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Now available to Texans that have A Pre-Existing Condition and have been declined. THIS IS NOT A DISCOUNT PLAN but the Government Guarantee Issue Health Insurance.
THE PCIP PLAN ENDED IN FEBRUARY 2013….YOUR NEXT CHANCE IS OCTOBER 2013. BOOKMARK THIS PAGE AND CALL ME IN OCTOBER 2013.512-963-5000 SCOTT
Call 512-963-5000 for all your options inside and outside of the Texas Health Insurance Marketplace
Expanding health insurance coverage in Texas
The Affordable Care Act will expand health insurance coverage by establishing a Health Insurance Marketplace in every state and increasing access to the Medicaid program. 4,888,650 or 23% of Texas’s non-elderly residents are uninsured, of whom 4,478,407 (92%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Texas participates in the Medicaid expansion.
All Texans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.
Higher premiums and complicated choices for health insurance are coming by October, as a part of PPACA (also known as ACA, Obamacare and Health Care Reform). Most Americans must change health insurance plans in 2014, with October 1, 2013 marking the beginning of Open Enrollment and the Exchange Marketplaces. I am writing to you early to help you prepare and make good choices. The mainstream news media is beginning to publish a story that we, as insurance agents, have anticipated for quite some time, which is that premiums will be high, choices will be dizzying, and the process will not be “simplified” as promised.
My first priority is you – my current and recent clients. I will be meeting with each client to go through their particular situation, discuss upcoming options, and design a plan for each particular situation. In the meantime, I will be sending newsletters about important issues that are pertinent to your upcoming decisions. Below is my “top 8” list of issues you should be aware of now regarding the law, so we can design your course of action.
1. Change is mandatory. In 2014 every American must carry health insurance, and it must have benefit levels that comply with the new law. For people currently insured under a non-grandfathered Small Group or Individual/Family (IFP) health plan, the upgrade to the new benefit levels is substantial and will cause higher costs. The effective date is January 1, 2014, and Open Enrollment begins October 1, 2013. Most people are scheduled to change plans January 1, 2014. Fortunately, the law allows people to wait until their current plan’s renewal date on or after January 1, 2014. Insurance Companies are currently working on options to offer group plans new renewal dates for late 2013, so that many of their customers will not feel the effect until as late into 2014 as possible. Individual/Family plans must change on 1/1/2014 or their current 2014 renewal date
2. Premiums will be high for the new plans. The benefits required by the law are quite a bit richer than most small businesses and families have now. The law also mandates painfully expensive requirements for insurers, and tacks on many new taxes. It won’t be cheap. We expect rates in Arizona to double for young adults (especially young men), who currently have non-group plans (known as IFP or Individual/Family Plans). We expect others in Arizona’s small group and IFP market to see rate increases of 25% to 70% when they are required to update to the new plans. The IRS estimated that the national average family premium will be $20,000 per year for the lowest cost plan allowed by the new law. From other sources, I have heard estimates of $14,000 to $21,000 in Arizona as an average family premium for the lowest cost plan allowed by the new law. Hold on, though. Like everything else, there are options and loopholes to consider, as well as potential subsidies and tax credits.
3. The Exchange Marketplaces are scheduled to open October 1, 2013. The Exchange Marketplace is the new government run source for purchasing health insurance if you qualify for a subsidy. The private market will still exist. So those of you who choose not to use the Exchange Marketplace can still buy your insurance in the private market like you always have. Whether you use the Exchange Marketplace or the private market depends on quite a few factors, the biggest of which is eligibility for a subsidy, since subsidies are only available in the Exchange Marketplace to thrive leads vs bloom comparison. I am licensed to help you with every market (the Exchange Marketplace and the private market), for both business group plans and IFP (Individual/Family plans). I will also be certified to help you with subsidy applications. So, when we talk over your specific situation, we will look at all valid options, with all insurance companies, whether subsidized or not, whether inside the Exchange Marketplace or in the private market. The second most important factor determining whether you will use the Exchange Marketplace or the private market is “network size and restricted access to care”. The plans inside the Exchange Marketplace will have very narrow networks. That means that the list of doctors and hospitals in those networks will be small. Exchange Marketplace plans will also have restricted formularies for prescriptions, and restrictions on access to care like the HMOs of yesteryear. The private market will have a lot more choices and less restrictions. So, the choice of “Exchange or Private Market” will be a big one. Each case is different, which is why I will be talking specifically with all of my clients.
4. The subsidies are rich. A subsidy is available to help many families pay for their premium. If your family’s Modified Adjusted Gross Income (MAGI) is below 400% of Federal Poverty Level (FPL) you may qualify for a subsidy. For a family of four, 400% of FPL is currently $94,200. Clearly, many middle class families will qualify for subsidies. These subsidies are large, often worth thousands, and even tens of thousands of dollars annually. That is because the premiums are high, and because of the way the subsidies are designed. The subsidy is designed with a “backwards” calculation. It doesn’t tell us how much the subsidy is. It tells us how much you will pay as your share of the premium, if you chose the 2nd lowest cost Silver plan. Once we know that, we can calculate how much the subsidy will be, and we can apply that amount to any of the Exchange Marketplace plans (Platinum, Gold, Silver and Bronze). There are many other qualification rules, but family income is the first and biggest issue. Attached is a chart showing 400% of FPL (Federal Poverty Level) for varying family sizes. It also shows the maximum amount the family must pay for their share of the premium, which grades up to 9.5% of the family’s AGI. So, if your MAGI (Modified Adjusted Gross Income) is less than 400% you’ve met the first test of subsidy eligibility. That is good news for many. It is bad news for others who must pay the entire premium for these mandated rich benefit plans. It is also bad news for people who qualify for a subsidy, but still must pay up to 9.5% of their family’s Adjusted Gross Income for it (especially if their current plan costs a lot less than 9.5% of their income). It is also bad news for taxpayers who fund these large subsidies.
