This is a special feature by Sherry Franklin of Sherry Franklin & Associates, Inc. in Cornelia. For more information visit her online at www.sherryfranklin.net or call 706-963-1465.
February 15 is the deadline for Americans to enroll in health insurance, as mandated by the Affordable Care Act. Those who already have coverage may also change it by February 15. Rates for insurance purchased through the Marketplace also known as “on exchange” are determined by household income, geographic location,tobacco use, and age. As a result of the health care law, pre existing conditions no longer prevent coverage from being obtained, nor does its presence increase cost.
The Marketplace considers household income as a factor in deciding the policy cost; married couples must file jointly to get premium tax credits. Individuals must project earnings at $11,670 or higher for 2015. Applicants shouldn’t include anyone who isn’t a tax dependent, a spouse,or someone who earns their own income and is covered under their own insurance policy. From a 2014 tax return, an estimate can be found by going to Line 37 of a 1040 tax form, Line 4 of a 1040 EZ form, or Line 21 of a Form 1040. If an applicant expects their income to be the same as 2014, they can use these numbers. Otherwise, an estimate will need to be made; update your Marketplace application promptly during the year whenever there are household or income changes, as the coverage amounts could change during the year going forward.
The premium tax credit subsidy can lower monthly costs of insurance, and is available to families with incomes between 100 and 400% of the federal poverty level. For 2015, the poverty level used is $11,670 for a single adult and $23,850 for a family of 4. These individuals and families will pay no more than 2.01% -9.56% of their incomes for a mid-level ” silver” plan. Above that, the rest of the cost is paid by the federal government. For families and individuals making between 100 and 250% of the poverty level, the cost is even less as cost-sharing is given, allowing lower costs for hospital stays or doctor visits and deductibles.
In Habersham county, four insurance carriers are offering ON MARKET/ ON EXCHANGE coverage: Alliant, Assurant, Blue Cross, and United Health Care. Of these four, Alliant and Assurant offer PPO plans, giving both in and out of network coverage. Blue Cross Pathways and United HealthCare Compass plans offer HMO coverage, with no out of network coverage. Check plans to find participating hospitals and physicians; for example, Northeast Georgia Medical Center and its Physician Group do not participate in the BC BS Pathways network. For example, a 39 year old making $25,000 / year may receive a subsidy of $125.00/ month toward a policy purchase. A married couple both aged 39 making $35,000 together would be eligible for $325.00/ month in tax subsidies, qualifying at 223% of the Federal Poverty Limit.
Coverage can also be purchased OFF MARKET / OFF EXCHANGE. These policyholders are generally those who make more than the tax subsidy allowances or want to purchase insurance outside of their workplace. Carriers offering Off Market coverage in Habersham County are Aetna,Alliant SoloCare, Blue Cross HMO Pathways, Assurant Health Plans, CoventryOne, Humana, and United HealthCare. A 39 year old person can expect to pay $203 for a Bronze plan ($6300 deductible) with Blue Cross; for a Platinum ( 90% coverage) plan with United Health Care Navigate PPO a rate of $469 per month has a deductible of $750.
Four levels of insurance are available: Bronze, Silver, Gold and Platinum. Coverages range from 60 to 90%, respectively. The most commonly purchased plans are those in the Silver plan, as these plans also offer cost-sharing for qualified applicants. In this case, deductibles are reduced as low as $350 or $700 per family, depending on income qualifications.
Those who didn’t have qualified health coverage for 3 months or more in 2014 will experience a penalty fee when filing a 2014 federal income tax return, if an exemption was not obtained. Exemptions may be given for special circumstances, and may be obtained at tax filing time, or by completing a Marketplace application and requesting a waiver. To claim an exemption due to cost, you’ll need to know what the lowest cost Bronze plan that was available to you in 2014, and complete Form 895 for Health Coverage Exemptions.
Penalties are as follows:
In 2014, families will be charged 1% of household income above filing thresholds or a maximum fee of $285, whichever is higher. The breakdown is $95 per person, and $47.50 for children under 18.
In 2015, the fee increases to 2% of your yearly income above filing thresholds or $325 per person,whichever is higher. In 2016, rates rise to $695 per person or 2.5% of income, whichever is higher.
In addition to the penalties, uninsured persons should consider the financial implications should illness or injury strike. Health insurance puts limits on the out of pocket charges, preventing serious financial costs or even bankruptcy. Uninsured adults are less likely to get routine care, and could be unaware that a medical issue exists. Many preventive screening tests are available under the new mandate; these tests are covered 100% by the insurance carrier.
When getting quotes or applying for coverage, HealthCare.gov can be accessed on line or by phone at 1 800 318 2596, 24 hours a day. To get an estimate of eligibility, the Kaiser Family Foundation offers a health insurance marketplace calculator, which can be accessed at www.kff.org. Using an independent insurance agent or broker does not increase the cost of purchasing a plan.
