If you would like to purchase health insurance outside of the yearly Open Enrollment window, then you will need a qualifying life event (QLE) to do so. Open Enrollment begins on November 15th and lasts through February 15th each year. Without such an event, insurance companies will turn down your application.
How Do Qualifying Life Events Work?
There are several events that will allow you to purchase health insurance outside of Open Enrollment. We list the most common ones just below. It’s important to know that these Special Enrollment Periods only last 60 days, however. If you do not seek out and purchase health insurance within this 60 day window, you may have lost your opportunity to enroll in a health plan.
It’s also important to know that voluntarily canceling your health insurance outside of Open Enrollment does not constitute a QLE. Some carriers will allow you to change plans if your plan is renewing outside of Open Enrollment, but if you simply cancel your coverage because you are not happy with it, you may not be able to find new coverage.
Listing The Most Common Qualifying Life Events
- Involuntarily losing health insurance that meets minimum standards
- Marriage or divorce
- Gaining or losing a dependent due to adoption or death in the family
- Becoming a U.S. citizen or gaining lawful status in the U.S.
- Moving to a new coverage area that your current insurance does not serve
- Gaining or losing eligibility for a government subsidy
- Government error during enrollment on the exchange
There are several common QLEs that will allow for a Special Enrollment Period. Insurance can be purchased on or off the Federal (or your State) Exchange during this window of time.
The only place where you can enroll and claim a tax credit or subsidy (based on your income and family size) will be the exchange that serves your state of residence. We can help you understand how that works while also helping you to find coverage that meets your needs and budget.
What About Short Term Health Insurance Plans?
If you have missed your Special Enrollment Period or otherwise do not want to enroll in an Obamacare compliant plan, then short term insurance can help to fill a gap. These plans can be purchased for up to 6 months (12 months in some states) and will help to cover catastrophic costs.
It’s important to understand that short term health insurance plans are not compliant with the Affordable Care Act. In other words, you can face a penalty for not owning Minimum Essential Coverage. And they are medically underwritten – which means you can be turned down. Finally, short term plans do not usually provide coverage for preexisting conditions.
Typically, short term coverage works best to fill gaps for 6 months or less. They may not be advisable as plans to purchase in lieu of more permanent ACA compliant coverage. But if you have missed your Special Enrollment Period, they can be your next best option.
Contact Us For Quotes, Coverage & Enrollment Assistance
If you are experiencing a Qualifying Life Event and would like to explore your health insurance options during your 60 day Special Enrollment Period, we can help. We work both on and off the Federal Marketplace and can assist you with your needs. Contact us today to get started.
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Category: Health Care Reform, Health Insurance
If you are looking for Ohio health insurance plans in Columbus, Cleveland or Cincinnati -then you are in the right place. Our Ohio based independent insurance agency offers coverage from several carriers both on and off the federal exchange.
In our opinion, it is important to work with an Ohio based insurance agency if that’s your state of residence. Using our expertise, we can help you find the plan(s) with the most comprehensive networks and lowest prices. A broker from another state may not offer coverage from regional carriers like Medical Mutual or InHealth and that can be to your disadvantage.
Your best options will also depend on the type of insurance you are looking for and whether you will benefit most from a plan purchased on or off the federal exchange. We can help and it doesn’t cost you a penny more to place your coverage with our agency.
Columbus Ohio Health Insurance Quotes & Enrollment
There are several reasonably priced carriers in Columbus offering health insurance plans. Medical Mutual is popular as is Anthem Blue Cross and Blue Shield. Other carriers that are often purchased are Aetna and United Healthcare. And InHealth is gaining traction although they are a co-op and new to the marketplace.
But you are not shopping on price alone. Network availability is very important. Your health insurance plan does you little good if few doctors and hospitals accept it. In other words, you may not benefit from purchasing the cheapest plan you find. You should consider several variables and not just price alone.
And networks can differ based on whether you purchase your plan on or off the federal exchange. Of course, you can only obtain a tax credit on the exchange, but if you are not eligible due to your income, then it may be wise to purchase coverage off the exchange as your chosen carrier’s network might be larger. Our agency can help you understand the differences.
Cincinnati Health Insurance Quotes & Coverage
There are a couple of carriers that offer affordable health insurance in Cincinnati, but Humana is best in many cases. They have very competitive rates in the southern part of Ohio as well as a robust network of doctors and hospitals.
Humana is more widely known for their senior insurance policies like Medicare supplements and Advantage plans, but they should also be considered for traditional individual, family and small business health insurance in and around the Cincinnati area. We can help you compare their plans and quotes during open enrollment or if you are experiencing a qualifying life event.
We understand that one size does not fit all, but the purpose of this article is to point out how different carriers are more competitively priced in certain areas of Ohio. If Humana is not a good fit for any of our Cincinnati clients, then we will help them find an insurance company that is more suitable.
