Health Insurance Information
Health Care Reform – 2021 Making an Informed Decision
Our goal is to inform you of your options regarding the Affordable Care Act (ACA). We are here to help and guide you through the application process. There is NO COST to the applicant when working with an Agent!
The Affordable in the Affordable Care Act applies to those who qualify for the Advance Premium Tax Credit. We like to say; “The Government is not in the health insurance business; they are in the helping you pay for it business IF you qualify based on you income!”
Annual Open enrollment is normally from November 1 to December 15 for an effective date of January 1 of the following year.
If we are not in the open enrollment window you may qualify for coverage if you have a qualifying life event and qualify for a Special Enrollment Period (SEP).
What Is a Qualifying Life Event?
What if I have existing health concerns?
- You move to a new area that offers you different plans, or isn't covered by your HMO network.
- You get married.
- You have or adopt a child.
- You lose other health coverage due to job loss, a decrease in work hours, end of COBRA coverage or other reasons.
- You become a U.S. citizen.
- Your income changes or some other event changes your income or household status.
- You can prove that your health insurance company violated its contract with you.
- You are no longer covered on a family member's policy because you turned 26, you have legally separated from or divorced your spouse, or the policy holder has passed away.
- You become a member of an American Indian and Alaska Native tribe.
Effective 01/01/2014 you no longer have to answer health related questions to obtain Affordable Care Act (ACA) compliant coverage. Policies have guaranteed issue. There are only 4 factors used to rate policies ACA compliant plans:
- Family matrix
- Geographic area
In addition, ACA compliant plans have to meet “Essential Health Benefit” requirements. Two significant mandates included in compliant plans are maternity care and coverage for mental health benefits. The reality of these new guaranteed issue policies with additional coverage mandates is that rates have increased.
Transitioning into the new era of health care and making an informed decision requires us to address the following question.
- Determine if you qualify for a subsidy on your health care coverage. This is based on your Modified Adjusted Gross Income.,
Qualifications for a Health Care Subsidy in 2021 are based on family size and income:
|| 12,760 to 51,040
|| 17,240 to 68,960
||21,720 to 86,880
|| 26,200 to 104,800
|| 30,680 to 122,720
||35,160 to 140,640
| Each Additional Add
|| 4,480 to 17,920
If you and/or your family earnings fall within these earnings parameters you may qualify for a subsidy. To calculate and estimate your potential subsidy, go to the following Kaiser Family Foundation link by clicking here
Selecting a Plan:
A health plan is a generic term referring to a specific benefit package offered by an insurer. You will see references to HMO, PPO or CDHP plan designs. As with all insurance, the higher the deductible the lower the premium.
Plans on the Exchange fall within the following categories to make it easier for consumers to compare plan premiums and coverage options: Catastrophic, Bronze, Silver, Gold and Platinum plans.
Applying for a Plan:
If you apply for coverage:
ON-EXCHANGE: You are registering to obtain the premium tax credit. You can get this as an advance to assist with paying your monthly premiums or you can receive a lump sum credit when you file your tax return.
OFF-EXCHANGE: You are going straight to the carrier and not registering through the Exchange.
If you are applying off-Exchange, you can go to www.StatewideHealthInsurance.com and easily obtain and compare current rates from Blue Cross and Community Health Choice.
Once you have reviewed plan options, found a plan that is suitable for your needs and determined if you qualify for a subsidy, you are ready to apply. If you qualify for the premium tax credit (subsidy) you must register and apply through the Exchange.
The government is not in the health insurance business! Plan designs are the same on or off of the Exchange. If you register through the Exchange your coverage is still provided through one of the carriers that participate in the Exchange.
We have limited carriers offering coverage in the individual market. Many Counties in Texas Blue Cross is the ONLY option. Blue Cross only offers HMO plans in the individual market. You have to select a primary care physician.
Aetna (Coventry), Humana, United (Golden Rule) and Memorial Hermann (local option) are NOT offering individual coverage options in Texas!
There is no cost to the applicant when working with an agent!
A licensed health insurance agent can assist you with making an informed decision and guide you through the application process.
today for more information!