Informed on Reform


Paul Cholak - Principal
Licensed Insurance Agent


November 2017 - In This Issue:

We Offer:
  • Individual and Family Health Insurance (Affordable Care Act)
  • Health Plans for Medicare Beneficiaries
  • Life Insurance
  • Pre-Need Funeral Arrangement Plans
  • Final Expense Insurance
  • Life Insurance for Diabetics and Other Hard-to-Insure Individuals
  • Annuities
  • Dental and Vision Care Coverage
  • Supplemental Health Insurance
  • Prescription-Only Drug Plans
  • International Travel Medical Insurance
  • Disability Insurance
  • Short-Term (Recovery) Care Insurance
  • Long-Term Care Insurance
  • Pre-paid Legal and Identity Theft Plans
About our Principal,  
Paul Cholak

Paul holds resident (Florida) and non-resident life, health and annuity licenses in 31 other states and is registered to sell individual and SHOP plans on the Federal Facilitated Marketplace.  He also has a Florida pre-need sales agent license,
In addition, he's also appointed to sell Prepaid Legal Expense and Identity Theft Plans.

He has many years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms.

Paul negotiated the first labor contracts that included the concept of "reasonable and customary" reimbursement and also implemented the first group dental insurance plan.  

He knows all aspects of individual and family health insurance and has extensive experience with group plans, as well.

He's available 24/7 and stays in touch with his customers before and after they've made their insurance purchase.  He's always available to help customers who have claims or other problems with their coverage or have any questions about their policies.

He's a recipient of the prestigious Albert Nelson Marquis Lifetime Achievement Award and been listed in Who's Who in America, Who's Who Registry of Business Leaders and Who's Who in Finance and Industry. Early in his career he was identified as one of the Emerging Leaders in America. 

He's a member of Phi Beta Kappa and other national honorary societies and organizations such as Omicron Delta Kappa. He's also an Ambassador with the Boca Raton Chamber of Commerce. He's a graduate of certificate programs from a number of prestigious institutions, been invited to speak at corporate and university training programs, been featured in articles in national books and magazines, and is also a published author.   

ACA Open Enrollment Begins November 1
Open enrollment for ACA plans begins November 1, and all carriers will be offering their on- and off- Exchange plans as of that date.  Please note that not all carriers offer plans both on and off the Exchange.  (AvMed offers only off-Exchange plans, for example.)
Open enrollment is compressed this year. Open enrollment runs only from November 1--December 15 for a 1/1/18 effective date.

In previous years, individuals could apply for effective dates of February 1 and March 1 if they applied after December 15 but before February 1, but that won't be permitted this year.

The ONLY effective date that can obtained is January 1, 2018.
Carriers are sending renewal notices for next year's plans. Some individuals with Molina are receiving more than 100% rate increases after subsidies are applied, so most of those with Molina plans will want to change to other carriers. All individuals who had Humana and Aetna plans will also need to change plans. as those carriers will no longer be offering ACA plans..

I've been contacted by some policyholders who have received letters from AvMed that contained close to 100% increases.
Except for highly subsidized people on the Exchange who are eligible for Cost Sharing Reduction plans, most others will probably receive rate increases (and some will be significant) if they remain on the plan they have. HOWEVER, there ARE alternatives, so please call us at 877-734-3884 to discuss.

Note: Carriers are sending notices concerning net premiums (i.e. premium less any subsidy) for next year, but at least one carrier (Florida Blue) has sent notices that include ONLY the gross premium.

IF YOU HAVE A FLORIDA BLUE PLAN AND ARE SUBSIDY-ELIGIBLE, THESE NOTICES ARE IN ERROR.  Please contact us after November 1 at 877-734-3884, and we can provide estimates of what your actual net premiums will be.
We"ll attempt to communicate with all our ACA clients prior to the end of the first week of November concerning their alternatives. Please call us at 877-734-3884 if you receive notice from your carrier and want to speak with us before we're able to get in touch with you.
Highest Insured Rates By State
Here is an article and slide show that shows the number of uninsured individuals in the 10 states with the highest uninsured rates. Note that Florida has the third highest uninsured rate and Texas has the highest.

I've seen projections that project ACA enrollments will decline significantly this year.
IRS Issues Statement They'll Enforce Tax Payment Penalties And Audit Returns To Verify Individuals Report Insured Status
While some members of the Administration, including the President, have said the government won't enforce payment of tax penalties and reporting of ACA covered status, the IRS issued a contradictory statement that they WILL audit returns for reporting of ACA status, reconciliation of tax credits, and payment of tax penalties.
Some clients have told me they don't intend to pay any tax penalties, won't reconcile tax credits against actual income, and report whether or not they had ACA coverage for 2017.
I've been advised that software programs like Turbo Tax WILL require reconciliation and will calculate tax penalties in their 2018 programs.
You should speak with your accountant for advice on this issue if you don't intend to comply.
Update On Recent Executive Orders and Announcements
Only two of the items in the Executive Orders and Announcements reported in the special bulletin on this subject that we issued early in October should have immediate impact.

The decision to stop sending payments to insurance companies to fund Cost Sharing Reduction (CSR) programs has been implemented. (However, there is increasing pressure on the President to reinstate payment for the CSR's.) Some states already anticipated this development and increased premiums to account for this.

The law requires carriers to provide Cost Sharing Reduction plans whether or not they receive payment from the government. As a result, we've been advised that individuals eligible for silver Cost Sharing Reduction programs and whose income falls between 100 and 200% of the Federal Poverty Level should experience little or no effect, although it's possible that those in the 200-250% range may see slight increases in required cost sharing (e.g. co pays, deductibles, and out of pocket maximums).

It's anticipated that short-term health insurance policies that offer coverage for up to 11 or 12 months (varies by state) will be reinstated early next year.  Short-term policies that offered coverage for up to 12 months were no longer permitted to be offered starting April 1, 2017.

For now, individuals can only buy a short-term policy for a maximum of 3 months, but some carriers have established procedures whereby individuals can qualify for up to four 3-month policies when they first apply and only have to answer health questions when they buy their first policy. (However, the requirement to actually apply for each policy at the expiration of the previous 3 month policy still applies.)

Senators Alexander (R) and Murray (D) are working on bi-partisan legislation that will fund CSR payments and on other items of agreement. However, President Trump has signaled that he won't support a bi-partisan effort at least for now.
Paul Cholak