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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…

Will You Get a Health Insurance Subsidy? You Might Be Surprised.

subsidyOne of the ironic points about the Patient Protection and Affordable Care Act on the horizon (also known as “Obamacare”) is that insurance rates are going to rise. In fact, they already have since the plans offered today are required to provide immediate benefits up front: most notably preventive care (physicals, screenings and immunizations) offered at no out-of-pocket cost to the patient.  It’s a benefit and it costs money. Read More…

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

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…

Uninsurable? Not Any More. Open Enrollment for 2014 Coverage Begins October 1.

hourglass200x133I am sure you are no stranger to the political rhetoric that has floated about when it comes to the Patient Protection and Affordable Care Act (PPACA, or more commonly referred to as “Obamacare.”). However, if you haven’t given much additional thought to health reform, here are a few points to consider:

  • Despite this debate and division over its merits, on March 23, 2010, President Obama signed the law into effect.
  • Many thought that the Supreme Court would strike down the law by ruling the individual mandate as unconstitutional; yet the Supreme Court upheld the individual mandate last summer.
  • Many thought President Obama would not be a re-elected based on his health reform-related policies; however, he was reelected. 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…

Healthcare Reform is Coming…or Is it Already Here?

longterm-careDespite all the endless debate about the merits of President Obama’s Patient Protection and Affordable Care Act (PPACA or, “Obamacare”), I think we can all agree that the health insurance industry has been in disarray. Prices have been rising for decades while care levels have been falling. The point of debate has been about who is going to fix it, who is going to take credit for the fix and whether the fix will be something more government centric or more free market centric. Read More…