Penalties for Not having Health Coverage

People who are required to have health insurance but choose not to buy it will have to pay a penalty when filing their taxes.

Pay the greater of…

Year —- Percentage of family income — Set dollar amount

2014 — 1% — $95 per adult and $47.50 per child
(up to $285 for a family)

2015 — 2% — $325 per adult and $162.50 per child
(up to $975 for a family)

2016 — 2.5% — $695 per adult and $347.50 per child
and beyond (up to $2,085 for a family)

People who are exempt from the requirement are those who:
• would have to pay more than eight percent of their income for health insurance
• have incomes below the threshold required for filing taxes
• qualify for religious exemptions

Also exempt are:
• undocumented immigrants
• people who are incarcerated
• members of Native American tribes

Application Glitches Being Worked Out – Obamacare

Covered California shut down its online enrollment system Saturday night through early Monday morning for what it described as “regular maintenance.” Last week, the state took enrollment offline two other times to address problems consumers had with repeated error messages and general slowness on the site. Some people said they were finally able to create an account on the website after numerous attempts, but they still couldn’t log in and complete the sign-up process for coverage under the federal Affordable Care Act. Officials attributed the initial problems primarily to a larger-than-expected response during the first week of enrollment.

Enrollment in the exchange lasts until March 31, 2014, although you must pick a plan by Dec. 15, 2013 to have coverage starting Jan. 1, 2014. “We continue to make improvements and address issues as they arise,” said Covered California spokeswoman Anne Gonzales. “The pages were loading more easily and quickly as of late last week.” 

 California allows consumers to get price quotes and compare health plans anonymously without first creating a personal account. That requirement on other state websites appeared to create extensive problems. California plans to launch an online tool that allows people to search for specific doctors and hospitals by health plan before choosing an insurer. That feature was delayed last week as state officials addressed the enrollment issues. “Covered California had an enormous challenge to develop an IT system to manage such a large program,” said Patrick Johnston, president of the California Assn. of Health Plans. “It is working and the fact there are adjustments in the early days only means the demands were great.”
Reported by Chad Terhune – October 7, 2013

Overwhelming Interest in Initial Obamacare Offering

According to an LA Times article by Noam N. Levey and Chad Terhune
October 5, 2013, since the new marketplaces opened Tuesday, millions of Americans have flooded websites, call centers and insurance offices seeking information about health coverage offered through the Affordable Care Act.

More than 8.5 million people visited the federal site last week, according to officials at the Department of Health and Human Services and California’s Marketplace, Covered California, had 514,000 visitors to its website the first day of enrollment.

“Blue Shield of California said its consumer call volume more than doubled last week with hundreds of people asking about their options under the healthcare law and whether they qualified for federal subsidies,” the article stated.
Additionally, the federal call center received 406,000 calls covering residents of 36 states that are not running their own online markets.

Very few of those potential customers have been able to complete the process of applying for coverage because of a number of technical problems.

“Clearly there is a lot of interest in getting health insurance out there,” said Joel Ario, a former state insurance commissioner and Obama administration official who, like many, was surprised by the outpouring.

Fewer than 4 in 10 adults said they were familiar with the new marketplaces, with three quarters of the uninsured saying they were unfamiliar with the marketplaces.
Millions of low- and moderate-income Americans who make less than four times the federal poverty level — or about $46,000 for individuals and up to about $94,000 for a family of four — will qualify for government subsidies to help with their premiums. Officials hope to enroll 7 million people next year.

For help in answering your questions and assistance in applying for the new healthcare options, call Jeremy at (310) 486-7625.


Open enrollment for Medicare Supplemental Insurance begins October 15, 2013 and continues through December 7, 2013 for coverage January 1, 2014.
Seniors — contact Jeremy with questions and concerns regarding your existing coverage.
Turning 65? Contact us for information on the best ways to protect your health and enjoy your Golden Years, free from worry about medical costs determining your quality of life.

Open Enrollment – Affordable Health Care Exchange

Reasons to Use An Agent for the Exchange
Open enrollment for the Affordable Health Care Exchange begins October 1, 2013 for effective coverage January 1, 2014. The Exchange can be confusing so let us guide you through the decision and application process. All agents are required to complete hours of training to prepare to aid you in deciding whether the exchange is right for you and to help you navigate the application process.
Small business owners will be directed to Certified Agents. In order to ensure that you have personalized service throughout the length of your coverage, Covered California is referring applicants to Licensed Agents.
Call Jeremy at (310) 486-7625 to have your questions answered and your particular insurance needs met.

Health Exchange Tax Breaks

According to a new Kaiser Family Foundation analysis, Americans who currently buy their own insurance through the individual market would receive tax credits averaging nearly $2,700 next year for coverage purchased through new insurance marketplaces. The tax credits or subsidies would be an average of 32 percent of the premiums for this group of enrollees in “silver” plan.

These rate announcements do not reflect federal subsidies that will offset the cost of insurance for many current individual market policy holders.

“Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year,” Foundation President and CEO Drew Altman said. “They will help make coverage more affordable for low- and middle-income people.”

