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Tag Archives: health care reform

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…

Navigating Health Reform – First Dollar Coverage & Preventive Care?

matts_bro

 

One of the most common questions people ask is “Why should I buy health insurance if I am healthy? And what do I get for my premium dollar?” If your plan is health reform compliant, then it should provide preventive care at no out-of-pocket cost. And that’s not a bad start.

 

Read More…

Apples and Oranges: Understanding the Four Levels of Health Care Coverage

apple-orangeOne of the most common—and justified—complaints heard from consumers when it comes to choosing heath insurance plans is the difficulty in comparing different plans, whether it is from the same carrier or across different carriers. It has likened to the challenge of comparing “apples to oranges,” as the old saying goes. That’s one of the reasons the Patient Protection and Affordable Care Act (PPACA) has established what it refers to as the Four Metal Levels of Health Care Coverage. 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…

What is a Health Exchange?

anatomy of the exchangeAs we move through health reform, there is little question that prices are going to rise. The reality is that the Affordable Care Act (aka Obamacare) is not going to be able to deliver on its promise of affordability for some time, and part of the reason is that new regulations require that your policy become more rich, more robust, with more up-front benefits being included. This includes but is not necessarily limited to: Read More…

Uninsured Help, Health Care Affordability Help

Some great resources for the uninsured and those with affordability issues (isn’t that all of us now?)

http://jfs.ohio.gov/ohp/bcps/factsheets/HCAP.pdf
http://www.needymeds.org/
https://www.panfoundation.org/
http://www.healthwellfoundation.org/
http://coverageforall.org/
http://www.eyecareamerica.org/
http://www.cdfund.org/
http://www.ohiobestrx.org/en/index.aspx
http://healthreform.kff.org/~/media/Files/KHS/Flowcharts/requirement_flowchart_2.pdf

MyHealthQuoter.com helps individuals and families find affordable health insurance. Call (866) 577-3620 to speak with a consumer advocate today.

We will be hosting series of Health Reform Webinars on the first Friday of every month from 12-1pm. If you are interested, let us know and I’ll put you on the invitation list. Email: matt@myhealthquoter.com

The next 4 sessions:

February 1, 2013
March 1, 2013
April 5, 2013
May 3, 2013

Matthew Byrne has made a career helping people find affordable health insurance. He is the founder of MyHealthQuoter.com, a Dublin-based brokerage providing health insurance for individuals, families and corporations. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Defined Contribution Programs, COBRA, and Medicare.

Subsidy Calculator – Health Reform Premium Calculator

HEALTH INSURANCE REFORM

The health care reform law also imposes requirements on health insurance issuers to reform certain insurance practices and improve the coverage available.

• Eliminating Pre-Existing Condition Exclusions for Children. Group health plans and health insurance issuers may not impose pre-existing condition exclusions on coverage for children under age 19. This provision will apply to all employer plans and new plans in the individual market. This provision will also apply to adults in 2014.

• Coverage of Preventive Health Services. Group health plans and health insurance issuers offering group or individual health insurance coverage must provide coverage for preventive services. These plans also may not impose cost sharing requirements for preventive services. Grandfathered plans are exempt from this requirement.

• Prohibiting Rescissions. The health care reform law prohibits rescissions, or retroactive cancellations, of coverage. Group health plans and health insurance issuers offering group or individual insurance coverage may not rescind coverage once the enrollee is covered, except in cases of fraud or intentional misrepresentation. Plan coverage may not be cancelled without prior notice to the enrollee. This provision applies to all new and existing plans.

• Limits on Lifetime and Annual Limits. In general, group health plans and health insurance issuers offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for any participant or beneficiary or impose unreasonable annual limits on the dollar value of benefits for any participant or beneficiary. This requirement applies to all plans, although plans may request a waiver of the annual limit requirement. The annual limit waiver program will be close to applications effective Sept. 22, 2011. Annual limits will also be prohibited beginning in 2014.

