I have revised this month's newsletter 4 times due to the constant changes. Most recently, the individual enrollment system at www.healthcare.gov was postponed once again. The small business marketplace known as SHOP was postponed until November 2014. Affordable small group plans are available with start dates as late as 12/28/13.
As part of a press conference held to address recent issues related to the Affordable Care Act, President Obama announced that some individual clients may now keep their current previously cancelled plan for another year. He left it up to each state's Insurance Commissioner to decide for their jurisdiction.
The decision is designed to ease the impact on individuals who have received cancellation notices from their health insurance company because the policies do not meet essential health benefit requirements under the Accountable Care Act (ACA). The administration has known since 2010 that a vast majority of plans would be canceled but did not feel this would be a problem. This decision should have been made before the Marketplace opened. It was only made now to alleviate the pressure of healthcare.gov enrollment site not working.
Health Insurers will be required to notify individuals that have policies that predate the ACA that other benefit alternatives are available under the ACA and also must specify the areas of their current plan that fall short of ACA essential benefits.
The President's announcement does not impact employer sponsored health care benefit programs.
We are carefully evaluating the announcement and awaiting further guidance. We understand that you probably have many questions right now. While we do not have all the answers, neither does anyone else. We do know that our efforts to work with federal and state regulators will continue as we determine how to implement the Affordable Care Act, and we must comply with any new requirements. Our ultimate objective is to continue to provide affordable and high-quality health insurance choices to all consumers.
As we learn more, we will continue to share important information and will also communicate with customers as appropriate. Now more than ever, our role as trusted advisor is key to the success of your future coverage. We know you value the role agents have served for more than 120 years as the personal distribution avenue for insurance - and we remain committed to helping you be informed and successful in your insurance choices. We appreciate your loyalty.
Blue Cross Blue Shield & Anthem has decided to move all current individual clients to a Keep Fit plan with similar coverage to the current plan you may have. The new plan will be effective 12/31/13. Stay tuned for additional information. There are logistical issues involved. The internal software system for 2014 may not allow for the compatibility of current plans and new PPACA plans since it wasn't designed to. In addition, the upcoming holiday closures create a short time frame for which changes are to occur.
If this decision of the Administration was made earlier in the year, it would have avoided a lot of headaches. We have been fighting for your rights to keep your current plan and shop for something better. Freedom of choice has been your right and we advocate personal decisions for highest satisfaction in using health insurance benefits.
We will keep you updated to the options available. We anticipate resolution by mid-December. Thank you for your patience during this time of transition.
2014 Blue Cross Blue Shield plans include choices of 3 networks, availability depends on where you live. The Partner plan is available only in Kent, Muskegon, & Oceana county and includes only the Mercy Health System. The Preferred plans include the Blue Care HMO Network and the Premier plans include the BCBS PPO network. Plan choices are the same benefits but pricing varies depending on which network you choose.
"If you like your health insurance plan"... most individuals can keep it until 12/31/14 (with the exception of BCBS), & groups can keep it until they renew in 2014. Most of you are safe for this year and most of next! That was a big accomplishment and we are working hard to keep options affordable for you. If you haven't spoken with us yet, please contact us at your convenience. Having an agent is more important than ever with all the changes and complications of our industry. Thank you for your trust in our services. You have no idea how difficult all the new rules are, it's up to 18,000 pages of legislation!
Now for those who were looking forward to new expanded options for health insurance. It's been a really long and frustrating month since the www.Healthcare.gov website opened. This is the Affordable Care Act enrollment system we've been waiting for as it's the only way for us to assist with enrollments. If you watched the news even once in the past month, you know it's been a disaster. The "Marketplace" is the new term for the exchange which is a government run website to enroll in coverage and have the government help pay your premium. If you make too much money to receive a subsidy, or do not wish to apply for a subsidy, it is not a good idea to enroll thru the Marketplace. Contact us directly to discuss your best options. Here's a link to determine if you are eligible to receive a subsidy and approximate amount. http://kff.org/interactive/subsidy-calculator/
Keep in mind, this is not a guarantee of your actual subsidy....naturally it's complicated. I've tried 3 different calculators and they each gave me a different answer. You'll get a firm subsidy commitment when you apply. Some have found they receive a letter in the mail from Health & Human Services confirming a different subsidy amount than what was offered during the application process. Keep in mind the final adjustment will be made on the 2014 tax return.