Cleveland Ohio Health Insurance Exchange Plans
Medical Mutual offers some of the lowest prices on health insurance in northern Ohio as well as several other parts of the state – including Toledo. MMO is also a popular pick as they have the largest network of doctors and hospitals in all of Ohio. Choice is good.
Medical Mutual has grown over the years to be a very prominent insurance carrier in Ohio and beyond. They may be new to some prospective buyers, but they should not be dismissed. Most doctors accept them and their prices are very reasonable.
If there is one drawback to Medical Mutual, it’s that there is no out of pocket limit to the cost of care received out of network. Like all health insurance plans, it’s best to stay in network when possible. As MMO has the largest network in Ohio and a significant out of state presence as well, this is usually not an issue for our clients.
Should I Buy Insurance From An Agent Or The Exchange?
You can do both. Again, health insurance prices are controlled by law. It does not matter who or from where your purchase originates, the cost will be the same. Thus, it may be wise to use an agent. It won’t cost a penny more and you may benefit from their insight and experience – especially considering all of the changes from health care reform.
The only place you can receive a tax-credit or government subsidized plan however is from the federal exchange. Our brokers are equipped to guide you through which Silver plans will provide the most savings and lowest premiums. In our experience, Anthem Blue Cross & Blue Shield is currently offering some of the most affordable subsidized plans on the exchange.
Contact Us For Quotes, Information And Enrollment
We are a full service Ohio health insurance agency. Our independent agents and brokers can help you find the plans that best suit your needs and budget.
Whether your are in Columbus, Cincinnati, Cleveland, Dayton, Toledo or the Akron/Canton area, give us a call and we’ll help you enroll in the health insurance plan that will keep you protected and compliant with the law.
Category: Health Care Reform, Health Insurance
Health insurance open enrollment under Obamacare has different rules. Unless it’s Open Enrollment, you may not be able to purchase health insurance without a qualifying event.
Special election periods will be available outside of open enrollment for those who meet certain criteria. If none of the life events listed below apply, then applicants will need to wait until the next open enrollment window in the fall – or purchase a short term or limited benefit plan – in order to have some coverage.
While short term and limited benefit insurance plans will not avoid Obamacare penalties, they will offer some protection against unforeseen medical bills. In other words, they can help bridge the gap.
Obamacare Special Election Periods & Qualifying Events
There are several qualifying events that will open up a special election period for those who want/need to purchase health insurance outside of the Obamacare open enrollment window that closed on March 31st, 2014. These events will allow for the guaranteed issue of an insurance plan either on or off of the exchange.
If you qualify for a subsidized plan, then you will need to purchase coverage on the Federal Health Insurance Marketplance either with or without the assistance of an insurance agent. If you do not qualify for a tax credit, then it may be best to purchase a plan off of the exchange with an insurance agent.
The Special Election Periods are as follows:
- Losing your health coverage through a life event
- Examples of these life events include: getting a divorce, losing your job, losing your Medicaid or CHIP eligibility, your current plan being decertified or expiring COBRA coverage… basically any time someone loses their coverage through no fault of their own
- Individuals receiving their renewal notice from their carrier enhancing their benefits. If they decide not to take the new offer, this is a life event
- Please note: If you voluntarily quit your health plan or are terminated because you didn’t pay your premiums, you are not eligible for a special enrollment period
- Having or adopting a child, or placing a child for adoption
- Permanently moving somewhere with different health insurance options
- Experiencing an enrollment error
- Having a change in income or household status that changes your eligibility for tax credits or cost-sharing reductions
- Your plan or issuer substantially violating a material provision of the contract you’re enrolled under
- Individuals losing their coverage through work when their employers decide to drop health insurance from their benefits packages at renewals starting 4/1/14 and beyond
As you can see, there are several events that will trigger a special election period for the purchase of health insurance either on or off the exchange. The most common event will simply be the involuntary loss of coverage.
In this way, health insurance will now work somewhat like Medicare supplement insurance. When someone over 65 involuntarily loses group health insurance, they can automatically purchase a Medicare supplement plan no questions asked.
What If I Don’t Qualify For A Special Election Period?
If you don’t qualify, then you have two options: You can either wait for the next open enrollment period or purchase a short term or limited benefit plan.
While short term health insurance plans and limited benefit policies will not provide full coverage (and won’t eliminate Obamacare penalties) they will bridge the gap until the next open enrollment window. We can help you shop for both types of plans so that you have some coverage.
Contact Us For Health Insurance Quotes & Information
Without a Special Election Period, you cannot purchase traditional health insurance either on or off the exchange until the next open enrollment window.
Our independent health insurance agency offers short term and limited benefit plans to help individuals and families obtain some coverage until the next open enrollment window.
Category: Health Care Reform, Health Insurance
Our insurance agency has received several inquiries about the upcoming Obamacare penalty amounts for those who do not purchase health insurance. It is important to understand how these penalties will be enforced and ways to avoid them.
