Shop and compare health insurance Marketplace plans in minutes. Enrollment often takes as little as 15 minutes and the federal subsidy continues to save single persons and families thousands of dollars. You do not have to have prior coverage to qualify and all medical issues are covered. You can choose cheaper catastrophic and high-deductible plans, or more robust comprehensive coverage with lower deductibles and smaller office visit and prescription drug copays.
Individual and family healthcare plans are purchased through State and Federal Exchanges. New rates and updated regulations changed how we buy medical coverage and the price that we pay for it. Our website provides the lowest available Health Exchange rates, and makes it easy for you to apply and enroll for a policy. Ancillary dental and vision benefits are also offered. Most areas offer HSA plans that feature tax-favored treatment of qualified medical, dental, and vision expenses. Unused contributions will not be lost.
We also help you request and obtain instant subsidy tax credits that reduce your premium and teach you about the Affordable Care Act and the Marketplaces. Determining your eligibility involves several steps, and we quickly determine the amount in about a minute. Our unique health insurance cost calculator saves you money. Applicants that are eligible for Medicare or Medicaid will have different options. The Senior Open Enrollment period begins October 15th and ends December 7.
What Is Different About Buying Coverage Through An Exchange?
Each policy that is offered must (by law) contain certain provisions or 10 essential health benefits (referred to as EHB), whether you request them or not. Some of these benefits are newborn and maternity, substance use disorder, mental health, treatment of behavioral health, vision and oral care, prescriptions, and management of chronic diseases. Of course, this is just a partial list of ailments that must will be covered without a waiting period or surcharge.
Every year, the Department of Health and Human Services (HHS) adds several new mandates. Mental illness and preventive coverage are two of the major areas that have made the most progress in previous years. Newborn expenses and chronic treatment may be the next items that are expanded. Enhanced treatment of opioid addiction has been discussed and may soon be implemented. The cost of treatment and rehabilitation is substantial to both families and the government.
Viewing a carrier’s formulary and non-formulary drug list will not involve having to register or create a private account. Detailed prescription coverage will be available including specific differences in plans. If any changes are made during the year, they must be posted (in writing) before the changes go into effect. If prior authorization is needed, this information must be included in the drug description.
Also, provider directories must include additional information regarding location of offices, and whether new patients are accepted. Each month, information must be updated, and if specific plans utilize a different network, it must be clearly defined and explained. However, contacting your physician or specialist is the best method to ensure they are an “in-network” provider and accepted by your carrier. Often, insurers offer HMO, PPO, and EPO options, so it is important to clearly identify the type of plan you own.
When Do Rates Become Available?
Prices are published by each state separately, since costs are different. Usually, carriers officially file their anticipated pricing by June or July. State Insurance Departments typically approve (or disapprove) the requests within 3-5 weeks. Also considered are rates from new companies entering the Marketplace. For instance, five years ago, Aetna and UnitedHealthcare began increasing their Marketplace participation. However, since that time, both carriers have exited the Marketplace.
Five years ago, Assurant exited all states. Three years ago, Aetna and UnitedHealthcare exited the Exchanges. Humana also no longer offers private medical plans. Kaiser, another large US carrier, only offers plans in selected states. However, Ambetter (Centene Corp.) has been expanding their market share each year. Note: UnitedHealthcare has returned in several states.
Vermont was the initial state to publish their premiums. Vermont Health Connect initially charged between $750 and $1,750 per month for a family, depending on the plan. Tax subsidies reduced these amounts. Blue Cross Blue Shield of Vermont and MVP Health were the two carriers that initially offered policies in the state. Vermont also previously rejected a single-payer system, and the issue is not expected to be considered in the next few years.
Bigger states, such as Texas and California are often able to quickly provide their Marketplace prices, despite the higher number of carriers and plans available for consumers. Larger states will typically feature a combination of HMO, PPO, HSA and Point-Of-Service options, which often allows a broker to custom-fit a plan to meet needs more easily. New carriers frequently enter the Exchange and existing carriers often increase their service area.
All states have published prices for the current or upcoming year, and you can request a free quote from our website. Additional policies are offered “off” the Exchanges and options are especially attractive for upper-income households that have no pre-existing conditions. There are also several “non-compliant” plans that cost about 40%-65% less than a Marketplace policy, but contain mainly catastrophic benefits. These types of plans are often considered “short-term,” although up to 36 months of coverage is available in several states.
How Has Enrolling And Applying Changed?
Applications look completely different than from six years ago. One reason is that there are no medical questions! Although your premium can be adjusted due to your age, smoking status and zip code, your overall health has no impact on prices. Thus, an applicant that is treated for terminal cancer and insulin-dependent diabetes will pay the same rate that a perfectly healthy person pays (assuming same age etc…). Is that fair? That depends on what medical conditions you are being treated for.
We have set up a special section of each page on our website to provide your zip code. A free online quote will be provided so you can easily view different plans. Ultimately, if you decide to apply for benefits, we will help, including determining how much money the government will give you in the form of a federal subsidy (tax credit). It is possible that some or all members of your household may become eligible for Medicaid or CHIP (children). In most states, several carriers are available with different provider networks.
