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 . . . .

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.

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!

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

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.