When Turning 65 - People Who Have Marketplace Plans or Other Individual Insurance Need to Review Options

Now that the Affordable Care Act has been offering plans through the Marketplace for 2 full years, there is new confusion for those turning 65.  Normally, in the pre-Affordable Care Act (ACA) world, someone turning 65 in an individual plan would have coverage cease upon their eligibility date for Medicare.  They were not able to continue.

In this new Post-ACA world, especially when plans are purchased through the Marketplace - people turning 65 often are not notified that they should be looking at enrolling in Medicare.  Further, those getting subsidies are often unaware that if they are Medicare eligible, they are no longer able to collect subsidies through the Marketplace to help pay for insurance.

Know that there are penalties in the Medicare system if you do not enroll when eligible.  These penalties are imposed once Medicare is actually picked up and last a lifetime.  Financially, they can be large, and many people do not understand this unless someone is advising them.

My advice to someone turning 65?  Enroll in Medicare when eligible, unless you are an unusual case, such as a person who has immigrated here and would have to pay for Part A since they haven't paid enough Medicare taxes to warrant "premium free" Part A coverage.  (Part A - Hospitalization is automatic for most people at age 65 and costs nothing, if you've worked 40 quarters (10 years) or more in this country.  The fees to support this have already been paid for through payroll during a person's lifetime while working in the US.)

Part B - which covers outpatient services, carries a monthly premium.  If you do not sign up for that when first eligible, there are penalties associated with enrolling later.

Here's a good article from Kaiser Health News that discusses this in more detail.  Read more here . . .

A Detailed Analysis of the Republican Alternative to Obamacare

Bob Laszewski has offered a detailed look at the Republican's alternative to "Obamacare".  I agree with Bob, that it may have been easier to accept "Obamacare" as the baseline, in need of major renovations - but it seems that it won't happen.

Some of the ideas in these proposals make perfect sense, but they will have different consequences for different consumers within the market.  The other big challenge here is that these solutions proposed are also very complicated for the average person to really understand.  What do you think?

Here's Bob's article . . . .Health Care Policy and Marketplace Review - Bob Laszewski

Surprises Lurk for People Re-Enrolling on HealthCare.gov

This year, there may be surprises in store for those who do not do a subsidy "re-determination", and then shop for new plans and coverage.  If you were given subsidy money to purchase a policy under the new Affordable Care Act through Healthcare.gov last year, you may need to go back in and do a subsidy re-determination - especially if you believe your income for 2015 will be different than what you have projected for 2014.

Even if income stays the same, the plan choices and level of subsidy offered for the same income could differ considerably.

The Wall Street Article below spells it out pretty well. 

Surprises Lurk for People Re-Enrolling on Healthcare.gov 

I know that in the Kansas & Missouri markets there will be additional insurers entering the Federal Exchange/marketplace that were not present last year.  Insurers will also be offering some new plan designs that may impact what choices people make - even if they have been satisfied with their current coverage.

"Off-Exchange" policies will also offer more choice, for those who already know they will not qualify for subsidies.  If you do not qualify for a subsidy, there's really no good reason to shop through Healthcare.gov - unless you really want to go through the entire income verification process before you can purchase.

If you know you're going to purchase "off-exchange", you can go directly to the carrier to purchase, or work through an agent/broker (like me) who can run side-by-side quotes for you to choose from.

Open enrollment for individuals and families begins on 11/15/2014 and goes until 2/15/2015.  If you need to have coverage in place for a January 1 effective date, you'll need to be enrolled in a plan no later than 12/15/2014.

The Next Chapter of Obamacare

As we approach this next enrollment period (11/15/2014 - 02/15/2015) for individuals and families under the Affordable Care Act there are some things to be considered.

People who are receiving subsidies today, are being told that they can "do nothing" and automatically be re-enrolled in the plan they have today.  If that plan isn't going to be available for 2015, the insurance carrier will place you in a plan that's close.

But - even if you do want to keep the plan you have, you must keep in mind that if you do nothing, the subsidy amount you are currently receiving will stay the same and your share of the premium that you'll have to pay could increase.