The penalties will vary for singles and for families and can, for some, end up being a portion of their income. Those who are caught off guard by the Obamacare penalties can end up owing much more that what they might have anticipated.
How Much Is The Obamacare Penalty For 2016?
The penalty for those who do not purchase health insurance will vary. In other words, contrary to what you may have heard or read, it is not necessarily a flat rate. And the amount will increase year over year as well.
- The penalty for individuals will be $695 or 2.5% of your gross income – whichever is greater
- The family penalty will be the same $695 per person – plus $347.50 per child up to a maximum of $2,085 – or 2.5% of your income – whichever is greater
The piece of this legislation that is not getting enough attention is the percentage of income clause. For reasons unknown to us, no one has really sounded the alarm on this issue.
If you are a self-employed with significant income, you should strongly consider purchasing health insurance if you don’t already own coverage. Multiply your income by .025 and you can see how much this new law might cost you.
Does The Obamacare Penalty Increase Year Over Year?
In a word, yes. The penalties as they are drawn up now will increase each year through 2016. By 2016, the Obamacare penalty for not purchasing health insurance will be $695 for an individual or 2.5% of income – whichever is greater. That could be a sizable tax penalty for high earning individuals and families.
As contentious as this legislation is, it would not be surprising to see changes over the next few years, but if the law is not amended or postponed, then then individual mandate (and penalties) will continue to be enforced by the IRS.
(It should be noted that there will be many who purchase insurance on the exchanges who will qualify for a premium subsidy.)
How Will The Obamacare Penalties Be Enforced?
The IRS will enforce the Obamacare penalties through tax return information. If you file a return each year, it is our understanding that there will be a place to provide proof of insurance.
If you do not have proof of insurance, then your penalty will be applied.
In other words, the IRS could garnish your end of the year tax refund should you be owed a rebate. If you’re not due a refund, then it is somewhat unclear how the IRS would enforce the penalty.
Needless to say, the tax enforcers will find a way. That’s their job – to enforce tax laws. Those who run afoul of the law will likely receive correspondence of some kind.
And it may be likely that those who owe more than $695 (due to the 2% income rule) would be a higher priority for the IRS than those will smaller penalties. If you don’t file a tax return, the IRS may not find you right away – or at all. That story is yet to be told.
Avoid Healthcare Reform Penalties – Contact US
There are several ways to avoid the upcoming Obamacare penalties – some less expensive than others. Our independent insurance agency can help you through your options.
We are offering health insurance on and off the exchanges and can help you to remain compliant with the law. Contact us today for more information.
Category: Health Care Reform, Health Insurance, Uncategorized
Under current rules and regulations, you buy health insurance either on the the Federal (or in some states local) exchange or off. Here in Ohio, we are on the Federal exchange.
Understanding your options will help you know whether you qualify for subsides, Medicaid and what your penalty might be. We help our clients sort through all of these matters to find the most suitable coverage for their needs.
Where Can I Find My Health Insurance Exchange?
It depends on the state where you live. Some states have developed their own exchanges and some are participating in federally run exchanges. Either way, most brokers, trained navigators, and some volunteers can help you explore your options.
Your premiums will not be affected by who you choose to work with. You will be able to submit applications electronically, in person or using a traditional paper app. Submitting your enrollment electronically will likely be the fastest way to submit.
Plans sold on the exchange will be labeled as precious metals. There will be four levels offering descending amounts of coverage in this order: Platinum, Gold, Silver and Bronze. Any level will be health care reform compliant.
Should I Buy On The Health Insurance Exchange?
If you qualify for a subsidy (due to your overall income) then yes. There are IRS provisions that allow individuals and families that are within certain proximity of the Federal Poverty Level to receive significant assistance with their monthly premiums.
The amounts will vary between households and as of now will be determined based on personal disclosure. In other words, it’s on the honor system until further notice. Subsidies can vary quite a bit, but you can click here to get a better understanding of how they work.
If your income is too high to qualify for a subsidy, then you do not need to purchase insurance on the health insurance exchanges. In fact, you will likely have more plan choices if you do not.
That is to say that several insurance companies have chosen not to participate in exchanges in some states, but they have not left these states altogether. And it is unclear if there will be different networks of doctors and hospitals depending on the origination of your insurance plan.
Some doctors may treat insurance from the same provider differently depending on whether it was purchase on or off the exchange. You may have a larger network of doctors and hospitals to choose from with plans purchased off your health insurance exchange.
What About The Obamacare Penalties?
They are here. It is still hard to tell how they will be enforced – especially for those who do not file a tax return. But if you do file a tax return, then you will need to provide proof of credible/compliant health insurance coverage.
Penalties for individuals and families will be either a fixed dollar amount or a percentage of income – whichever is higher. And these penalties are slated to increase each year. You can read more about the penalty amounts here.
What About Pre-Existing Conditions?
This is a significant change to health insurance. During the open enrollment window (slated to run from October 1st, 2013 to March 31, 2014) insurance companies cannot turn anyone down due to pre-existing conditions.