For some individuals and families, your policy may be free, since the subsidy could possibly exceed the cost of the plan you are buying. And of course, certain states (Ohio and Pennsylvania) will be cheaper than other states, such as New Jersey and New York. Also, Medicaid eligibility has expanded in many states, allowing low-income households to qualify for comprehensive benefits.
Do All Of The Big Companies Offer Policies in 2021?
Initially, in the first year, not every company actively participated. This included the “biggies” like Blue Cross (Blue Shield), Aetna, UnitedHealthcare, Humana and Cigna. Although there will be other carriers that join this group, it is expected that several companies will eventually stop offering individual health care coverage to consumers. For example, UnitedHealthcare originally opted out of most states, but offers contracts away from the Marketplaces, along with ancillary and short-term plans.
Aetna and Cigna originally exited most states by writing business in selected states that they felt would be profitable to them. Ciga remains in many states, while Aetna no longer offers private medical coverage. Both carriers, like UnitedHealthcare, offer many ancillary contracts, group benefits through employers, and Senior Medicare plans.
Why? The toll of having to guarantee unlimited benefits to anybody who applies for a policy is a tremendous financial risk. And not every insurer can sustain paying out higher than expected claims every year. Both UnitedHealthcare and Aetna have stated that one reason they did not initially participate in many State Exchanges was because of profit concerns.
Consolidation and attrition also must be considered. Assurant exited the business and does not participate in State or Federal Marketplaces. Also, many local health cooperatives no longer offer policies because of excess claims and high expenses. Six years ago, the largest nonprofit cooperative funded by Obamacare legislation (Health republic Insurance Of New York) was shut down because of massive losses.
Will I Be Able To Keep My Current Plan?
Although seven years ago, President Obama said you can, actually, the majority of plans were not able to be kept. Since there were requirements (by law) to include maternity, mental health coverage, drug addiction treatment and contraceptive coverage in all policies, any existing plans that did include them, had to be scrapped. Exceptions were “grandfathered” plans that were issued in April 2010 or earlier. In 2021, many plans are discontinued, and several carriers have left the Marketplace. However, replacement options are always available.
While it is possible that some of these plans can be revised to include these benefits, premiums may increase. Also, many employers opt to pay a small fine instead of offering healthcare to their employees. This often saves millions of dollars, and it would be hard to explain to company shareholders why they did not consider this option. And often, the number of part-time employee hires increases, since benefits paid are often a fraction of what full-time employees will receive.
Our Household Income Is More Than $100,000. Will We Receive Instant Tax Credits?
It depends. The older the ages of family members, the more likely you are to qualify for a federal subsidy in the form of an instant tax credit. A major variable (other than age) is where you live. Each state has a slightly different method of calculating the Obamacare subsidy, and often, the differences are thousands of dollars each year.
Below, we have illustrated several examples in random US cities. The dollar amount shown is the annual tax credit per year given to each household to help pay premiums. We used an exact income of $100,000 in all situations. Incomes lower than $100,000 will result in bigger subsidies and lower rates.
$4,380 – Harrisburg, Pa. Family of 5 (55, 55, 15, 17, and 18)
$3,000 – Harrisburg, Pa. Family of 4 (55, 55, 15, and 17)
$3,760 – Dayton, Ohio. Family of 5 (50, 50, 14, 17, and 20)
$2,664 – Dayton, Ohio. Family of 4 (50, 50, 14 and 17)
$1,572 – Chicago, Il. Family of 5 (50, 50, 11, 13, and 16)
$0 – Chicago, Il. Family of 4 (50, 50, 11 and 13)
$2,304 – St. Louis, Mo. Family of 5 (42, 42, 11, 9, and 7)
$3,540 – St. Louis, Mo. Family of 5 (47, 47, 20, 18, and 16)
Can I Buy A Plan Outside Of The Exchange?
Yes, you can. But you will not be eligible for tax credit reimbursements by purchasing an outside policy. However, assuming it is a reputable plan from one of the large insurers, the premium you pay could be slightly less than what is typically available. In that situation, it may benefit you to choose coverage outside of the Exchanges, especially if your household income exceeds the threshold needed to qualify for a subsidy. And often, you can expect a richer network provider list.
Commonly referred to as “off-Marketplace” or “off-Exchange” policies, one important concern is that these plans meet Affordable Care Act regulations by including the 10 “essential health benefits” that were earlier discussed. If they don’t (short-term contracts don’t), you are not required to pay up to 2.5% of your household income in penalties. Although remaining uninsured is not recommended, it is no longer unlawful.
Are HSA Plans Available?
Fortunately, they are, and all tax advantages of these types of contracts remain. The usage of HSAs will substantially increase in 2020 and continue. Many of the other plan options will be very expensive to consumers that are in excellent health and thus, may not utilize many of the benefits that will be required to have. Blue Cross, Oscar, Kaiser, Gunderson, Vantage Health, Alliant, and Bright Health (and perhaps some other carriers) are some of the companies offering the best options.
