Obama Care 2017  -  A Brief Overview

Important Dates

  • Open Enrollment for new plans and renewals start November 1, 2016
  • Apply by December 15, 2016   for January 1, 2017. 
  • Last day of Open Enrollment is January 31, 2017.  

All Plans Cover Essential Benefits

The ACA sets the rules for what your insurance plan must cover. These " Essential Benefits " are the same with ALL plans. Coverage includes primary and specialist doctors, hospitalization, skilled nursing and rehabilitation, RX prescriptions, out patient diagnostic and surgery; 100 % payment for defined Preventative Care - annual physicals; mammograms, pap and women's health and expanded preventative for children.  What will vary from plan to plan are the copays - what you pay for a doctor visit or Rx drug - and  deductibles - what you must pay first before what the insurance payments for covered benefits like prescriptions, out patient or hospitalization begins. 

Think of insurance as a Car  - they all have 4 wheels, an engine, seats and a roof. And all will get you down the road.  The difference is between a Porsche and a Rambler. 
Biggest Difference between Plans and Insurance Companies -  " Networks " of Doctors, Hospitals and Medical Providers

The insurance companies negotiate what they pay doctors for covered medical services.  Those physicians who agree to work with that particular insurance companies' reimbursement rate are " In - Network " .  Other doctors may be considered " Out of Network " where  you would pay a higher copay. Or even not covered at all -   you would pay the entire bill ( except in a life threatening emergency ) 

As all the insurance plan cover those " Essential Benefits " -  checking to see if your particular doctors you see are " In Network " is now a VERY important comparison between insurance companies.  

  • Tax Penalty Increasing   

If you choose not to take coverage, what will the penalty tax cost you?  For 2016, $ 695.00 per adult and $347.50 per child (up to $2,085.00 per family) OR 2.5% of family income, whichever is greater.

Compare  with  2015 tax year,  these were  $ 325.00 per adult and $ 162.50  per child (up to $ 975.00 per family) OR 2.0% of family income, whichever is greater.

So a big increase  -  Having compliant coverage allows you to avoid this.

Updating Your Premium Discount Tax Credit 

When you signed up on Healthcare.gov, you had the option to check a box " Allow the Marketplace to review your tax return."    If you did so,  The Health Insurance Marketplace will (in most cases) update your tax credit; using your 2015 tax return, any changes in number of dependents, the 2017 baseline Silver plan and income guidelines. 

If you believe your income will change in 2017 as compared to 2016 -  you should log on to Healthcare.gov and update this -  starting November 1, 2016.  

As an agent certified to work on The Marketplace and having helped some 800 plus folks - we have the experience and training to guide you thru the process. And our New software will make this much easier for 2017. 

ALL Insurance  Plans Renew 
January 1 of 2017 

Rates are going UP.  This applies to all the plans and all the insurance companies.

Think about  ---  

  • How you use medical services ?
  • How much will you pay before the insurance pays ? 
  • Are my doctors " in network " ?
  • COMPARE and SAVE 

Health Insurance is More than Just a Website 

Now that Healthcare.gov is working well, it is relatively easy to log on, create an account and buy insurance– just like any other website selling everything from widgets to wingnuts.
 
But knowing the insurance plans - what they cover, which doctors to use and how they will help you when you actually need health care – can be a challenge.  Copays, deductibles, preventative, Rx coverage, HMO’s, PPO’s, in-network, out of network, out of pocket, tiered, local, limited, unlimited, facility fees, etc, etc. So many details, so little time !!!   
 
As an independent agent with over fifteen years experience and certified by the Insurance Marketplace – I can help you determine the insurance coverage to best meet your needs, values and budget.  I know the insurance plans and how the premium discounts thru Healthcare.gov actually work. AND – you pay NO  additional premium or fees for my services.
 
Be sure you are buying effective insurance  - Not a box of nuts
Jeremy Sheridan
Mobile 828.606.7994 
 Office 828.484.9180
jsheridan@troutinsurance.biz

Marketplace / ObamaCare 2017

From Blue Cross Blue Shield NC
OUR DECISION TO OFFER ACA PLANS IN ALL 100 COUNTIES FOR 2017

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In May, we shared our intention to sell Affordable Care Act (ACA) plans on the federal Marketplace by filing our rates with the Department of Insurance. Despite major challenges with how the ACA has played out in North Carolina, BCBSNC has confirmed its decision to continue offering ACA plans in all 100 counties for 2017. In fact, we will again be the only insurer to serve all North Carolinians in the individual market....
READ MORE
ACA Open Enrollment - for folks with Marketplace / ObamaCare coverage - this year will be both simple and somewhat complicated again.  As of this writing - it appears we will only have the Big Blue (Blue Cross Blue Shield) as a carrier in most of North Carolina.  If you have coverate through another carrier, the Marketplace will automatically "map" you to the most similar plan available.  And your premium subsidy (APTC) will be recalculated to match adjustments with your age, last reported income via your 1040 and the "benchmark" plan premium.

Yes - that's a lot of technical stuff - We know this stuff inside and out and can HELP.

Look for more information soon.

Open Enrollment starts November 1, 2016


Dave joins the discussion on WLOS about Open Enrollment.  "Trout Says..."