This will be very helpful for those who have had trouble obtaining insurance in the past. The lack of medical underwriting will be beneficial, but it does not last all year. You will need to use the open enrollment window each year to avoid being uninsured. Otherwise you can be turned down for insurance outside of the open enrollment window due to pre-existing conditions.
Do I Have Any Other Health Insurance Options?
If you have group coverage, other qualifying coverage (VA/Tri-Care), or you are Medicare eligible, then the Affordable Care Act should have little impact on you. Seniors will be affected very little by this legislation.
And there will certainly be those who try to game the system by jumping in and out of insurance to try and fake compliance. However, if you do not enroll when you are supposed to, then insurance companies can later turn you down if you are in poor health. You would then need to wait until the next open enrollment window which is slated to begin in October of 2014 for a January 2015 effective date. And of course, there are the penalties.
Whether or not the IRS catches up with those who are non-compliant is anyone’s guess. If the IRS choose to be aggressive about this matter, then it may eventually catch up with those who deliberately avoid purchasing health insurance.
HELP!!! This Is All Very Confusing!
Our agency and our brokers are licensed to operate on the health insurance exchanges and off. We can help you explore your options and then enroll in a plan that you feel best fits your needs and budget.
Category: Health Care Reform, Health Insurance
Now that the Supreme Court has upheld most of the provisions in the Patient Protection and Affordable Care Act (otherwise known as Obamacare) high income investors can expect to pay higher taxes on most investments.
Legislative changes of this magnitude certainly come at a cost and in order to pay for Obamacare, investors must now share more of the burden in the form of a 3.8% surtax on investment income. This will be in addition to any future rollback of the Bush tax cuts already proposed for the wealthy.
Explain The Obamacare New Investment Tax
This new tax that was passed in 2010 when Democrats controlled the House, Senate and Executive branches and affects joint filers with adjusted gross income of more than $250,000 and single filers with income above $200,000. Earned income amounts above these thresholds will be subject to the new tax, but income below will remain at current levels.
The tax is slated to begin January 1, 2013 assuming Congress upholds the legislation and barring no significant changes to the political landscape in the November 2012 elections.
How Much Is The Obamacare Investment Tax?
In a nutshell, certain investment and income taxes will increase by 3.8% from their current levels assuming no other legislative changes or expiration of current tax rates. Capital gains for high earners will jump from 15% to 18.8% on long term holdings.
In addition, there are also changes to the payroll tax. What once was a flat tax is now a means adjusted, progressive tax that will raise the Medicare payroll tax for joint filers with income above $250k and singles above $200k.
The Medicare tax will increase 0.9% to 2.35% from the current 1.45% on wages and self employment income. The Medicare tax is uncapped, so this new tax will apply to all income and wages above the aforementioned thresholds. High earning self employed persons will pay this amount twice.
What Investments Are Subject To The Health Care Tax?
Most tax experts believe that ordinary dividends and income, interest income, short and long term capital gains, rents, royalties, taxable annuity income, sales of primary residences above the $250,000/$500,000 exclusion, gains from sales on second homes and passive income will all be counted and subjected to the 3.8% surtax.
That is to say that almost all investments, save for a few, will now be subjected to these higher rates. Primary residence sales that result in large capital gains will not avoid this new tax. Joint filers are afforded a $500,000 exemption on the sale of a primary residence and single filers are allowed $250,000.
However a couple with $200,000 in adjusted gross income who has a $100,000 capital gain above the $500,000 primary residence exclusion amount would have to pay an additional 3.8% on the extra $50,000 above the joint $250,000 limit. Income and capital gains tax are combined and not mutually exclusive.
Investment properties and second homes are offered no exclusion upon sale and capital gains above the $250k joint and $200k single amounts would be subject to the 3.8% tax increase. This can be problematic for those with significant real estate holdings, but read on.
How Can I Avoid Or Reduce The New Investment Tax?
For those who are selling investment properties and residences that will result in significant capital gains, one such strategy may be a structured sale. With a structured sale annuity, the owner can defer constructive receipt of the capital gains and defer them over several years.
At present, structured sales have been accepted by the I.R.S when setup and executed properly by qualified tax professionals along side annuity insurance agents. By taking payments over several years, the capital gains can be spread out and in many cases help to keep investors below the new tax thresholds.
What About Other Tax Deferred Insurance Products?
When considering investments with tax advantages, there are two insurance products that can be helpful for many investors.
The first is a simple and straightforward investment account known as a tax deferred annuity.
When compared to bank certificates of deposit, mutual funds, and dividend paying stocks (among others), a non-qualified tax deferred annuity can shelter income for the life of the owner. There are no forced distributions with a non-qualified annuity and the deferred income tax can be spread out over several years during the owner’s lifetime or amongst the annuity beneficiaries at settlement.