The minimum 2021 HSA deductibles are $1,400 for single plans, and $2,800 for a family. These amounts remained the same from last year. The maximum amount of contributions that can be made are $3,600 and $7,200 respectively. Maximum out-of-pocket limits slightly increased to $7,000 for single policies and $14,000 for family policies.
What Type Of Scams Should I Look Out For?
The Better Business Bureau and State Attorney Generals are already watching very closely how consumer confusion with the legislation continues to give scammers some ideas, especially with seniors who are already a big target. Both telemarketing boiler room operations that make calls, and questionable mail that is sent in bulk, seems to increase during Open Enrollment periods.
Releasing your social security number should always be a top concern. When comparing and reviewing different plans, you do not need to provide your social security number. You should also never provide your checking account, debit account or credit card information when visiting a website. The exception, of course, is when you are applying for coverage through a respected and recognized broker or government website. If you’re uncertain, ask us and we will investigate.
Also, if you receive a call (phone) from a federal worker that is offering to send you a new “federal medical card,” but needs personal information, it is probably a bogus call. Simply hang up. This type of card does not exist and no legitimate person or company will call you about it. If you have concerns or questions, please contact us and we will investigate the source. Although we can not recover lost funds, we can refer you to the most appropriate resource.
Are The Establishment Of The Health Insurance Exchanges The First Step Towards Socialized Medicine?
That depends on who is answering the question. We have 39 years of experience in this field, so we believe we are fairly informed and unbiased. Based on the large number of unanticipated claims that will be filed by previously uninsured persons, there will be a lot of financial pressure on the health insurers, especially the smaller regional carriers.
Not all of them will survive. And what happens if only a few are left…or perhaps even one? Ironically, perhaps we have begun to see consolidation with the Aetna/CVS merger. This could create a very different outlook, although federal intervention would likely not be required. The Aetna/Humana and Anthem/Cigna mergers were not completed because of antitrust concerns,
A single-payer socialized medicine health care system is also not likely to replace the current system within the next five years.
Was your health insurance policy canceled? If it was, you’re getting a slight reprieve since you now ill not have to pay the tax (mandate) for not purchasing qualified coverage. Also, you will now be eligible to buy “catastrophic” plans, that are often the cheapest option on the Exchanges. However, they do have very limited benefits in some areas.
The timing is helpful since December 23rd is the deadline for securing a January 1 2014 effective date. Applications received after December 23rd will be issued with a February 1 effective date. Open Enrollment ends in the Spring, and will start over again later in the year.
Open Enrollment is scheduled to end at the end of the month. However, it is possible an extension will be announced (despite contrary rumors). An additional 30 days was added. Also, it was announced by the White House that if you own an existing policy that does not meet ACA guidelines, you may keep it an additional two years.
Annual limits for out-of-pocket costs (cost-sharing) has now been increased to $6,600 for individuals and $13,200 for families.
Open Enrollment for plans begins on November 1st and continues through January 31st.Originally, the start date was going to be on November 15th. The extra two weeks will help consumers shop and compare policies that will be more expensive most areas. Also, in selected states, new carriers will enter the Marketplace. Co-ops, however, are suffering financially in many areas.
Montana is the first state to officially publish their Marketplace rates. Average increases are between 22% and 34%, and more than 40,000 residents will be impacted. However, persons that are covered through a work group plan or Medicaid will not be affected by these price hikes.
The three carriers offering individual plans are PacificSource, Montana Health CO-OP, and Blue Cross Blue Shield of Montana. Small business-owner group plan rates offered by the most popular companies, are expected to only increase approximately 6%-7%. Insurance Commissioner Monica J. Lindeen published individual and group rates this week.
Only two companies will be offering Marketplace plans in Oklahoma after three carriers announced they will not be participating. UnitedHealthcare and Blue Cross Blue Shield of Oklahoma, the biggest insurer in the state) will be available.
Assurant is no longer writing individual business in any state. GlobalHealth, an HMO based in Tulsa, also will not be offering any Exchange coverage to state residents. And CommunityCare of Oklahoma will be terminating existing plans and not returning. Most carriers were not profitable the last few years, so these recent departures were expected.
The New York Health Plan Marketplace will feature 16 companies offering individual plans. The only non-returning carrier from 2015 is troubled CO-OP Health Insurance Republic of New York. Federal regulators forced them to cease operations because of severe financial and insolvency concerns.
Last year, Health Republic covered one out of every five persons that purchased Exchange plans (more than 80,000). For 2016, some of the larger carriers include Excellus BlueCross BlueShield, Fidelis Care, EmblemHealth, and North Shore.
Congress passed several budget and tax agreements that impact the Affordable Care Act legislation. The Excise (Cadillac) tax has been postponed for an additional two years and will not be effective for 2020. The medical device tax has also been delayed, and the standard ACA tax has been eliminated.