Unless you have a health plan you purchased prior to March 23, 2010 (*grandfathered plan), you will be required to switch to a Qualified Health Plan (QHP) sometime in 2014. If you haven’t already, you will receive a notice from your carrier explaining your options. Please read the notice and respond or call me with questions! Most carriers are giving an option to “early renew” your policy. This means you will get a new renewal date of Dec. 1, 2013 (with a small rate increase) and then you will lock in the rate until the end of 2014. At that point, you will be migrated to a more expensive Qualified Health Plan. This early renewal strategy will save many people a lot of money. QHPs are defined at the bottom of this page.
A couple of carriers will put you in a QHP on Jan.1, 2014 — as the default option — if you don’t request the early renewal option. Again, please read the notices from your insurance company and let me know if you have any questions.
2. The Exchange (Marketplace)
As you know, Open Enrollment for Georgia’s Federally-Facilitated Exchange (Marketplace) begins on October 1. You might want to consider enrolling in a plan based on your modified adjusted gross income. Close to half of all the people who currently purchase their own health insurance in the personal plans market will qualify for a subsidy. This is a huge number!
If your adjusted gross income for your household is above the numbers below in italics, then skip to section 3.
If you will have access to “affordable, qualified” health insurance through your employer (or your spouse’s employer), then you will not be eligible for a subsidy — even if you qualify financially.
If your household annual income is less than 400% of the Federal Poverty Level, then you should qualify for a subsidy:
Individuals with annual income below $45,960
Family of 2 with annual income below $62,040
Family of 3 with annual income below $78,120
Family of 4 with annual income below $94,200
If you are expecting changes to your income in 2014, then please estimate your anticipated income since eligibility is based on your projected 2014 income. If you have questions about this or anything else related to Exchange plans and subsidies, please call me.
You can get quotes and enroll in Exchange plans through me. I explain why this is the best place to do so in a couple of my blog posts —
Here and
Here.
3. Pre-existing Health Conditions
One of the key provisions of the Affordable Care Act (ACA) is that carriers will no longer be able to increase rates or exclude coverage due to pre-existing conditions. If you have a plan now and you or a family member received a high “rate-up” or an exclusion rider due to health conditions, then you might want to consider enrolling in a new “Qualified Health Plan” that will start on January 1. This might be a good move and it might not. I will run comparisons of rates and benefits to help folks determine the best option.
Keep in mind, all carriers, even if they are not participating in Georgia’s Federally-Facilitated Exchange, will offer new qualified health insurance plans starting on Jan. 1.
4. What is your Best Option?
If you and your family are healthy or take just a couple of low-cost medications, you probably don’t want to switch to a QHP on Jan 1., 2014 (unless you qualify for a financial subsidy).
Some of my clients are sticking with their current plan, but putting one family member on a QHP due to their health condition(s) or medication(s). This can be a very good strategy.
You might want to shop for coverage now. A couple of carriers have announced rate decreases for the fourth quarter of this year. This would be a good time to shop to see if you can save money and lock in a lower rate until 2015.
In an effort to keep this email somewhat concise, I just highlighted some important points for you. I am here to help answer any of your questions related to Healthcare Reform and health insurance. I will be working long hours between now and mid-December, so please call me with your questions. If you have friends or coworkers who need advice, I’ll be glad to help them too.
Thank you for your business!
Greg
*grandfathered plans: Sometimes it makes sense to replace these plans. Each situation if different, so please ask me for advice.
DEFINITIONS:
Qualified Health Plan (AKA Obamacare plan) or ACA Compliant plan:
Under the Affordable Care Act, starting in 2014, an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan will have a certification by each Marketplace in which it is sold.
Essential Health Benefits:
A set of health care service categories that must be covered by certain plans, starting in 2014.
The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.
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