for Health Insurance

Will my health claims affect my rate?

#9) The amount you pay for insurance will NOT be determined based on your health history.  Everyone of the same age, in the same zip-code, will pay the same amount. Except for smokers who will pay a lot more.

#10) Prices for 2014 plans are expected to cost significantly more than plans today due to Health Reform mandates.  The 2014 plans are richer plans, more robust than 2013 plans and therefore will cost more.



Before you take the next step you need to consider your health, age, income and current coverage options to determine if you should move quickly into a Reform compliant plan or take steps to delay your entrance into the world of Obamacare.

Feel free to call or email MyHealthQuoter.com, so that we can schedule a time to analyze your unique situation.


Some other resources for your review:

If you know anyone who has questions about Health Reform, please share this 2 minute animated YouTube video we created to help, http://youtu.be/-YUAPJssBOc

War Stories from Health Reform (Webinar Recording); www.anymeeting.com/myhealthquoter/EE55DD888747

Our website; http://www.myhealthquoter.com/ (A Private Health Insurance Exchange)

Our Blog; http://www.ohioindividualhealthinsurance.net/?p=625 (7 part Blog about Health Reform, among other things)

Facebook: http://www.facebook.com/pages/MyHealthQuotercom/31908081738?fref=ts

LinkedIn; www.linkedin.com/in/matthewsbyrne/

Twitter;  https://twitter.com/myhealthquoter


About The Author…

matt_81x106 Matthew Byrne has made a career helping people find affordable health insurance in Ohio. He is the founder of MyHealthQuoter.com, a Dublin-based brokerage providing health insurance quotes in Ohio, and additional services for individuals, families and corporations. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Defined Contribution Programs, COBRA, and Medicare. He can be reached at (614) 336-3636, and online at www.MyHealthQuoter.com.

Need a Health Reform Speaker? Find Matt on COPEC! http://copeceducation.org/speaker/Matthew.Byrn

Will congress defund health reform?

Defund or Delay? Don’t Count On It.

National Health Underwriters reports,

It’s been widely reported that when Congress returns from August recess, some Republican lawmakers hope to tie defundreform defundinging of health reform provisions to the overall federal government funding continuing resolution that needs to be passed by September 30. Many of these lawmakers have proclaimed defunding as their last and best hope to stop health reform implementation. As an alternative, some conservative groups have endorsed a one-year delay of all of the provisions of the law slated to take effect on January 1, 2014.

Not everyone in the GOP agrees. Many conservative thought leaders and political leaders, including Representative Paul Ryan, Senator Tom Coburn, Mitt Romney among others, have said they think the defunding plan is a bad one. Representative Tom Cole, who before being elected to Congress was a national GOP pollster and political operative, has even predicted that going forward with a defunding strategy could cost the GOP the House of Representatives in the 2014 midterm elections. Polling data bears that out—a recent health policy tracking poll shows that by a 2-1 margin voters say they will be less likely to vote for their member of Congress in 2014 if they support a health reform defunding effort tied to a government shutdown.

It’s important to know that the train has left the station.  Health Reform and 90% of its major provisions will spring to life on 01/01/2014. It’s important to get a game plan to determine how you will navigate health reform.  All politics aside, there are some critical decision (with potentially long term impact) that each of us must make this fall. Finding the right health insurance quotes in Ohio will take time and a clear understanding of where you fit into the system.

Here is a partial list of the provisions set to arrive in 2014.

  • All health products will be guarantee issue with no pre-existing condition exclusions.
  • No health status rating; ratings limited to
    • Age 3:1
    • Tobacco 1:5:1
    • Family Size
    • Geography (notice how your medical claims history and prescription use has no impact on how much you pay)
  • Health Insurance products must exhibit at least 60% “actuarial value”, must cover “essential health benefits”
  • Employer mandate (penalty delayed until 2015 but measurements for penalty will occur in 2014)
  • Individual mandate (all individuals are required to have health insurance, starting 01/01/2014)
  • Exchanges – an online marketplace where those eligible for federal subsidy will buy health insurance (starts 10/01/2013)

Many individuals are more comfortable with professional assistance when making decisions that involve detailed and confusing material.  Evaluating Health Reform coverage, federal subsidy money available and the complex enrollment on the exchange marketplace is unlike any other healthcare program you have evaluated in the past.  Mistakes can be costly.  This is why we developed our Health Advocate Program.

A Health Advocate will provide one on one consulting is designed to provide you the information and assistance you need as you navigate through all your options so you can confidently choose what is best for your personal situation.

About The Author…

matt_81x106 Matthew Byrne has made a career helping people find affordable health insurance in Ohio. He is the founder of MyHealthQuoter.com, a Dublin-based brokerage providing health insurance quotes in Ohio, and additional services for individuals, families and corporations. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Defined Contribution Programs, COBRA, and Medicare. He can be reached at (614) 336-3636, and online at www.MyHealthQuoter.com.

Need a Health Reform Speaker? Find Matt on COPEC! http://copeceducation.org/speaker/Matthew.Byrn

Leveling Insurance Premiums with Community Ratings: The Good News and the Bad

levelLast week, we talked about how the time for open enrollment is fast approaching—at which point those individuals who are presently “uninsurable” will no longer be declined coverage. This enrollment period begins October 1 for coverage to take effect January 1, 2014. We also mentioned how the structure of insurance rates will also change under the Patient Protection and Affordable Care Act (PPACA).

Under Obamacare, insurance premiums will be determined by something called “community ratings.” Read More…

Do You Have a Health Insurance Advocate?

HEALTH REFORM INDIVIDUAL MANDATEWhen it comes to health insurance, one of the most common complaints I hear from people is that it’s way too complicated and confusing. Further, when they talk with agents, it’s almost as though the expert they are speaking to trying to keep them in the fog, as opposed to clearing the air.

Further, as we get closer to the full deployment of the Patient Protection and Affordable Care Act (also known as Obamacare), many people, especially those in business with employees, are realizing that health insurance is not getting simpler. In fact, it is becoming even more complex than before. Read More…

Switching Up Your Grandfathered Health Plan: Hit the Gas or the Breaks?

4364595229_e4b455182c_mA few weeks ago I posted an article about some of the changes in President Obama’s Patient Protection and Affordable Care Act (PPACA or, “Obamacare”)—changes that were not forthcoming but were already here. This is still news to many people, despite the fact that the vast majority of change is due to go into effect come January, 2014.

Most of those previous changes went into effect in September, 2010. If your health plan predates that time, it is likely “grandfathered,” which means that it is not subject to most of the new mandates. Because of these mandates, according to the PPACA,  the vast majority of policies issued since September, 2010 must now include: Read More…

Why is the Cost of Healthcare So High?

Pill bottle with cash inside BEThere are a lot of factors that have led to the rising cost of healthcare.  Even with health reform, intended to reign that in, it will probably be decades in the making before we completely solve that equation. However, one of the key factors that drives the cost of health care—and health insurance—is consumption.

How you access care is a huge factor in determining how much that care costs.  For example, if you go to ER or wait for your chronic illness to become acute before you seek treatment or help, that is going to put a huge burden of cost on the system. Indeed, it will cost much more to treat that illness later in the game (often with less desirable results) than it would have been had the illness been diagnosed and treated earlier. It’s the classic “cost of prevention” scenario. That’s why, in the effort to reign in control of the cost of healthcare, there is such a focus on wellness and prevention. Read More…