Perhaps even a better investment is life insurance. Life insurance policies grow tax deferred, but in contrast to an annuity, the proceeds are payable income tax free to the named beneficiaries. There is really no better investment when it comes to wealth transfer than a whole or universal life insurance policy.
What About A Roth IRA Conversion?
Converting your traditional IRA to a Roth IRA can be beneficial when done properly. Considering that time is running out in 2012 before the new investment tax takes hold, now is a good time to consider a Roth IRA conversion.
It goes without saying that you would want to speak with your tax advisor before converting any qualified account, but it should be noted that distributions from a Roth IRA are considered income tax free by the I.R.S. and thus would not be counted towards your adjusted gross income.
Those with sizable IRA accounts might consider a total or partial Roth IRA conversion now in order to potentially reduce taxable required minimum distributions at age 70 1/2 and beyond.
Contact Us To Discuss Tax Avoidance Strategies
Hyers and Associates Inc. is a full service, independent life and annuity insurance agency. We specialize in wealth transfer and tax avoidance strategies for those in higher income tax brackets.
Category: Articles, Health Care Reform, Wealth Transfer
Now that the Supreme Court has upheld the Affordable Care Act (otherwise known as Obamacare) there are many questions about the individual mandate as it relates to new taxes and/or penalties for those who have not purchased health insurance.
It is important to understand that these new taxes (or penalties) will be phased in over the next few years and do not take affect right away. And with a program that is so politically charged, there could be changes by Congress or the president after the elections in November 2012.
Understanding The Individual Health Care Mandate
The Supreme Court has allowed for significant latitude when it comes to Congress’ ability to tax its citizens. While Congress cannot force consumers to buy health insurance under the Commerce Clause, it can assess a tax or penalty for those who do not comply.
Beginning in January of 2014, individuals and families must have “essential” health insurance coverage each month or be subjected to a financial penalty. Those who are below the federal poverty level, can prove hardship conditions or are part of a few other small minorities will be exempted from the new legislation, but not many.
How Much Is The Obamacare Tax Penalty?
Those who choose not to purchase health insurance under the Affordable Care Act will face a financial penalty enforced by the Internal Revenue Service.
The yearly tax penalty for not having essential coverage will be the greater of a flat dollar tax per individual or a percentage of the individual’s income. In other words, the penalty will vary from household to household.
In 2014, the flat dollar tax amount per individual is $95; in 2015 the amount is $325; and in 2016 the maximum is $695. For dependents under age 18, the flat dollar amount is half of the individual amounts above.
After 2016, the tax penalty will be indexed to inflation and capped at 300% of the flat dollar amount for families who choose not to purchase health insurance. Thus, the amount of the penalty will vary for families depending on the number and age of dependents as well as if the maximum cap applies.
- For example: A family with two adults and one child under age 18 would pay a penalty of $1737.50 in 2016. (1/2 of $695 for the dependent plus $695 x 2 for each adult = $1737.50)
- A family with two adults and two children over age 18 would cap out and pay $2,085 in yearly penalties in 2016. ($695 x 300% = $2085)
Factoring In Taxable Income To Calculate The Penalty
Here is where it gets a little tricky. The higher your household income, the higher your penalty for not complying with the health care mandate. This wrinkle begins in 2014 when the majority of the Affordable Care Act will be implemented.
The law states that the percentage of taxable income is the amount in excess of a household’s tax filing threshold phased in at 1% in 2014, 2% in 2015, and 2.5% in 2016.
- For example: Assuming the tax threshold is $10,000 in 2014 and $50,000 of income for a single filer, the tax penalty would be calculated by subtracting the $10,000 threshold from the $50,000 in taxable income to arrive at $40,000. That $40,000 would be subject to the 1% penalty rate in 2014 for a total of $400.
An individual with a household income of $50,000 would owe roughly $400 in 2014, which of course is higher than the flat dollar amount of $95 mentioned previously.
Again, the penalty is the greater of the flat dollar amount per individual or a percentage of the individual’s income. In a nutshell, this tax is begin means tested by the ACA.
However, the annual penalty is to be capped based on an amount equal to the national average for premiums of a qualified health plan with a “bronze level” rating by the government and offered through state or federal health insurance exchanges. As these exchanges have not been setup yet, these numbers are still unknown.
How Will The Health Care Tax Be Implemented?
If an individual or family does not purchase essential health insurance coverage while also not meeting any provisions that allow for an exclusion, then they will be subjected to the tax/penalty.
The fine will be administered federally and reported/calculated on the non-compliant person(s) tax return. The mandate is to be enforced by the Treasury Department via the Internal Revenue Service.
The fine can be withheld from the offender’s yearly tax rebate if one is due from the Federal government or if none is due, then collected through normal and customary means. In other words, one could expect a letter from the I.R.S in the form of a past-due notice.
It is important to note that at this time the law states that individuals cannot be subjected to criminal penalties, fines, or levies when found to be in non-compliance.
