ObamaCare Sticker Shock

Posted on: June 10th, 2013 by Bill

Rates are starting to become available little by little and so are the warnings. “The Looming Premium Rate Shock” – http://energycommerce.house.gov/rate-shock – is a report recently released by the House Energy Committee estimates that premiums for some could go up 500%. Hopefully that won’t happen in Florida. The reports example of Florida estimates increases of 100 to 120% on less comprehensive plans. Small group health plans in Florida rates are estimated to go up 13-75%.

There are a number of factors contributing to these increases including lower deductibles, 3-1 community rating, maternity for all, and no pre-existing condition exclusions. Even with a subsidy you could end up paying more. The PPACA requirements cost money and that has to come from premiums.

So what can you do?

You can keep your current plan through your policy anniversary date in 2014. Many carriers will be offering anniversary date changes to 12/31 to give you more time to see how the Obamacare rollout goes.

If you qualify for a subsidy AND it lowers your premiums then it would probably be a good idea to switch on January 1, 2014. Open enrollment starts 10/01/2013. Also if you are interested in maternity coverage then the exchange plans will offer you a much better selection than what is available in the individual market today.

If you have an individual / family insurance plan then at some point next year you will have probably have to make a change. If you are on a group health plan then you will just have to go along with whatever the plan sponsor decides.

Hopefully the Florida Obamacare rates and subsidy amounts will be available soon.


3 Things You Should Know About the Health Insurance Exchange

Posted on: February 26th, 2013 by Bill

3 Thing You Should Know About the Health Insurance Exchange

If all goes as planned, beginning October 1, 2013 the federal Health Insurance Exchange (HIX) or what the White House is calling the “Health Insurance Marketplace” will be open for business. US citizens and legal residents will be able to evaluate plan options for the 2014 calendar year. Not everyone will be eligible to purchase on the Exchange. It is expected that initially exchange shoppers will consist of individuals and families buying their own coverage and employees from companies with fewer than 100 employees. If this applies to you then here are three important need to know facts about the Health Insurance Exchange:

  1. Open enrollment begins October 1, 2013 and ends December 15, 2013. This is a guaranteed issue period in which you can enroll in a health plan beginning January 1, 2014. You will be locked in to the plan you choose for the remainder of the year. There is no obligation to stay on the plan but if you cancel, you will the assessed the tax penalty and be unable to enroll again until the next open enrollment. There are certain qualifying circumstances to purchase a plan through out the year, for example the discontinuation of your employer provided coverage.
  2. Premium Tax Credits will help subsidize the cost for individuals purchasing insurance on the Exchange. Individuals and families with incomes below 400% of the Federal Poverty Level (i.e. $44,680 individual or $93,200 per family of 4) will qualify for some assistance.
  3. Individual mandate – Having credible health insurance coverage is mandatory in 2014. Failure to comply will result in tax penalties levied by the IRS. The penalty in in 2014 will be the greater of $95 per uninsured adult or 1% of the household income over the tax filing threshold.

Call me 866-495-4111 if you have any questions and I will keep you updated as new information pertaining to the implementation of the PPACA is released.


What are the PPACA Essential benefits?

Posted on: February 25th, 2013 by Bill

What are the PPACA Essential benefits?

The PPACA essential benefits are benefits falling in 10 categories that must be covered by all plans offered in the individual or small group markets, or through an exchange, without annual or lifetime limitations. The PPACA regulations also affect cost sharing and coverage.

• Hospitalization
• Emergency services
• Maternity and newborn care
• Prescription drugs
• Laboratory services
• Preventative and wellness services and management for chronic diseases
• Pediatric services including vision and oral care
• Mental health and substance abuse disorder services
• Ambulatory patient services
• Rehabilitative and habilitative services and devices

Cost sharing includes all deductibles, co-payments, and coinsurance. PPACA regulations dictate that the annual cost sharing limit (ceiling) be set at $6,400 for individual and $12,800 for a family in 2014. For insurance plans that offer in and out of network services, only the in network services are subject to the out-of-pocket ceiling. In 2014 Deductibles will be subject to a separate limit.