So, most ACA subsidy recipients, should really go to the website (Healthcare.gov) when the enrollment period begins to re-apply and do a subsidy re-determination at that time for the year 2015.  If you don't, you may be surprised when the January 2015 bill comes.

In addition, you may want to re-visit things, simply because there will be some new plan offerings and, in some cases, some new carriers available on the exchange in your area.

Some of the Pre-ACA plans will only extend through the end of 2014 for some, so even if you are not receiving any subsidy money, you'll need to go shopping for a plan to begin on January 1.  If you don't qualify for the subsidy money, you can purchase "off-exchange" plans from a variety of sources - including your local agent or broker.

If you do qualify for subsidy money, then you can get assistance from a Navigator, Agent, or broker to review the process, help you access the local exchange in your area, and assist you with selecting plans.

People who had grandfathered plans (meaning, they were effective prior to 3/23/2010) can keep them as long as they desire.  Some others have received extensions of pre-ACA style plans that are not grandfathered beyond the year 2014.  Even though people can keep these plans - they must pay attention to note any rate activity on the plans that they currently have.  That may affect a decision on what to do in the coming year.

Each of you should be receiving some type of communication from your insurance carrier regarding your personal situation.

 - For policies to be effective on January 1, 2015 (i.e., for those who will absolutely lose coverage at the end of December 2014), you'll have to shop and be enrolled no later than December 15, 2014.

 - If you enroll by 1/15/2015, you'll have an effective date of 2/1/2015.  If you enroll by 2/15/2015, then your insurance will be effective on 3/1/2015.

 - If you do nothing, your insurance will continue and any price changes will be reflected in your first billing cycle in 2015.

Bob Laszewski's latest blog post outlines many things to be considered.  Read the blogpost here . . . .

FAQ: Hospital Observation Care Can Be Costly For Medicare Patients

I have addressed this issue with many of my Medicare clients, so that they can ask the right questions regarding their status if they go to a hospital and are told to stay overnight.  A variety of difficulties can arise when your status is considered to be "outpatient". 

This becomes especially acute when someone is on a Medicare Advantage plan, as most of those plans in recent years have classified all "outpatient services" as requiring 20% coinsurance from the client.  If held in an "observation" mode in a hospital, that means the patient would be billed 20% of each charge incurred while in the hospital's care.  This can lead to thousands of dollars of coinsurance that the patient may not understand he or she owes.

Just because you're in a bed, and staying overnight in the hospital does not necessarily mean that you've been admitted.

Here's a good Frequently Asked Questions article from the Kaiser foundation that explains this phenomenon in more detail:

Medicare Observation Care FAQ

Obamacare: To Buy Or Not To Buy–––An Entrepreneur Would Have Done It Differently

Bob Laszewski's blogpost today discusses how the plans under the new Affordable Care Act were built and whether or not people will actually purchase them.  I have had discussions about this with my clients, as to what they will decide to do at the end of 2014, when they will no longer be able to hang on to their 2013 style insurance plans any longer.

Many of these people are self-employed, and do not qualify for any type of subsidy.  Most of them are relatively healthy, and have always carried health insurance on their own.  And yes, it was "real" insurance - not sub-standard coverage.  When the time comes for them to choose an ACA style plan next year for coverage to take effect in the year 2015, they are going to find that their premiums without a subsidy will double in many cases.  The reason for that is that all of the current plans include all of the "essential health benefits" that the government built into every health plan, whether you deem it essential or not.

That is not to say that plans previously didn't have their problems - access to maternity coverage was a huge problem in the individual market.  Often, it was not even offered as an option.  But, maybe they could have found a solution like having every insurance company offer a maternity "option", that people who wanted the coverage could purchase - rather than build it into every plan.  Same for things like pediatric dental.  There were many other ways to have offered these benefits to people rather than baking them into every plan.

As an individual in the marketplace, I should have the right to purchase a catastrophic plan if I so choose, but that right was also taken from me, in the government's zeal to have everyone own a plan that looked very much like employer based plans look and feel.  Well, that's great, if you have an employer either paying for the plan, or kicking in 50% or more.  For those of us who are self employed, or work in places where no health insurance is offered, buying a Cadillac is just not a feasible proposition.