At this point, it is somewhat unclear as to whether late penalties would be implemented for those who do not comply with the mandate or if their maximum penalty would simply carry over to the next year.
Purchasing Health Insurance To Avoid Penalties
While the new health care rules and regulations are yet to be implemented, what is clear is that health care will likely be forever changed by the approval from The Supreme Court of this sweeping legislation. Most consumers will simply buy health insurance in order to avoid I.R.S. fines/taxes/penalties etc.
Hyers and Associates, Inc. is a full service independent insurance agency and will help you find the coverage you need at the best rates available in your area. Contact us today for assistance with your health insurance needs.
Category: Health Care Reform, Health Insurance
Parts of the new health care legislation have already taken affect, but there is quite a bit of confusion over the guaranteed issue status for children under the age of 19 years old. (Editor’s note: Some of the information below is outdated – please contact us to discuss a child-only health insurance application.)
As of September 23, 2010 the new law requires that all children under age 19 must be offered health insurance regardless of their medical history. As of 2014, all insurance carriers must accept child-only policies.
Child Only Health Insurance Restrictions and Risk Tiers
At present, it seems that most if not all insurance companies will only offer coverage to children under age 19 as long as at least one parent or legal guardian also applies for coverage on the same policy. Should the parent or guardian be declined for any reason, then the child would also be declined.
Health insurance providers are also creating new risk tiers as they expect to be insuring children with potentially significant health concerns. Thus, some parents might find that their portion of the policy premiums are reasonable, but the cost for a child with preexisting conditions is very expensive.
Open Enrollment Ruling by the Ohio Dept. of Insurance
In an attempt to provide clarity on the issue, the Ohio Department of Insurance recently enacted an “emergency rule” providing for open-enrollment windows for all children applying for coverage without an adult.
However, insurance companies may still have the right to decline child-only applications. Put another way, there is no legislation at this time that forces an insurance carrier to accept an application for a child-only policy.
The open enrollment window ruling by the Ohio Department of Insurance requires insurers offering child-only policies to accept applications at the same time and for the same length of time each year. Initially, the open enrollment window will run from September 23, 2010 to November 15, 2010. In 2011 and beyond, open enrollment will occur twice a year and include the entire months of July and January only.
Issues with Adverse Selection and Child Health Insurance
The emergency rule is designed to help alleviate fears of adverse selection with the large medical insurance providers. Adverse selection allows children to jump in and out of health insurance coverage only when they might need expensive care. The insurance companies worry that they will have a disproportionate amount of unhealthy children in their pool of applicants resulting in unfair financial risks.
As there are no penalties for refusing to purchase coverage, parents could enroll and dis-enroll their sick or injured children as often as they wished. Open enrollment windows might cause those who are trying to game the system to second guess this decision if they understand that coverage will not be available for a child only policy but twice a year or when applying with an adult.
Contact Us – Request Quotes
At present, very few companies are accepting child only health insurance policies and are requiring acceptance of a parent or guarding on the same policy.
Undoubtedly, this will create issues for parents who have coverage elsewhere, but these are some of the unintended consequences of health care reform. This particular rule has no bearing on group health insurance coverage.
Hyers and Associates, is a full service, independent life and health insurance agency offering medical coverage in several states. Please contact us to discuss your needs or to request child only health insurance quotes.
Category: Health Care Reform, Health Insurance
As part of the health care reform bill passed by Congress and signed into law by President Obama in March, new high risk health insurance pools will be created by several states. The pools are designed to last 40 months and bridge the gap until applicants with preexisting conditions must be underwritten for permanent coverage.
(Editor’s note: There is no longer a high risk pool needed or offered.)
The Department of Health and Human Services is working closely with individual states in order to provide program regulations and specifications. Ohio is one such state that has chosen to create their own pool as oppose to joining the federal program.
Medical Mutual of Ohio
Medical Mutual was chosen by the Ohio Department of Insurance to setup and operate the high risk pool. Applications will be accepted as of August 1st and coverage can begin on September 1, 2010 at the earliest. Two plans will be offered; one with a $1,500 and the other a $2,500 deductible. Age, gender and tobacco use will affect monthly rates for the applicant.
The state of Ohio is expected to receive approximately $152 million from the federal government to administer the pool. Once that money has been spent, it is unlikely that any new funding would be appropriated for coverage expenses.
Visit http://www.ohiohighriskpool.com/ for more information.
Admission Requirements for Ohio’s High Risk Pool
There are several requirements that must be met before consumers can gain access to the pool. Individuals will need to provide proof of the following:
- Must be uninsured for six months
- Can have no access to employer sponsored health insurance
- Been denied coverage from two separate insurers
- Ineligible for Medicare and/or Medicaid and other state run programs
- Afflicted by a generally accepted preexisting condition
- Citizen of the United States
- Resident of the state of Ohio
Proof of the above listed requirements may be required in most cases. Consumers may need two letters of declination, a letter from a medical professional detailing their preexisting condition(s), and acceptable forms of state and or federal identification.
