Marketplace | Benefits | Subsidies | Calculating Your Income

Marketplace

With the 2014 Affordable Care Act no one can be declined or have a premium increase due to having pre-existing conditions or not meeting height and weight guidelines. The government’s website was known as the Exchange and has been renamed the Marketplace.

The enrollment period is from November 1st to December 15th. From January 1st to October 31st one must qualify for a special enrollment period (SEP). You must enroll during a period of 60 days after a life changing event has occurred, which you must qualify for. Examples of qualifying life events are moving to a new state, changes in your family size (marriage, divorce, having a baby) or losing your group insurance.

Benefits

The 2014 HealthCare reform is the same from state to state, with the exception of some states provide different minor benefits, such as dental for children or an eye exam. 35 states have the same exact plan, while 15 states differ with minor benefits.

It’s more important to focus on a plan’s benefits and coverage rather than the plan’s name. As some carriers Bronze is better than other carriers Gold. Some insurance companies don’t even offer the Gold or Platinum plans in certain states.

Basically, there is just one plan. The difference between plans is the medical and prescription deductible, co-insurance and maximum out of pocket. All the plans have the same benefits. If you are choosing a higher plan such as Gold or Platinum you are paying a higher premium. Meaning, you are paying your deductible, co-insurance and maximum out of pocket upfront or ahead of time.

If one knows that they will have an upcoming claim that will reach the maximum out of pocket, it makes sense to choose the plan with the lowest maximum out of pocket. This is basically the main reason to choose a more expensive plan. Then there’s the getting a lower prescription deductible. Which buy itself makes little sense. The savings on a lower deductible is eaten away with the higher monthly premium. But, it may be beneficial if one is using their insurance with medications in conjunction with other claims.

Choosing a plan with the lowest premium and adding a supplement that includes injury and critical illness is most often the best choice for coverage and premium. These are some of reasons why it’s important to talk to an insurance broker and be properly informed and educated before making your decision.

Once your deductible is met, the insurance will pay their part of the co-insurance till you reach your maximum out of pocket, then your insurance pays at 100%. Doctor visits and prescriptions do not count towards your deductible, with the exception of some plans offering co-insurance for expensive formulary prescriptions.

Due to the 2014 health care reform, there cannot be limits for hospitalization, surgeries and so forth. The only exception could be the number of covered office visits. Also, a limited schedule of benefits is a thing of the past.

These plans cover prevention at 100% with no deductible. Meaning, a wellness visit costs you nothing. If blood work, MRI’s and colonoscopy falls under diagnostic testing, then it would fall under your deductible and co-insurance. MRI’s are typically are considered diagnostic testing.

Subsidies

The subsidy amount, is the amount that the government will pay towards your premium on a monthly basis, going off your projected 2017 income. We have a subsidy calculator for you to use, if you are wondering how the numbers work. It is located on at the bottom of the Health Insurance located towards the top of our website, not to be confused with our Insurance Tips.

To clarify subsidies for you. No matter what you qualify for, it may not be more than the Silver plans premium for a non-tobacco user. There is a minimum and maximum income amount to qualify for a subsidy. Subsidies are based off income, age, ZIP codes and number of people in your household.

The subsidy goes off your 2017 projected household income. When you file your 2017 taxes in 2018 is when you and the government will square up with you. If you over estimated your income, you will receive money back. And, if you underestimated your income, then you’ll be owing them. It doesn’t matter, if everyone is or is not applying for the subsidy or insurance. It’s all calculated in the quoting software, as far as number of people in the household and number of people needing insurance.

If you are required to pay more than 8% of your income for health insurance. no penalty is accessed for being without an exchange approved plan and you are eligible to purchase more affordable coverage.

Calculating Your Income