Keep in mind too, that the self employed also pay the maximum amount already on things like social security contributions and Medicare contributions in the form of self-employment tax, since they don't have an employer kicking in a portion of that.  Read Bob's Blogpost Here . . . .

Some Little Known Subsidy Cuts to "Safety-Net" Hospitals, May Leave Some Without Care . . . . .

As various subsidies to hospitals that provide care to the uninsured, especially those that do not qualify for Medicaid, are implemented - some could be left with nowhere to go for much needed medical care.

The Medicaid expansion under the Affordable Care Act would have provided coverage to many of these people.  But - since Supreme Court ruled that the states would have to be given the ability to "opt out" of the Medicaid expansion, many did.  That leaves a gaping hole in the body of people who would have been covered by the expansion.  Without the expansion, many of these individuals will not qualify for Medicaid - AND - they may not qualify for a federal subsidy to purchase health insurance through the new health insurance marketplaces.  An individual must have a Modified Adjusted Gross income of $11,490 to qualify for a subsidy.  If you make less, but do not qualify for Medicaid coverage, you will have no options other than to pay full price for a health insurance policy - which many cannot possibly afford.

Hospitals that previously might have cared for these patients because they were subsidized for doing so, will now have those subsidies cut and may need to begin to refuse care or turn people away.

The Wall Street Journal published a good article that explains the predicament very well.  Read more here . . . .

Obviously, some adjustments will need to be made to the health care law to compensate for these unexpected situations arising out of modifications in the law to date.  A lot of delivery of care and coverage issues were hoped to be solved with the Medicaid expansion.  Since that was limited significantly, large groups of people who had counted on it as a mechanism for health care coverage will be left behind once again and will remain uncovered, unless something is done to correct that.

"Bad Apples?" - Really?

Although there were some policies sold in the individual insurance market in the past that were not what I'd term "real major medical insurance", I know that those of us in the agent community did our best to educate our consumers and make sure they understood the differences and what to look for in a legitimate policy. 

My clients all had policies that offered them a good amount of financial protection for the money.  Yes - there were trade offs - if you wanted a lower premium, you could raise the deductible, or forgo other benefits.  But my clients made  those choices after discussing the ramifications of those decisions, so that they would buy a policy that would protect them in the ways that they thought were important to them.

The President made it sound as if the individual market was the wild, wild west and this total overhaul was the only way to protect the public.

Also, in the hearings on Capital Hill, they never once advised that people could get advice, or help from independent agents (like myself), while they try to fix their broken system and can't handle the phone traffic coming into their call centers with questions.

As Bob Laszewski sites in his post that follows, you begin to wonder if they understood anything about our insurance system at all.  I never would have dreamed that to be the case, considering that Kathleen Sebelius ran the Dept. of Insurance in Kansas before she was Governor.  I guess memories are short . . . . .

Health Policy and Marketplace Review

Personally, if my policy loses its "grandfathered" status, I have no idea how I'd ever afford an ACA compliant plan that would be comparable.  Hopefully, I won't have to ponder that decision (or "non-choice")  for awhile . . . . .

Missouri Exchange Rates - A Snapshot

Many of my clients in MO have been wondering what rates for the new ACA compliant insurance plans will cost.  Here is a quick snapshot of what the rates currently look like.

Snapshot of Missouri Exchange Rates

Those who are eligible for a subsidy, would be able to have some help paying for these plans.  You can use the calculator below to determine how much help you might receive.  I've posted this before, but here it is again.

Kaiser Foundation Subsidy Calculator

Since Healthcare.gov hasn't been accessible, using the tools above may be a quick way to estimate what your premiums might be under the new system.

If you don't need the federal money, there are plenty of plans that you can buy "off-exchange" if you need to purchase insurance.

If you already have insurance, you may want to keep your current plan, if you are able to do so.

As always, my clients can always e-mail me or call with questions.

Should the Administration shut down Healthcare.gov?

Bob Laszewski asks that very question in his blog post today.  Another insightful entry from Bob about the computer system and its continued failing.

