Health Insurance Special Election Periods

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

Health Insurance Exchanges

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

Explaining The Health Care Tax Penalty

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

Child Only Health Insurance Coverage

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

Ohio High Risk Health Insurance Pool

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

Ohio Health Insurance for Dependents

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