Let’s look at how ObamaCare affects immigrants and how immigration status affects Marketplace coverage, cost assistance, Medicaid, and coverage requirements. Most immigration statuses qualify people to use the Marketplace, but only lawfully present immigrants have access to cost assistance and are required to obtain coverage. Limitations apply to specific groups in regards to Marketplace coverage, Medicaid, and… Read More
How Health Insurance Networks Work With Health Insurance The general types of networks are HMOs and PPOs. A given provider will then either be “in-network” or “out-of-network” for a given plan. You and your insurer save money by using “in-network providers.” You’ll almost always have different cost-sharing when you use a provider “out-of-network,” so you’ll… Read More
Some say ObamaCare doesn’t do enough to control health care cost. Let’s look at how ObamaCare controls healthcare spending with cost controlling provisions. TIP: To find out what coverage under the Affordable Care Act will cost you, make sure to check out the healthcare.gov marketplace and find your cost after assistance is applied. Taxpayers are benefitting as… Read More
Alicia, 39, and Rusk, 37, have been married for 14 years, and have two sons, 11 and 7. Alicia, a former teacher, and Rusk, who owns an auto repair shop, did not have health insurance until the Health Insurance Marketplace opened last year. The 2015 premium for Rusk and Alicia is $373 a month, much… Read More
Cost-sharing in health insurance is your share of costs (copays, coinsurance, deductible, out-of-pocket maximum) for covered benefits in a policy period. Typically cost-sharing does not apply to Premiums, uncovered costs, or balance billing. TIP: In simple terms, cost-sharing describes your share of the costs vs. your insurer’s share of the cost in respect to your… Read More
ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. Other Metal Plans include Bronze, Silver, and Gold. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. Platinum plans have the highest premiums and the lowest cost-sharing. They only make… Read More
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and generous cost-sharing. Other Metal Plans include Bronze, Silver, and Platinum. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. Gold plans mean higher premiums, less Tax Credits, but much… Read More
ObamaCare’s Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Other Metal Plans include Silver, Gold, and Platinum. Also a Catastrophic Plan is available to young adults and to some people with hardship exemptions. All plans offer basic benefits and minimum cost-sharing, Bronze Plans tend… Read More
ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost-Sharing subsidies. Other Metal Plans include Bronze, Gold, and Platinum. Also, a Catastrophic Plan is available to young adults and to some people with hardship exemptions. HealthCare.Gov, or your state’s Marketplace in states that don’t… Read More
Understanding the difference between HMO Health Maintenance Organization and PPO Preferred Provider Organization health plan types helps you compare plans to get the right coverage for you and your family. You can learn about the less common EPO Exclusive Provider Organization plans here. Under ObamaCare most plans are either HMOs or PPOs. Knowing which one is… Read More
Your health plan’s Summary of Benefits and Coverage (SBC) is a summary of what your plan covers in terms of benefits and cost sharing, and explanations of how everything works. We suggest opening up a Summary of Benefits and Coverage sheet as you follow along. The Summary of Benefits and Coverage PDF can be found… Read More
Get health insurance quotes and find out if you qualify for cost assistance from CMS approved brokers and on HealthCare.Gov. Below we will discuss the best ways to get health insurance quotes (HINT: Start at ObamaCare’s Health Insurance Marketplace sometimes called “the Marketplace” AKA HealthCare.Gov). We’ll also give you lots of helpful advice to help ensure you get… Read More
Here is a quick list of tips for getting the best health plan. No matter how you shop, this list will ensure you don’t over or under-buy health insurance. NOTE: Finding the best health plan for you and your family depends on your family size, income, needs, region, and more. The best plan for one… Read More
The Save American Workers Act changes the definition of full-time workers so fewer employers have to comply with ObamaCare’s employer mandate. Let’s take a look at the legislation, why it was passed in the House, why it won’t pass the Presidents desk, what effects it has, data on part-time hours and job loss, and some alternatives… Read More
What is Modified Adjusted Gross Income (MAGI), Adjusted Gross Income (AGI), Gross Income (GI), Family Income, Household Income, Etc? Modified Adjusted Gross Income (MAGI) is Gross Income (GI) Adjusted for deductions (AGI) and then Modified by adding some deductions back in (MAGI). On this page, we cover MAGI as it applies to Medicaid and the Marketplace…. Read More
Having Health Insurance means you are covered in an emergency. Not getting coverage could result in big fees for those who wait until taxes are due. Obtaining and maintaining health insurance isn’t just about avoiding a fee, it’s about taking responsibility for your health, knowing you have coverage when you need it, and avoiding the devastating… Read More
Let’s take a look at factors that affect health insurance costs for premiums and cost sharing under ObamaCare, including Marketplace subsidies and Medicaid. ObamaCare helps ensure fair health insurance premiums (Sec. 2701), helps curb premium growth, and provides Tax Credits to lower premium costs. The ACA also includes measures to reduce out-of-pocket spending and curb national… Read More
With ObamaCare deadlines for open enrollment approaching, it’s important to think about health insurance policy periods. Here are some key facts to help you understand why getting covered during open enrollment isn’t just about avoiding the fee, it’s about value. Your health insurance deductible (the amount you have to pay for covered in-network services before coinsurance kicks in)… Read More
What is Health Insurance Coinsurance? In health insurance, coinsurance is your share of costs of the allowed amount for a covered service after you reach your deductible. Coinsurance is different from a copay which is a fixed dollar amount for services and is not typically dependent on meeting your deductible. How does Coinsurance Work? Each service or drug that is subject… Read More
What is a Health Insurance Copay? In health insurance a copay (copayment) is a fixed amount you pay for covered services, typically when you get the service. Copays differ from coinsurance (the percentage you pay for covered services, usually after reaching your deductible). Each plan treats copays and coinsurance differently, so it’s important to understand if… Read More
What is a Health Insurance Deductible? Your health insurance deductible is the amount you have to pay out-of-pocket for covered services before your insurance begins to pay. It doesn’t include premiums or costs that aren’t covered by your plan. Once you meet your deductible, your plan will pay its share of your coinsurance. TIP: Your maximum deductible… Read More
What is a Health Insurance Premium? Your health insurance premium is the amount paid to an insurer, typically per month, for a health plan. Tax Credits are available to lower monthly premiums through the Health Insurance Marketplace. If you have coverage through work, your employer typically pays part of your premium. Let’s look a little more… Read More
ObamaCare’s Premium Tax Credits can be paid to your insurer in advance to lower your monthly premium on a Marketplace plan or adjusted on your tax returns. Tax Credits are based on household income and are available to folks making between 100% and 500% of the Federal Poverty Level FPL. Expanded Premium Tax Credit Cap:… Read More
How Do Cost Sharing Reduction Subsidies Work? ObamaCare’s Cost Sharing Reduction Subsidies (CSR) lower out-of-pocket costs, based on income, for Silver plans bought on the Health Insurance Marketplace. Along with Premium Tax Credits, ObamaCare’s Cost Sharing Reduction subsidies lower what you pay for out-of-pocket costs like deductibles, copays, and coinsurance, making health insurance coverage more affordable and… Read More
December 15th is the last day to get a health plan that starts by January 1st. The 15th is also the last day to verify your plan and information for the 1st. Visit HealthCare.Gov or find your state’s Health Insurance Marketplace and enroll in a plan by December 15th. This general rule applies for private… Read More