As I've stated before, if you do not need the federal subsidy money and can keep your current individual health insurance policy, do so for as long as you're able. Based on what I've seen, the new ACA compliant plans are more expensive overall in this geography (Kansas City metro).

If you do have to shop - there are plenty of "off exchange" plans (plans sold outside of the federal marketplace) where you can purchase an ACA compliant plan for individuals and families.  The carriers have plans up on most of their own websites now, and eventually, I'll be able to run side by side quotes for these new plans.  To date, it's been impossible to do so, since most data resources at the insurance carriers and other entities (like the quoting engines most agents use) have been overwhelmed. 

That said, I do believe visibility to plans outside of the federal marketplace will increase greatly during the coming month or so.  So - for those who have been unable to buy health insurance in the past due to medical conditions, you'll definitely be able to fulfill the requirement to carry insurance.  The jury is still out as to whether or not you'll be able to get online at the Healthcare.gov website.

Read Bob's blog post here . . . .

System Glitches? Really?

Haven't been able to get into the Federal Exchange to peruse pricing or see if you qualify for a subsidy?  Most people haven't.   The website & the press keep saying it's due to traffic and I say - not so.  Now, there's finally confirmation in print of what some agents have been saying all week. 

Read the Story Here . . . .

The Center for Medicare and Medicaid Services (CMS), who is running the Federal Marketplaces in 36 states could barely handle agent training, and then had a security breach after some agents completed the coursework - sending agent information along with related social security numbers "into the wind" by "accident".

I would advise anyone who feels they need Federal Subsidy money to pay for their plan, to wait and see through the month of October.  Wait to see how this plays out and to be sure that the systems are working and have some level of security before putting in all of your personal information.

You have plenty of time - if you want your insurance policy to take effect on January 1, 2014, you need to apply no later than December 15.  Then, you still have until March 31 during this initial enrollment for plans to begin with effective dates after that.

No hurry - believe me, they need time to work this out.

For those who feel they won't qualify for the Federal money, and still need or want to buy a new ACA compliant plan for 2014, the options are actually greater outside of the exchange.  You have more choices of companies and plans, and the plans have slightly different benefits than those on the marketplaces.

If you'd like any help in looking at those in MO and KS, I'd be happy to assist, as always.

Monthly Premiums For A 'Benchmark' Silver Plan In Federally Run Insurance Marketplaces

Here we are one day before the October 1 enrollment through the Federal Marketplaces begins for those of you who are under the age of 65 and do not receive insurance through your employer.

I still do not have actual pricing from any of my carriers in Missouri or Kansas yet, so advising people as to what to do has been difficult, if not impossible. 

Some of you who have "grandfathered" plans - meaning your plan effective date was prior to March 23, 2010 - can keep the plan you currently have.

Those of you who do not have a "grandfathered" plan may be able to keep your existing policy for an additional year, depending on how your existing carrier is handling things.  In these cases you may have received a letter already indicating that this option will be available to you and that you'll simply sign an addendum in December, most likely, and agree to a small rate increase at that time.  This would allow you to continue with your plan through the end of December 2014.

Depending on what the new plan pricing looks like, the options above may be appealing.

Those of you who feel you will qualify for Federal subsidies will have to apply through the exchanges to receive the federal money.

I am certified to sell policies within the exchanges, but do not know what that process will look like yet, since the exchanges (or marketplaces, as the Federal Government is referring to them) do not exist yet.  Supposedly these will be online tomorrow, October 1.

Once I have detailed plan & pricing information, I'll share that with all of my individual and family clients.

The article from the Kaiser Foundation this morning offers an idea of what a Silver plan may cost in various "areas" within a state where the Federal Marketplace will be offering plans.  You can see that here . . .Benchmarks for Silver Plans through the Marketplaces.

Simply find your county and you'll see how rates compare with other areas of your state.

Within this article you'll also see the link for the subsidy calculator where you can play around with your numbers to see what might happen in real time once the Federal Marketplaces are operational.

Once I see that enrollments are going smoothly I'll discuss options with my clients.  In the meantime, I'd advise waiting to see how the initial launch goes, before making changes.  (but, that's just my opinion . . . .)

