There’s a lot of confusion with people thinking they can’t purchase health insurance on or off the Exchange after January 1st.  That’s not true.  You can enroll in health insurance through February 15th and avoid the IRS penalties for 2015.  Here are some things you need to know that aren’t on the website:

  • Using an exchange certified broker or agent from our agency costs you nothing.  In other words, the price is the same as enrolling for coverage yourself.
  • The penalty for not having a 2015 ACA Compliant health plan in place will be 2% or $325 per adult; 2% or $162.50 per child with a maximum family penalty of $975.
  • How do I qualify for a subsidy?  By supplying us with your approximate 2015 annual income, number of members in your family (including age) and address, our certified agents will tell you immediately what you qualify for.
  • All carriers’ bronze, silver, gold and platinum plans are not the same.  Different plans from different carriers (even though they fall into the same medal category) are not priced the same and, most important, do not have access to the same hospitals and doctors.  It is critically important to know what you’re buying in terms of access to providers before you purchase the policy.  Certain plans have very narrow networks and may limit you to only one or two hospitals in the metro area with a very limited number of doctors.
  • We’re your advocate.  We’re there for you.  Using one of our licensed, exchange-certified brokers or agents guarantees you will have help when you have a claims or a provider issue.  This will not happen if you purchase a policy directly on the exchange or using a navigator, sister or application expert,  In other words, when you have a claim for an ER visit that’s $11,000 and the carrier kicks it back for non-payment, we step in and solve the problem. Otherwise, you get to deal directly with the carrier and try to resolve the issue yourself.
  • I bought a policy last year, and I’m not happy.  If you bought a policy last year on the exchange or off the exchange, this is your opportunity to change policies and move to a policy or carrier that better suits your needs.  You can only make these changes during the open enrollment period (November 15th through February 15th) and you must enroll by December 15 for a January 1 start date.  Policies purchased after that date will have an effective date of February 1 or March 1.
  • Will my pre-existing conditions be covered?  There are no pre-existing conditions on individual policies.  Any medical condition is covered whether purchasing a new policy or moving from an existing policy to a new policy.
  • My group health insurance is too expensive, Employers with small groups (25 employees or less) may find individual health insurance as a viable option from a cost effectiveness standpoint since individual policies oftentimes are now less than group health insurance.  They can still be payroll deducted through the List Bill program, but individual policies do not give employers the tax credit they currently receive when buying group health insurance.  We can help you determine if this is a good fit for your company through a comparison analysis

Cary Hall

America’s Healthcare Advocate