The Health Insurance Agent’s Role
In Ohio, Medical Mutual will not be compensating agents who assist with entry to the high risk health insurance pool. In this way, applicants may be working directly with the carrier. However agents can provide some assistance with letters of declination from insurance companies. Even if a consumer has been without coverage for six months, he or she will still need two letters of denial.
There are some health insurance providers that simply underwrite to a yes/no standard. On the other hand, some carriers might provide coverage, but rider out preexisting conditions. If an individual desires access to Medical Mutual’s plan, then they will want to make application to two companies that are more likely to decline coverage than to rider out a condition.
When it comes to traditional health insurance in Ohio, both Anthem Blue Cross Blue Shield and Aetna are more likely to decline coverage whereas Assurant, Medical Mutual and United Healthcare may provide limited coverage. If an individual is in need of two letters, then they may want to make application or speak with Anthem and Aetna first.
Individual and Family Health Insurance
Hyers and Associates, Inc. is an independent agency providing medical insurance in Ohio and beyond. Should you need coverage outside of the high risk pool, then we can help you.
In some cases, only one family member will be eligible for state run coverage. We can help the other family members gain entry into a traditional or HSA medical insurance plan with any of our well known carriers. Contact us today for more information.
Category: Health Care Reform, Health Insurance
New state and federal laws allow Ohio residents to keep children insured on a parent’s health insurance policy past age 23.
Federal and State laws only require coverage is offered to age 26.
Those who are insured through an employer based group health insurance plan – and those who have purchased individual or family insurance – can keep their children covered longer under these rules.
State and Federal Eligibility Requirements
Under the state of Ohio law, there are eligibility requirements. The prospective insured must be:
- Unmarried
- A natural child, step-child or legally adopted
- Not yet age 26
- Resident of Ohio or full-time student
- Not employed by a company offering eligible health benefits
- Ineligible for Medicare or Medicaid
Under Federal law the child can be married or unmarried but must be:
- A child of the employee as defined under the group policy
- Not yet age 26
- Not have group coverage from their own employer plan
It is important to note that the child does not need to be financially dependent on the parent(s) in order to qualify for coverage under the new state and federal health care reform laws. Additionally, parents should be able to write off their child’s monthly premiums for income tax purposes as before.
Health Insurance Plans – Adding Dependents
The state law in Ohio takes effect July 1, 2010. Parents can request to add their children on an existing group or individual plan during the first renewal date of their policy. All new policies issued after July 1 will automatically allow for the addition of older dependents.
The state law applies to group policies that include coverage for dependents as well as COBRA and state continuation coverage. It is important to note that not all employer offered group health insurance policies offer coverage to dependents.
Ohio law also offers extended coverage to those who purchase individual and family health insurance on their own if group coverage is unavailable to them. All plans including basic, standard, open enrollment, and conversion plans will fall under the new state law.
Federal Implementation of Health Care Law
The Federal law will go into effect on September 23, 2010. It applies to group plans as well as individual health insurance that provides benefits for dependents. Self insured ERISA plans are also covered.
For Ohio residents, the Federal law only requires health insurance coverage is offered to age 26. Thus, insurers offering group or family health insurance coverage in Ohio will need to abide by the state law up to age 26.
Requirements for Employer Health Insurance Plans
Employers who do not offer health insurance for dependents will not be required to do so under these laws. Nor will they be required to offer coverage to a spouse of the insured. These laws only affect group plans currently providing coverage for children of the insured.
You can learn more about current rules and regulations concerning the Affordable Care Act at the Ohio Department of Insurance.
Request Information and Quotes
We are an independent agency offering coverage throughout the state of Ohio and beyond. If you are in need of individual, family or group health insurance quotes, please contact us today.
Category: Health Care Reform, Health Insurance
One of the first components of the health care bill to take effect is the requirement that insurance companies provide coverage for children under age 19 who have preexisting conditions.
The change is slated to take place in September of 2010 and is designed to prevent children from being excluded from their parent’s policy or a similar stand alone policy that can be purchased in the open market.
No Exclusions for Children
After September, health insurance companies will no longer be able to exclude children with preexisting conditions from coverage. Additionally, they cannot place a rider or exclusion on any conditions which would trigger a waiting period for coverage to begin. The simply means that health insurance carriers will have to insure all children regardless of their past health history.
Health Insurance Premiums for Children
It is still somewhat unclear how these legislative changes will affect premiums. The intent of the new law is to put a cap on premiums that can be charged by the insurance carriers and to close any loopholes which could result in a child being denied coverage. Working through the NAIC, insurance providers have said they will cooperate with the federal government and operate within the confines and intent of the law.
Overall, this is good news for children who have had difficulty enrolling in a comprehensive health insurance plan. How these changes may play out as part of the health care overhaul in total is yet to be told. It is the opinion of this insurance representative should health care reform be repealed or overhauled, guaranteed coverage for children is one area politicians are unlikely to change.