There Will Be Fewer Medicare Advantage Plan Offerings for 2014

As we head into the Annual Enrollment period for Medicare eligible people, they will ultimately find that in some areas, some Medicare Advantage plans have withdrawn some plans they previously offered.  This article is a good synopsis of what's happening in this marketplace:

View the article here . . .

October will be a very busy month!

Is the Affordable Care Act Actually Affordable?

I've been wondering that myself as I complete the training associated with being able to assist clients as the law is implemented.

My conclusion is that maybe it won't be - especially for some segments of the population.  Even with the federal subsidy money, I've been wondering whether or not people with very limited incomes will be able to afford the portion of the health insurance premium that is left for them to pay once the subsidy is taken into account.  Apparently, I'm not the only one.

This article from AlterNet takes a closer look:

Read the full article here.

Enrollment for new, ACA compliant plans is scheduled to begin on October 1 and will continue through 12/31/2013.  This is an extended enrollment period, since the government realizes that there will be a lot of confusion in the marketplace about when they must enroll or make changes.  After this year, the annual enrollment period for individuals and families under the age of 65 will be from October 15 - December 7 each year.

As new information becomes available, I'll be sure to communicate it.

UPS Won't Insure Spouses of Some Employees

UPS is getting ready to remove thousands of spouses from their company provided group health insurance, in part due to the new healthcare law.  They have cited the Affordable Care Act as one of the reasons for its decision when explaining this to employees and others.  Read the article here . . . .

Many Consumers With High-Deductible Plans Are Concerned About Health Law Changes

For those of you who didn't know - unless your current individual or family health insurance policy is considered to be a 'grandfathered' plan - meaning, the plan effective date was prior to 3/23/2010 (when the new Health care law was signed) - you'll have to make some changes for plans effective on 1/1/2014.  Read more here . . .

Different companies are taking different approaches to this "migration", as they are calling it.  Some are simply ending your existing coverage as of 12/31/2013, and requiring you to purchase a new policy during annual enrollment - which takes place beginning October 1, 2013 for plans that will be effective on 1/1/2014.

Other companies are going to allow you to stay on your current 'non-grandfathered' plan, and they'll simply add essential health benefits and other features to make the plan compliant.  In those cases, companies will simply have you agree to that and any price changes, through the use of an addendum that the insured will sign, and you'd keep your plan through the end of 2014.

I am beginning to contact my clients to let them know what the options will be this fall.  Unfortunately, no pricing is available yet, so I'm only able to discuss potential situations, not real choices.  Some people will qualify for subsidies through the exchanges - if you're an individual and make up to $45,960 annually, you'd qualify.  The guideline is that there will be subsidies available for those making up to 400% above the poverty level.  In some geographic markets, that is a good amount of money, so many may qualify.

You can play around with the subsidy calculator below to get an idea of whether or not you & others in your household might qualify for subsidies being offered to help pay for new plans effective next year.

Health Insurance Subsidy Calculator

Income -- Not Assets -- Will Determine Subsidies In Online Insurance Marketplaces

As the enrollment for health insurance plans that will begin in January 2014 rapidly approaches, information about subsidies to purchase the insurance that will be offered in the new insurance exchanges that the federal & state governments are setting up, is being clarified.

Kaiser foundation published a helpful blog entry today regarding that subject.  You can read more about it here:  Questions Regarding Subsidy Eligibility

The links within the article are "live", so further information is available there.

Keep in mind that the health insurance plans referenced are for individuals and families- not businesses or people who have Medicare coverage.

There will be plans offered outside of the exchanges or "marketplaces" provided by the government, but if you need to obtain a subsidy to pay for your insurance, you have to buy the insurance through the government run marketplace.

What will Health Insurance Cost in 2014?

This article from Bob Laszewski's Health Care Policy blog is a good synopsis of what could happen to the price of insurance under the new Affordable Care Act.  It clearly outlines items that will drive cost & how that will impact the consumer.

The Affordable Care Act: 10 Months to Launch "Obamacare" - Get Ready for Some Startling Rate Increases