Open enrollment is almost upon as, and that’s a good time for you to do an annual “physical” on your health insurance coverage for the next calendar year, in this case, 2016.
It’s the most important time of the year to make your health insurance decision, bar none.
Why is that?
It’s the only time of the year that you can switch plans, change your existing plan without a Special Enrollment Period (SEP—and more on that later).
It’s also the time when carriers are allowed to make rate and plan changes, as well as changes in their networks.
For example, a carrier may replace all their Preferred Provider Organization plans) (PPOs) with Health Maintenance Organzation plans (HMOs) at a certain Metallic plan level (plans are placed in Platinum, Gold, Silver and Bronze families, with Bronze having the lowest prices and leanest benefits).
This can dramatically change the landscape of the coverage that you’re trying to get.
This happened with a major national carrier in Arizona who made an announcement in the spring of 2015 that it would be offering no insurance coverage at all in this state).
This is when you want to double check and make sure your favorite doctor and hospital is still participating in your insurance company’s network.
A call to the doctor’s office to confirm will probably suffice. But you can also access all carriers’ networks at www.arizonaplans.com .
It is also the time, if you’re already covered, to make sure that your subsidy is accurate. If you’re income has changed from the time you got your original coverage, either up or down, don’t wait any longer to let the exchange know.
If you’re income has gone down, you may be eligible for a larger tax credit, or a Silver plan with cost sharing reduction (which will get you lower deductible, among other things)
If your income has gone up, you want to find out if you need to lower the subsidy amount. Otherwise you may end up owing money at the end of the 2016 tax year.
Start out by letting us ask you some questions.
You want to make sure that you get it RIGHT.
Once we have your estimated 2016 income, we can plug it in and come up with an estimated 2016 subsidy.
This will help you determine your monthly cost for the insurance (remember, however, that it is an estimate. The Exchange makes the final determination of the subsidy amount, if any, at the time that you apply, but usually the estimate is extremely accurate).
The point we want to emphasize is that the end of the calendar year is a good time and the beginning of the Open Enrollment period to take stock on your insurance needs and options.
Enrollment and plan selection is so important that we recommend that you get help from someone who knows the market the best:
your licensed and certified health insurance agent (us!!!).
Of course, you can enroll on your own, but income questions can be a little tricky, and answering them wrong can keep you from getting the tax subsidy you deserve. Or even worse, you answer incorrectly and get overpaid by the government when it calculate your subsidy. Remember, it can only go by the numbers that you provide, or how you answer the application questions.
You could be overpaid for the entire year.
Household Income Is Key
Your household income is the key to determining a subsidy, although there are some other factors that come into play.
Even if you’re not living under the same roof (your husband is working at a remote site for most for the year for example), as long as your John
Henry and his are on the same tax return, your income is counted jointly.
And this is your modified adjustment gross income, so it doesn’t include such deductions as real estate interest (but can include student loans, alimony or child support ).
Uncle Sam emphasizes that this is only an estimate but it’s important for it to be it as realistic as possible so you get the subsidy that you’re entitled to.
A lot of questions, a lot of things to take in account.
Our advice is to go through a licensed agent who will help find out if you’re eligible for a subsidy and get them to match that amount to the best plan out there to meet your needs. The cost is the same to you, so why not take advantage of our services?
We know you realize the value of having health insurance for you and your family.
Why doesn’t everybody else do so as well?
Some people think they’re invincible, that they never go to the doctor, so why should they be covered?
Well, emergency rooms across the country are filled with these invincibles who are now trying to figure out how to pay their astronomical medical bills.
You may be in perfect health today, but who knows what will happen tomorrow? Without insurance, a major medical event could wipe you out financially.
From a strictly monetary point of view, there’s also the issue of the tax penalty that you’ll pay if you don’t have insurance.
It goes up this year if you’re not, or the plan that you have doesn’t meet the minimum Affordable Care Act (Obamacare) standards.
In 2015 the individual penalty was $325 per person for the year ($162.50 per child under 18), or 2 percent of your income, whichever is greater.
You need to remember that Jan 1., 2016, is the earliest date you can get coverage in effect, even if you apply on the first day of open enrollment (November 1, 2015).
The general rule, however, is that if you apply on or before the 15th of the month (on December 1, 2014, for example) , the earliest you can get coverage is the first of the following month(January 1, 2016 in this case).
If you apply after the 15th, you skip a month to the first of the next month:
So a December 16th application would mean a February 1st effective date.
Open enrollment is a great time to examine your health coverage on an annual basis, to see what changes in your income, either up or down, will do to your plan.
We’ll be glad to help you do this.
If you have a Silver plan, you want to think long and hard before changing to Gold or Platinum plan, because Silver is the only type of plan that has Cost Share Reduction (CSR).
CSR will lower your deductible amount and your copays if you’re eligible for it (eligibility is determined by a complicated formula based on income and family size; no other plans but the Silver plans can take advantage of CSR).
If you’re enrolled and do nothing, the Exchange should auto-enroll your plan. You shouldn’t have to requalify during open enrollment either unless:
So that’s a quick summary of what you can do during Open Enrollment for 2016, but you probably have questions.
That’s a lot to keep in mind, a lot of information to juggle.
We want to make it as painless for you as possible, so don’t
hesitate to call us at (866) 344-8061. We’re here to help.
Again, there is absolutely no cost to you for our services. Call 866-344-8061 Today!
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