Tax credits will be available to subsidize premiums for people who buy their insurance in the new marketplaces, do not have access to other affordable coverage, and have incomes between 100% and 400% of the federal poverty level (between about $11,500 and $46,000 for a single person, and $24,000 and $94,000 for a family of four).

An estimated 48% of people who currently have individual market coverage will be eligible for tax credits. Tax credits among those eligible will average $5,548 per family, and subsidies will average $2,672 across all families now purchasing their own insurance. Many people who are now uninsured will also be eligible for subsidies and their tax credits will likely be higher on average since they have lower incomes than those who now buy their own coverage.
For more information on the tax rates specific to your needs call Jeremy at (310)486-7625.

Out of Pocket Protection – Affordable Health Care

It has recently been reported that a little-noticed rule on the U.S. Department of Labors’ website since February would allow many group health plans to maintain separate out-of-pocket limits for medical and prescription drug coverage for 2014.

But according to a report in the Sacramento Business Journal, California may be in the lead on health care reform again. The Assembly Health Committee passed legislation in August to implement consumer protections in the Affordable Care Act against high out-of-pocket costs.

Senate Bill 639 by Sen. Ed Hernandez would implement key protections to provide a one-year delay for some plans if passed by the Legislature this year and signed by the Governor, despite a decision by the Obama administration.

““With this bill, California can once again not just implement the federal law, but improve upon it so our patients get these benefits as soon as possible,”” Anthony Wright, executive director of Health Access, said in a news release.

“This bill ensures that no California consumer in individual or small group coverage has to wait to get these important consumer protections.”

SB 639 would limit annual out-of-pocket costs to $6,350 per individual.

“”California has been implementing other pieces of the legislation early and should be in a place to go ahead on this,”” Wright said. “It is possible the question is moot in California because benefits and out-of-pocket costs are already set by Covered California for 2014,” he added.

Essential Health Benefits Included in Health Insurance Exchange

In the August 13, 2013 Kaiser Health News, Eric Whitney reports that the Affordable Care Act has set new standards — called essential health benefits — outlining what health insurance companies must now cover. But there seems to be a catch. Insurance firms can still pick and choose to some degree which specific therapies they’ll cover within some categories of benefit. And the way insurers interpret the rules could turn out to be a big deal for people with disabilities who need ongoing therapy to improve their day-to-day lives.
The Affordable Care Act is changing the benefits for people who require “habilitative” coverage defined as ongoing care necessary for people with disabilities.

“You’re much more likely to find these benefits in a plan in the individual market [starting in 2014] than you would be today. Far more likely,” says Clemans-Cope.

“Habilitative services” are included within the 10 categories of essential health benefits the ACA will require in those new plans. Still, while some categories are straightforward — such as maternity care and preventive care — the category including habilitative services leaves more room for interpretation.

For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.

Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they’ll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)

“This is a big improvement, but we should emphasize that it’s not totally fixed,” Clemans-Cope says. “And people are really going to have to get help to decide which plans cover the benefits they need.”
Covered California strongly recommends using a licensed, certified insurance agent to advise you on the benefits most necessary for your particular needs. Call Jeremy at (310) 486-7625 to be informed and ready for the changes with the Exchange.

Agents Recommended for Business Policies in Insurance Exchange

Covered California announced in a recent seminar that it does not have the capacity to oversee and manage group policies within the exchange. Representatives from Covered CA are strongly recommending that small and large group policy holders continue to utilize the expertise of licensed agents to select, manage and explain the details of the new policies in and out of the Affordable Care Exchange.
Small business options in the Exchange will include the Four Metal plans offered in the individual arena. Group coverage will be offered with Blue Shield, Health Net and Kaiser. Businesses with less than 25 employees are eligible for Premium Assistance (tax credits.) All of the resultant changes with the Affordable Care Act necessitate working with a trained, licensed agent. For more information, call Jeremy at (310) 486-7625.

New Affordable Care Act Sparks Scam Worry

The need to work with a reputable insurance agent or broker was spotlighted in an article in the LA Times (July 21, 2013.) According to Anna Gorman of the Times, the National Health Reform Law has the potential for scams leading to identity theft and fraud. The National Health Reform Law (Obamacare) will make more than 2.6 million people eligible for subsidized coverage and an additional 1.4 million low-income residents eligible for expanded Medi-Cal programs in California. The Federal Trade Commission said dozens of consumers have reported fraud since the law has taken effect. One scam involves a caller promising to send a healthcare card if the person reveals personal and financial information. False enrollment websites have sprung up and even one company promising huge savings for consumers and then swindling them with fake insurance.
The other major issue of concern is the 20,000 plus counselors that will be hired to process information through the health exchange. Although training, background and fingerprint checks and secret shoppers have been instituted to ensure compliance, fraud is inevitable.
The California Department of Insurance has warned that there is still not enough protection for consumers. “If someone is just careless with a consumer’s identity, that could cause all kinds of problems,” said Nancy Kincaid, spokeswoman for the insurance department. Insurance agents and brokers undergo a much more rigorous vetting process than will be required of the new staff counselors.
Working with a licensed agent or broker for all your insurance needs is still the best protection that your best interests, as well as your privacy are of utmost importance. For more information call Jeremy at Jordan Financial Network Insurance Services, your licensed broker – (310) 486-7625