Please complete this subsidy application and return to our office for processing.
DOWNLOAD SUBSIDY APPLICATION HERE
It is the first step in applying for coverage through the Marketplace. It is the paper version of what's not working on www.Healthcare.gov. You will get a response letter in the mail from HHS telling you how much your subsidy is, then we can assist with your online application.
If you choose to set up a user name and password on
www.healthcare.gov, you will need to enter our agent information in Step 3 in order for us to assist you and be your agent on the policy. It cannot be added later. If you've already set it up and want our help, you can create a 2nd user name and password and abandon the first one. Please keep the following information for future reference:
Federally Facilitated Marketplace Enroller# JKINZIE49316@616
and National Producer# 8049289
We are ready for 2014 and can provide quotes and plan designs from our www.GLIBrokers.com website for both on and off the Marketplace plans. All plans sold for effective dates in 2014 comply with the new Affordable Care Act mandates and the rates are the same for both on and off the Marketplace. The difference being that if you buy off the Marketplace, you will not have the opportunity to receive a subsidy. Some carriers are not participating with the Marketplace, and some are in a limited area. You may shop our website anytime without having a user name and password. We do not collect any additional information which is not required for viewing quotes. Feel free to check it out to see what's available and share it with those who wonder about 2014 rates and plans. Our website host is currently working with the government to create a private exchange option that works to enroll people with subsidies outside of www.Healthcare.gov. This would be exciting for us since the site would actually work!! We have all the information about the plans and rates on our site that you would see if you logged on to the gov't site, but without the hassle. Currently we can enroll off the Marketplace since the way the system is set up is that the ONLY way to enroll with a subsidy is thru www.Healthcare.gov. We can assist with Marketplace enrollments, so please ask for our help!
Warning: The rates are high! Anyone needing insurance should buy a 2013 plan if at all possible. Rates will never be this low again. Tell your family and friends not to wait any longer to call for personal assistance. This is the biggest social change in America since Medicare started in the early 60's. It is the introduction of expansion to a single payer system, otherwise known as socialized medicine. England has found that socialized medicine is too costly and they are working towards privatizing their coverage, the exact opposite direction our country is taking. But this is the law of the land, so here's a summary of what to expect in the new Affordable Care Act plans:
Typical out of pocket maximums on 2014 Bronze & Silver plans is $6,350 per individual and $12,700 per family. Family plans require the entire family deductible to be met before benefits are paid, so no more individual deductible within a family. Contrary to current plans, deductible comes first, then copays begin, so anticipate significant out of pocket prior to having a copay. However, all eligible medical expenses accumulates towards the maximum out of pocket, deductible, coinsurance, copays, and prescription costs, so that's a good thing. Priority Health has some plans which offer 4 copays before deductible for a higher price. Lower out of pocket maximums are available on Gold & Platinum plans. Platinum plans are only available off the Marketplace without a subsidy.
2014 Rates are averaging from $300-$1300 per adult, depending on zip code/county, age and tobacco use. Government subsidies can reduce the monthly premium you pay and are based on modified adjusted gross income (Line 37 of Tax Form 1040 if you itemize). If you have adult children on your plan, you need to include their income also. We can calculate the subsidy for you or you can try the online calculator link shown above.
Things to remember for subsidies:
If your employer offers you coverage, you are probably not eligible for a subsidy. It's complicated here and the government deems 9.5% of your w-2 wages as "affordable coverage" and only if your contribution to your group health premiums cost in excess of that amount, you can apply for a subsidy. If your family is eligible for your group plan, they cannot get a subsidy, even if your employer doesn't contribute towards their costs.
