Why the Obamacare 2016 Open Enrollment Stalled: The Big Unwritten Story About Obamacare––How Unaffordable It Is For the Working and Middle Class

Now that the most recent Open Enrollment period for the "Affordable Care Act" has ended, Bob Laszewski has written another article about the law and its impact that is right on the money.  The big "untold" story is about how it has impacted premiums for the segment of the individual market that do not qualify for subsidies and now have to bear the weight of astronomical premium increases.

You can read Bob Laszewski's blog post here . . . .

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 . . . .

Tax refunds may get hit due to health law credits

Get ready - here it comes!  Now that we're approaching the end of the year it's time to consider whether or not those of you who are benefitting from Advanced Tax Credits to pay for their health insurance underestimated their 2014 income.  If so, you may be subject to claw-backs at tax time.

This consideration also must be taken into account before the upcoming enrollment period, which is from 11/14/2014 through 2/15/2015.    During this next enrollment, you'll have to "estimate" your 2015 income.  If you've miscalculated for 2014, you'll want to be sure you don't build on that mistake.

Read the AP Article 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.

THIS JUST IN: White House offers exemption from insurance mandate for consumers whose plans were canceled

The White House released new guidance that offers some leeway to people who had policies cancelled and found that their options under the new law were more expensive.  They will now be able to qualify for catastrophic coverage (previously only available to those under 30 or who could demonstrate financial hardship), and avoid the penalty.

You can read the full article, from Modern Healthcare, here.  Within the article, you can access the actual .pdf that is the document issued directly by CMS.

There are only 4 more days left to enroll for those who need coverage to be in force by January 1, 2014.  Premium payments (which originally were required to be received by the insurance company prior to January 1), must arrive no later than January 10. Blue Cross Blue Shield of Kansas City requires their first payment no later than January 7.  If you are unsure, check directly with the carrier for clarification.

Enrollments after the 23rd will be processed for a 2/1/2014 effective date.  Enrollments processed after 2/15/2014 will be for plans effective on March 1, and those processed after 3/15/2014 will be effective on 4/1/2014.

Anyone who hasn't enrolled in a policy during this initial enrollment period, will have to wait until next year's enrollment to sign up or to make changes to existing plans.

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.

"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.

Healthcare.gov Offers New Shopping Feature - Sort of . . . .

Here's a link to the Kaiser Foundation Blog describing the new "shopping feature" on Healthcare.gov. 

Read the Kaiser Foundation Blog Entry here . . . .

Limited as the shopping feature is, I guess it's better than nothing.  How they could have developed a huge system like Healthcare.Gov and not understood that people want to see rates & plan information before deciding to create an account and then load a ton of personal information into the system blindly.

They wasted a lot of money on a dysfunctional system and are now having to spend more to remedy it without having to totally dismantle it.  In the meantime, people who may have wanted to purchase insurance there, cannot.  I guess people may have to phone in applications or do them on paper - you know, just like in the "good old days" . . .

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 . . . .)

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.

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.

Implementation of the Health Care Law is Quickly Approaching . . .

As the full implementation of the Health Care law draws near, I'm getting a lot of questions about what may be happening.  To date, there's not a lot to report.  I'm hoping that more concrete details will be available soon.  The carriers are working to develop compliant "qualified" health plans that will be sold inside and outside of the state based exchanges (or marketplaces).  One thing that many are not aware of is the fact that there's an "open enrollment" period being established for individual and family plans.  This is new -- currently in the individual and family market, people are able to purchase new insurance whenever they want to - they are not bound by 'enrollment periods'.

The initial enrollment period will begin on October 1, 2013 and will last through March 31, 2014.  Enrollment will be for plans with an effective date of  1/1/2014 or later.  After that, the annual enrollment period will coincide with the Medicare Annual enrollment period - which is from October 15 through December 7 of each year.  If a person doesn't sign up during an annual enrollment period, they will not be able to buy a plan again until the next one, unless they qualify for a special enrollment period.  Qualification is based on things like major life events/changes - marriage, birth of a child, etc.

There are still many questions to be answered.  One is whether or not the exchanges will be open & ready for business on October 1.  There was an interesting article about this topic and the software that will be used to sign people up for insurance.  Read about it here . . .

As more specifics are communicated to me, I will be sure to post items of note here for my clients and friends.