Until the states finish selecting their benchmark plans we won’t know what the effect on price is going to be. Safe enough to say that the increased benefits, community rating rules, and removal of pre-existing condition clauses will put additional upward pressure on health insurance premiums. Fortunately for many there will be a subsidy.


Healthcare Reform and You

Posted on: December 12th, 2012 by Bill
 Healthcare Reform is here and there are three very big changes that will affect everyone.
  1. The health insurance exchange open enrollment in October 2013
  2. Individual mandate – compulsory insurance starts in 2014
  3. Guaranteed issue – no more pre-existing condition exclusions starts in 2014. 
Over the next several months we will be seeing lots of changes.  I will try to keep you informed on these developments through this newsletter.  You are always welcome to call or email me your questions.

Beginning January 1, 2014 all US residents will be required to maintain minimum essential coverage unless the individual falls into one of the following categories: 

  1. religious conscience exemption (only applies to certain faiths)
  2. incarcerated individuals
  3. undocumented aliens
  4. cannot afford (exceeds 8% of household income)
  5. in coverage gap of 3 months
  6. hardship situation as defined by HHS
  7. below tax filing threshold
  8. members of Indian tribes

The penalty for not having the minimum essential benefits required by the government is $95 in 2014, $325 in 2015, and $695 in 2016 OR 1% of your taxable income in 2014, 2% in 2015, 2.5% in 2016 and beyond.

Beginning January 1, 2014, nobody can be denied coverage based on a pre-existing condition.  Pretty simple.

Healthcare reform is a restructuring of 17% of the US economy.  The transition is not going to be easy as consumers have to face some hard truths about the Patient Protection and Affordability Care Act – PPACA…aka “Obamacare”.  So far we have only seem minor changes causing relatively minor rate increases.  We can expect thousands of new provisions, taxes, fees, penalties, and regulations.  

We will stay informed so if you have any questions please let us know.


Flaws That Will Bring Down Obamacare

Posted on: October 4th, 2012 by Bill

What!! Flaws!! Shut the front door!! The Patient Protection and Affordable Care Act (PPACA) is 2,500 pages of magnificently written prose. What’s in it? Like Nancy Pelosi said “We have to pass the bill so you can find out what is in it.” –

So why are some libertarians and conservatives defending it. It seems that some parts were written too well, or not well enough, or they are just getting around to reading it now, nonetheless, some would like to simply ignore parts of what the law says.

For starters there is the issue of tax credits. People are eligible for tax credits IF they get health insurance from a state based insurance exchange. What happens if the state does not set up their own exchange? The law then states that the federal government will set up the exchange. The dilemma is that the federal insurance exchange does not come with any tax credits.

Many states oppose the PPACA and as a result have not set up, or even begun to set up a state exchange. Many of the state are not even prepared. According to an article in the Washington Post “More than three dozen could be unprepared or unwilling to set up the insurance marketplaces called for under the 2010 healthcare law”. read the whole article here. Without the tax credits and subsidies many people will not be able to afford the premiums on the exchange. Remember the laws mandate additional benefits and the government is not paying for them…you are.

The health-care law also protects companies and individuals from tax increases. The law penalizes employers up to $3,000 for each employee they don’t provide coverage for…but only if that employee is getting the health insurance with a tax credit. That means that if there isn’t a state based exchange, there isn’t a tax credit, and if there is no tax credit there there are no penalties. Oooops! I guess this means that the stage has been set for even pore lawsuits. I wonder who pays for all these lawsuits…maybe the lawyers are doing it for free.

Ramesh Ponnuru has written about this in more depth. His article can be found here – http://www.bloomberg.com/news/2012-10-01/the-flaws-that-will-bring-down-obama-s-health-care-plan.html