5. It’s complicated. No, it’s VERY complicated. The subsidy application is 21 pages long. Then you must choose a health plan, which will be complicated no matter if the government thought their Exchange Marketplace would simplify things. The only thing less complicated than today’s market will be that you no longer must answer health questions, because the rates and approval will not be based on the applicant’s prior health conditions. That also means you can switch plans without worry about a pre-existing condition waiting period. The health plans will fall into 4 tiers – Platinum, Gold, Silver, and Bronze, but there will be a dizzying array of benefit options inside each of those tiers. And the differences between Exchange Marketplace plans and private market plans will be large. Decisions for businesses will be complex. Some businesses will want to close their group plan and allow lower to moderate income employees to qualify for subsidies in the Exchange Marketplace. Others will refuse Exchange Marketplace plans due to the very narrow network of providers, restricted formulary and HMO-type restrictions, so they will keep a group plan in the private market or provide income to employees to choose their own plans. There are other factors to consider including special business tax credits and tax deductibility for business group plans. All of these factors will play into the decisions. Those with Grandfathered plans (plans purchased before 3/23/2010, with no increases to cost sharing) may keep their current plan, or they may wish to take subsidies for a new plan.
6. Let’s talk. I’m here to help you. Clearly each case will be custom, and the stakes are high. So I’m prepared to discuss every pertinent detail with you. We are stranded until July, the date the government estimates that they will complete their approval of the actual benefit plans and premium rates. Yet there is a lot we can do in the meantime. I will be sending you newsletters in the coming weeks to educate you on key issues that will affect your decisions. I’m determined to keep it understandable! In the newsletters I’ll select a few key issues at a time. (The next newsletter will discuss subsidies in detail, since “net cost” is one of the most important issues for most consumers.) Every future newsletter will focus on one issue at a time, with a broad overview first, then links to deeper details and guidance in layman’s terms, and finally links to more detailed resources and the actual rules and regulations. So, you can dig as deep as you need to, on each issue. At any point in time, feel free to contact me directly with questions and concerns that you have.
7. Let’s prepare. The government said it expects to finalize approval of the new health insurance plans and premium rates in July. Some governmental agencies have predicted it will be September before we have actual plan designs and rates upon which you could base a final decision. However, we can cross many bridges before then, which will help you narrow your choices and make a good final decision. You can prepare now by doing the following:
a. Find the MAGI (Modified Adjusted Gross Income) for your family (and/or for your employees). Your AGI (Adjusted Gross Income) is found on page 1 of your Federal Form 1040 tax return, on line 37. (Your AGI can become modified by things like tax-exempt interest and certain foreign earned income, but this will not apply to most people.) For businesses, estimate which employees will likely have income less than 400% of Federal Poverty Level. This will help us determine if you (or your employees) may qualify for a subsidy.
b. List your favorite doctors and providers so we can see if they are in-network for various plans. List your prescriptions so we can see if it is on the Formulary for various plans. (We expect plans in the Exchange Marketplace to use restricted Formularies to determine which medications are covered, and to use very narrow networks of providers).
c. For businesses, count the employees and number of hours worked in 2012 for every employee in every business that you own. Mark whether they are full-time, part-time, temporary, seasonal, 1099, leased or regular employees, because the government has special rules in the PPACA law for counting each type of employee. Employers with 50+ employees (known as “the large group market”) must offer affordable health insurance or face a stiff penalty. If you are certain that your count of ALL employees in ALL of your business entities will not approach 50 or more, then you do not need to perform this count.
8. Don’t lose sleep over this! Transitions like this are unsettling. Predictions in the press about probable economic repercussions may be frightening. I don’t deny their likelihood. However, it is my job as an insurance agent, to help you find the best insurance choices for your situation, that protects your finances and health, stays within your budget, and allows you peace of mind, and More Bonuses are waiting on it, This choice will arise. Following this law and its 20,000 pages of rules and regulations has been like riding a roller coaster, yet we found that solutions have arisen for many major issues. So far, major provisions have been delayed, repealed or terminated early, like the 1099 provisions, the CLASS Act, Discrimination Testing, the BASIC plan, the Co-Op plans, the PCIP high-risk pool, the SHOP multi-choice options, and so on. As each of these provisions came near time for implementation, all parties involved realized that they were not functional. Another realization is about to hit America. It’s not affordable either. When the actual plans and premium rates are released for the public by July to September, the backlash will be strong. Families cannot afford $20,000 annual premiums. Businesses cannot afford the taxes, penalties and premiums imposed by the law. Arizona’s premium increase is actually mild next to states like Ohio, Wisconsin, California, Idaho, Indiana and others that are expected to see 2-3 times the rate increases that Arizonans will see. This will be a much debated topic since the mid-term election occurs shortly afterwards. So until an answer to “affordability” is forged, I expect revisions and delays. In the meantime, insurers are using loopholes that were clarified in recently issued Federal rules and regulations, to create plan designs with valid insurance protection, but without the expensive mandates in the law. We anticipate a nationwide backlash this summer and autumn, aimed at both insurance companies and politicians, which is one of the reasons that I am writing to you early. Speaking of health and wellness, checkout this blog about Synergistiq Integraive Health.
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