Adults with Preexisting Conditions
Adults with similar problems finding insurance will have to wait longer. As it stands now, adults with preexisting conditions will have to wait until 2013 before insurance companies will be required to cover said conditions or provide coverage at all.
Legislative changes could happen between now and then, but states are moving quickly to create high risk health pools to accommodate those who are currently uninsurable. (It should be noted that high risk pools exist in many states already.)
State run programs for high risk individuals should be up and running within the next six months across the U.S. They will be subsidized by the federal government and will have caps on the monthly premiums which can be charged.
Request Health Insurance Information
Hyers and Associates Inc. is a full service independent insurance agency providing health insurance quotes for individuals, families, and groups in several states.
We work in Arizona, California, Florida, Georgia, Illinois, Indiana, Missouri, Ohio, Pennsylvania, and Tennessee.
Contact us today and we can help you find suitable medical coverage that fits your needs.
Category: Health Care Reform
Behind closed doors members of Congress are hammering out plans to change the shape of the current health care system. Details are still somewhat scarce, but House and Senate member are determined to have a bill put together by the middle of the summer and actual reform by year end. Outlined below are changes that we might expect to see in the not so distant future.
Government Health Insurance Pool
Congress seems determined to create a federally subsidized health care pool. In essence this will be government created and run health insurance. It will compete with the private carriers and most likely will force health insurance prices down across the board if it undercuts currently available plans.
If govt insurance provides good care and is popular with hospitals and doctors, then it will go a long way toward driving out private insurance in the individual and family marketplace. If the insurance is substandard and unpopular with health care professionals, then private plans will remain necessary. If consumers are receiving better attention from their health care providers with private insurance, it will be advantageous to avoid a government run plan.
Health Insurance Mandates
One goal of health care reform may be to ensure that all Americans have health insurance coverage. This could only be done by creating mandates like those we have seen with car insurance. Mandates will require that individuals and families purchase or qualify for some type of federally mandated minimum insurance coverage. Individuals and families will either qualify for state run coverage like Medicaid or be forced to either join the government pool or purchase private insurance. Underwriting will be virtually non-existent for preexisting conditions, but tobacco use will still be a factor in determining monthly premiums.
Employer Sponsored Health Insurance
There is also talk of requiring most, if not all, small and large businesses to provide health insurance to their employees. This will likely only be offered from private insurers like Anthem, Aetna, United Healthcare or others, but perhaps the government will be active here as well. How this will ultimately affect businesses is yet to be determined. It could however become a financial burden to small business owners across the country – especially those operating on slim profit margins.
In summary, plans are underway and change will soon be upon us. It will be interesting to see what evolves from the ongoing talks between legislators, unions, hospitals, doctors, pharmaceutical companies, insurers, and corporate advocates. It will also be intriguing to see if these plans actually drive down the cost of health care now and into the future.
If you are in need of a individual, family or group health insurance quote, please contact us today.
Category: Health Care Reform, Op/Ed
Our insurance agency receives several inquiries regarding health insurance including maternity coverage.
Our clients want their coverage to begin immediately. And they need to know which insurance company offers plans with no waiting period for pregnancy.
The good News: All Affordable Care Act Plans Must Now Offer Maternity Coverage.
Even if you’re pregnant, ACA plans must accept you. There is a catch, however. They do not have to accept you outside of the Open Enrollment window. Open Enrollment begins on November 1st and runs through January 15th.
If you’re outside of Open Enrollment, you will need a Qualify Life Event to enroll in a new plan. These event usually revolve around loss of other creditable coverage.
Maybe you lost coverage from work or perhaps you moved and could your insurance plan would not cover you in your new resident State. Another example would be losing your parent’s insurance at age 26.
In those cases, a new ACA Marketplace plan must accept you no questions asked. They cannot ask any health related questions nor ask if you’re pregnant. You will usually be covered at the beginning of the next month.
Maternity Insurance – No Waiting Periods
There’s more good new here too. Many plans before the advent of the Affordable Care Act has waiting periods before maternity coverage began. Sometimes it was six months, other times it could be an entire year.
That is no longer the case. ACA-type plans will begin coverage right away. There are no waiting periods whatsoever.
This is not the case with short term health insurance plans, however. They do not cover pregnancies and, in fact, can turn you down for coverage if you’re already pregnant.
You most likely do not want to purchase a short term health plan if you’re pregnant or want a plan offer maternity benefits. ACA and group (employer-based) plans are best for immediate and full coverage for pregnancies.
Contact Us Today For Personal Assistance
If you are unsure of your options when it comes to maternity insurance, please contact us. A lot has changed with the implementation of the Affordable Care Act.
We can help you understand the rules, regulations and timelines so that you can enroll in the health insurance coverage that best suits your needs and future.
Category: Health Care Reform, Health Insurance
