THE HEALTH INSURANCE MARKETPLACE / EXCHANGES
ARE NOW OPEN FOR BUSINESS
As of January 1st, 2014 all credible health plans sold on or off the health care exchanges now offer the same essential health benefits, as mandated by the Affordable Care Act. They also use the same cost-sharing measurements (actuarial value (AV), which is the percentage of health care expenses a plan would cover on average for a standard population) for all standardized plan tiers. These tiers will be broken down into 4 'metal" levels: bronze (AV of 60%), silver (AV of 70%), gold (AV of 80%), and platinum (AV of 90%). In addition to the tier level plans, young adults under 30 years old will have the option to purchase catastrophic coverage.
If your Modified Adjusted Gross Income is less than 400% of Federal Poverty Level (FPL), then you may want to purchase Health Insurance from an exchange through a licensed insurance broker because you could get subsidies (technically “advanced premium tax credits”) that can help lower premiums and make your costs more affordable. However, if you make more than 400% of FPL or expect more income than originally anticipated to show up once you complete your tax returns, you may elect to avoid the exchanges and purchase coverage directly from the carrier so you won't have to pay the government back at end of year or deal with other complications that could occur when you enroll through the exchange. That's right! You could be required to return a portion or all of the subsidy if they determine you made more then originally determined. You also may not have access to the subsidy offered through the exchange if you or your spouse’s employer offers group health coverage, even if your income is less than the 400% of FPL. In those cases you may be better served purchasing directly from the Health Insurance Carriers through a licensed insurance broker.
CLICK HERE - Deciphering The Health Law’s Subsidies For Premiums
As of Jan 1st 2019, if you do not have credible health coverage you will no longer have to pay a fine (individual mandate penalty).
The government will allow you to purchase plans on or off the exchanges on your own, but we recommend that you work with a certified and licensed insurance broker in order to select the correct plan for your family’s needs. These plans may look similar, but could have different Doctor networks, HMO requirements, copay/coinsurance amounts, and may cover only certain prescriptions; which may not include the ones you take.
PRIOR TO AUG 15th 2021 - If you make more than 400% of FPL then you probably would not qualify for government subsidies. You would then probably be better served finding insurance coverage off the Health Care Exchanges as there will be more plans, carriers, and possibly lower premiums to choose from. Especially, from those carriers who have elected not to take part in the exchanges. There are still many carriers that have decided to take a wait-and-see approach for now and may come up with different pricing strategies than those on the exchanges. Not every health insurance company offers plans through the exchanges and many offer different coverage off the exchanges in addition to the exchange plans.
Beginning in 2020, employers may offer their employees Individual Coverage Health Reimbursement Account (ICHRA) instead of traditional group health insurance plans. It is very important to know if your employer is offering you an ICHRA that is considered affordable. If so, then you will not qualify for an advanced premium tax credit and if you take that tax credit you'll likely be required to pay it back when you file your taxes. To Learn more check out DOL's explanation: CLICK HERE
2021 - 2022: The ARP premium subsidy enhancements are effective.
* People with income above 400% FPL will be newly eligible for marketplace premium subsidies. - OFF MARKET FAMILIES MAY NOW QUALIFY FOR SUBSIDIZED PLANS.
* People up to 150% FPL can now get silver plans for zero premium with vastly reduced deductibles.
* COBRA premium subsidies can be paid for coverage months no earlier than April 1, 2021 and no later than September 30, 2021. - NOT AVAIL FOR 2022
CLICK HERE - American Rescue Plan Act Expands Subsidies.
***2023: The ARP premium subsidy enhancements are going away unless congress acts. This means that many individuals will experience massive rate increases.
Please Note: We provide general information and resources for taxation questions applicable to health care reform. We do not provide tax advice since we are not a certified public accountant. If you have any questions, need clarification or tax advice, please contact your tax advisor.
Medicare Required Disclaimer: We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
We are not associated with Medicare, Medicaid or the Federal government.
A licensed representative may contact you regarding this insurance-related information request.
Any benefit information provided herein is a brief summary, not intended to be a comprehensive description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply.
© 2021 Coast to Coast Insurance Network, Inc. All rights reserved.
6003 Honore Avenue, Suite 104, Sarasota Florida 34238
We are not associated with Medicare, Medicaid or the Federal government.
A licensed representative may contact you regarding this insurance-related information request.
Any benefit information provided herein is a brief summary, not intended to be a comprehensive description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply.
© 2021 Coast to Coast Insurance Network, Inc. All rights reserved.
6003 Honore Avenue, Suite 104, Sarasota Florida 34238