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 . . . .

Are ObamaCare's Tax Credits Harmless? The Little Understood Dark Side Of The Subsidies

Now that the first annual enrollment through the new Health Care Exchanges has ended, it's important to understand how the subsidies that many have received to assist with paying their insurance premiums will be handled by the IRS.  Forbes published a good article regarding how fluctuations in income and other life changes, could affect how the subsidy that you receive can change. 

If your income changes, or your life circumstances change that can affect household income levels, YOU are required to notify the health insurance marketplace (exchange), so that the subsidy can be adjusted accordingly.  If you do not do that, the government will make the adjustments at tax time.

Read more about the way the subsidies work here . . . .

Many have benefitted from the subsidy allocation, but with that benefit comes a responsibility to report any changes that could significantly impact your household income - otherwise there will be tax implications.

Obamacare Week 10––A Dearth of Enrollment In the States and Continuing Backroom Problems

Here's an update from Bob Laszewski regarding the current status of the enrollments through the Federal Marketplaces, and in the states that currently have a state run marketplace.  There is also data here about how various aspects of system corrections and development are going. 

The one point here that I found very troubling was the item that notes that the federal government hasn't built a payment system that would provide insurance companies with the premium subsidy payments.  They are expecting the insurance companies to bill them for these amounts.  It makes me wonder how long it will take them to get paid, and how that money will be tracked through the various private & government systems.

Also troubling was all of the confusion and inability to deal with Medicaid enrollments.

We'll see how the end of the year plays out.  I am hearing from people I deal with that they are actually able to get through the process now using Healthcare.gov, so at least they've made improvements there and some are getting approved for subsidies and enrolled.  Let's hope the improvements continue.

To read Bob's blog entry, please click 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 . . . .)