The government sends the subsidy money to the insurance carrier each month. When you file your 2014 taxes, an adjustment will be made for the amount of the subsidy calculation based on actual income. It is important to be as accurate as possible when you apply for coverage, so you don't have a tax consequence later. When you apply, you have a choice to reduce the monthly subsidy applied, if you feel your future income will be higher.
Subsidies are paid for with new taxes and adding to our national debt. Insurance isn't free. It will make the cost to use health care rise. You must carry major medical insurance a minimum of 9 months in 2014 to avoid a tax penalty.
New Plan details emerge and Health Maintenance Organizations (HMOs) are making a comeback. HMOs require your care to be coordinated by your primary care physician and approved prior to use. Only HMO network providers are available. There is no coverage outside the HMO network unless a life threatening emergency arises.
Humana and Bronson in Kalamazoo are planning to end their network relationship at the end of the year, unless they arrive at a compromise. Humana is only participating in the Marketplace in the 3 counties around Detroit. Humana will sell plans statewide for those who wish to purchase outside the Marketplace, those not eligible for a subsidy, and those who like Humana's services. Current 2013 Humana medically underwritten individual plans are available until 12/27/13. Humana no longer offers group medical insurance in Michigan. Humana is only participating in the Marketplace in MI in the tri-county area surrounding Detroit.
Priority Health has HMO and PPO network choices. Priority Health plans have select benefits before the deductible, such as 4 Dr./Urgent Care/ visits before deductible. While this raises the cost of coverage, it offers more of a plan you can use. Priority Health HMO is not a good choice if you plan to use South Bend IN hospital systems and providers.
Plan coverage is determined by county. Not all carriers are available in each county. Blue Cross and Priority Health are the major carriers in Michigan. In addition, a few smaller carriers are available in Southeastern MI. Six carriers pulled out of the Marketplace already, and more pulled out of MI all together. We are seeing a reduction in competition, which typically leads to higher rates.
10 Essential Health Benefits are included in the new plans. (click for list). Pediatric dental and vision for children is a new benefit some may find useful, but be aware these limited benefits don't start until after deductible. Clinical trials are those which are near FDA approval and show promise to save lives, not just for data collection. Most of the essential health benefits are already included in your current coverage with the exception of maternity coverage which is currently only available thru group plans.
The Benchmark Plan used in MI for all plans to be based on is the Priority Health HMO 70. What does that mean to you? This plan doesn't cover as much as what you are accustomed to in most areas, but has coverage in other areas you may or may not need. On the new plans, if a medicine is available over the counter, you cannot get a prescription for it. Prescriptions for Ibuprofin, Prilosec, and Claritin are examples. Generics are required if available, unless you go thru the authorization process for a brand name medication.
Tax changes related to funding the Affordable Care Act Subsidies can be found at: http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions Most taxes are buried in the premiums in 2014.
Employers will begin reporting their share of the contribution to your group coverage on your W-2. At this time, it is simply for data collection, but I anticipate it will lead to taxation of this benefit in future years. The government already knows how much employers pay towards health insurance group wide thru their tax returns and 5500 filing, so they are looking for details regarding individual benefits.
Specials From Carriers
Humana is running a great package on dental and groups size start with just 2 employees, so let us know if you want to see a quote. They offer lots of options and vision, life, disability, & critical illness, too. Bundling discounts galore!
Allstate Worksite has an accident plan which bundles a short term disability benefit which is very affordable. It pays out $50 if you go for a wellness visit per family member, which helps pay for the plan! The new "Benefits in a Box" program makes non-medical easy. Ask us about it!
Penn Mutual has a simplified issue opportunity for those who have purchased life insurance with any carrier in the past 3 years. No medical exam! Ask for more details to see if you can obtain additional coverage with the stroke of a pen.
Questions? Contact Jeanine.