HEALTH INSURANCE EXCHANGES

The health care reform legislation provides for health insurance exchanges to be established in each state in 2014. Individuals and small employers will be able to shop for insurance through the exchanges. Small employers are those with no more than 100 employees. If a small employer later grows above 100 employees, it may still be treated as a small employer. Large employers with over 100 employees are to be allowed into the exchanges in 2017. The health care reform legislation provided that workers who qualified for an affordability exemption to the coverage mandate, but did not qualify for tax credits, could use their employer contribution to join an exchange plan. This requirement is known as the “free choice voucher” provision. The federal appropriations bill signed by President Obama on April 15, 2011, eliminated the free choice voucher provision from health care reform.

MyHealthQuoter.com is a consumer advocacy group assist insurance shoppers navigate plan choices and enroll on the exchange. Our case managers will guide you through the process and provide customized one-on-one consultations to maek sure you the the best plan at the lowest price.

Call (866) 577-3620 for more information.

Subsidy Calculator: http://healthreform.kff.org/subsidycalculator.aspx

HEALTH INSURANCE REFORM
Additional health insurance reform measures will be implemented beginning in 2014.

• Guaranteed Issue and Renewability. Health insurance issuers offering health insurance coverage in the individual or group market in a state must accept every employer and individual in the state that applies for coverage and must renew or continue to enforce the coverage at the option of the plan sponsor or the individual.

• Pre-existing Condition Exclusions. Effective Jan. 1, 2014, group health plans and health insurance issuers may not impose pre-existing condition exclusions on any covered individual, regardless of the individual’s age.

• Insurance Premium Restrictions. Health insurance issuers will not be permitted to charge higher rates due to heath status, gender or other factors. Premiums will be able to vary based only on age (no more than 3:1), geography, family size, and tobacco use.

• Nondiscrimination Based on Health Status. Group health plans and health insurance issuers offering group or individual health insurance coverage (except grandfathered plans) may not establish rules for eligibility or continued eligibility based on health status-related factors.

• Nondiscrimination in Health Care. Group health plans and health insurance issuers offering group or individual insurance coverage may not discriminate against any provider operating within their scope of practice. However, this provision does not require a plan to contract with any willing provider or prevent tiered networks. It also does not apply to grandfathered plans. Plans and issuers also may not discriminate against individuals based on whether they receive subsidies or cooperate in a Fair Labor Standards Act investigation.

• Annual Limits. Restricted annual limits will be permitted until 2014. However, in 2014, the plans and issuers may not impose annual limits on the amount of coverage an individual may receive.

• Excessive Waiting Periods. Group health plans and health insurance issuers offering group or individual health insurance coverage will not be able to require a waiting period of more than 90 days.

• Coverage for Clinical Trial Participants. Non-grandfathered group health plans and insurance policies will not be able to terminate coverage because an individual chooses to participate in a clinical trial for cancer or other life-threatening diseases or deny coverage for routine care that they would otherwise provide just because an individual is enrolled in such a clinical trial.

• Comprehensive Benefits Coverage. Health insurance issuers that offer health insurance coverage in the individual or small group market will be required to provide the essential benefits package required of plans sold in the health insurance exchanges. This requirement does not apply to grandfathered plans.

• Limits on Cost-Sharing. Non-grandfathered group health plans will be subject to limits on cost-sharing or out-of-pocket costs. Out-of-pocket expenses may not exceed the amount applicable to coverage related to HSAs and deductibles may not exceed $2,000 (single coverage) or $4,000 (family coverage). These amounts are indexed for subsequent years. Further guidance on which plans will have to apply these limits would be helpful.

MyHealthQuoter.com is a consumer advocacy group assist insurance shoppers navigate plan choices and enroll on the exchange. Our case managers will guide you through the process and provide customized one-on-one consultations to maek sure you the the best plan at the lowest price.

Call (866) 577-3620 for more information.

Subsidy Calculator: http://healthreform.kff.org/subsidycalculator.aspx