Your health insurance experts for NC & SC

Who should shop (or re-shop) for health insurance during the AEP?

October 27, 2015
As I write this, we are moving very close to the opening day for shopping for 2016 health plans. The Annual Enrollment Period runs from November 1st through January 31st. This is the third AEP under the Affordable Care Act (ACA or "Obamacare"). Let's take a look at who can benefit from this opportunity to comparison-shop among plans.

They include those who are:
  • Currently without health insurance, including those who have short-term (also called 'temporary') insurance, since those do not meet the requirements of the ACA. Not having creditable health coverage in 2016 could result in your having to pay a hefty penalty (which is increasing again in 2016) at tax time.*
  • Having current coverage cancelled. Lots of companies are having to "tweak" current plans, either to meet changes required by the federal government or because the insurers were losing money. Some insurers are changing their network options, so they're cancelling plans using those networks. They will be automatically moving you to the plan they think is the next best choice for you for 2016. Do you really want a health insurance company choosing your health plan for you??!
  • Receiving a subsidy. Subsidy amounts and eligibility change every year, along with the available plans. Just taking the passive route and letting your plan and subsidy roll over to next year may mean you're paying more for your health insurance than you need to be. It's always a good idea to revisit your options.
  • Currently on a "grandfathered" or "transitional" plan. A grandfathered plan is one which was in place prior to March 23, 2010. A transitional plan is one which became effective after that date but before January 1, 2014. Transitional plans were set to go away when the ACA went fully into effect in 2014, but have been allowed to remain through 2016 because of the pushback from citizens who had heard Obama say, "If you like your plan, you can keep your plan." Both types of plans were often less expensive for some people who had gotten low rates because they were healthy. However, over time and with annual rate increases (and changes in people's income making them subsidy-eligible), they may well not be the "deal" they were back at the end of 2010.  
  • Covered under a spouse or parent's group health insurance. Many employers, particularly in small businesses, pay some or all of the cost of the employee's health insurance but are not able to afford to do the same for the employee's families. It's worth checking to see if you can get a lower-cost individual plan for the family.
  • On COBRA. Even though you have the option to keep COBRA for, in most cases, up to 18 month, you should check to see if that's still the best choice for you. If you don't make the change to go onto your own health plan during the AEP, you will have to keep the COBRA plan for all of 2016 or until the end of your COBRA eligibility, whichever comes first.
  • Anticipating an income change in 2016. Will you be retiring, moving to a straight-commission position, reducing your working hours, or any of the myriad reasons for a predictable reduction in income in 2016? Conversely, do you anticipate a fairly substantial income increase that will affect subsidy eligibility? In either case, it's smart to re-run the numbers and look at the plans. What was a fit in 2015 may be all wrong in 2016.

Bottom Line: Once we hit November 1st, take a few minutes to run a quote (I'll have a link on the home page of this website) or feel free to contact me and I'll email you one! Nothing ventured, nothing gained, as the saying goes. And there's a LOT to be gained by choosing the right plan at the right time.

*If you don’t have a health plan that qualifies as minimum essential coverage, you may have to pay a fee for the months you’re uncovered. For 2016 the fee is the higher of these two amounts: 2.5% of your household income; or $695 per adult ($347.50 per child), up to a maximum of $2,085. You’ll pay the penalty on your federal income tax return.


Small Biz Owners - Are Your "Benefits" Actually Costing Employees More?

October 7, 2015
In another perplexing conundrum of the Affordable Care Act (ACA), health insurance benefits offered to employees and their families may well actually be costing the employees MORE!

How could that be? Here's how:

The ACA states that if a person has access to health insurance, whether through an employer plan (even as the spouse or child) or a government program such as CHIP or Medicaid or whatever, they are NOT eligible for any subsidy to reduce premium costs on an individual plan - even if thei...

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Falling through the ACA's cracks - one couple's story.

August 26, 2015
Any law has the possibility (probability?) of creating situations that demonstrate the Law of Unintended Consequences.

Unfortunately, to no one's surprise, the Affordable Care Act is no different.
Sometimes the resulting gaps leave agents scratching our heads trying to come up with viable work-arounds.

Let’s look at a situation that cropped up recently for one prospective client and her husband that demonstrates this. It is a perfect example of the Catch-22 created by the collision of two l...

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The Pink Slip Cometh - What to do about health insurance when you lose your job

August 18, 2015
No one is ever ready for the day the pink slip arrives. No one. Ever.

No matter how much the handwriting’s been on the wall. Not even if you hate the #@& job and are actually relieved.

I could write a whole post on how to handle a job loss, but there are many far more qualified than I to talk about that, and there’s certainly a ton of information online.

But one aspect I am uniquely qualified to address is the health insurance one.  And this is one decision I urge you NOT to make too hastily...

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Medicare: An Agent's Story - Part 2. Choosing prescription coverage.

August 5, 2015
Choosing prescription drug coverage (which is separate from what they call "original" Medicare - Parts A and B) was pretty simple for me, since I take two generally inexpensive generics. However, just to be sure, I decided to do my due diligence.

Thankfully, "due diligence" is made simple by the good folks at CMS (Center for Medicare & Medicaid Services), thanks to their Part D plan finder online.

A bit of an aside at this point: You may be wondering why in the world Medicare has all these "pa...

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Medicare: An Agent's Story - Part 1. How this agent chose supplemental coverage.

July 27, 2015
Medicare has been very much on my mind lately - for very (ahem) personal reasons! Not 'personal' as in 'private,' but personal because I'm about to be eligible. (This obviously happened when I wasn't looking and there must be a clerical error because I most certainly KNOW I'm only turning 45, not 65 :-))

I have to say, other than that a-g-e thing, it's been pretty darned painless. I applied for my Parts A and B coverage online through an "Apply for Medicare" link on the Medicare website, and a...

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Annual Enrollment Coming Soon!

November 12, 2014
The time has almost arrived! If your health insurance plan is going away (several carriers in the Carolinas opted not to extend their transitional, if-you-like-your-plans plans for another two years) or if you just don't like your current coverage for any reason - too expensive, not happy with the company, don't like the benefits, whatever -  your opportunity to make a change is coming up starting on November 15th.

You'll have until December 15th to submit an application for a January 1st star...

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The 10 Essential Health Benefits under the ACA

April 23, 2014
In order to meet the requirements of the Affordable Care Act, all individual (also called "private") health insurance plans must offer the same set of ten essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency servicesHospitalization (such as surgery)
  • Maternity and newborn care (care before and after your...

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What is a "qualifying life event" and why is it important?

April 22, 2014
When I've explained to people that under the Affordable Care Act there will be ONE annual enrollment period for buying or changing individual health insurance, many think that the rest of the year I'll be sitting with my feet propped up on the desk popping bon-bons.

Uh, no. Even if I were so inclined, that's not gonna happen! I will be busy helping people get health insurance all year round because of a phenomenon known as Life Happens. And when "life happens," it often creates eligibility...

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Catastrophic Plans under the ACA

February 4, 2014
Over the years I've had many callers tell me they just wanted "catastrophic" health insurance coverage. What they wanted was just a basic plan with little to no bells and whistles with a high deductible.

Well, the Affordable Care Act provides for an actual "Catastrophic" plan. And, yes, that's the name of it with all carriers. Not only that, but, as far as I'm aware, the benefits are exactly the same with all carriers.

However, Catastrophic (with a capital "c") plans are generally open onl...

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