Affordable Care Act 2020: A Brief Overview

ONLY 7 WEEKS FOR ENROLLMENT  ​

Important Dates

  • Open Enrollment for new plans & renewals begins November 1st, 2019
  • Apply by December 15, 2019 to be insured for January 1, 2020.
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Important Changes for Marketplace Health Insurance 2020 
  •  Be sure you have reconciled your premium tax subsidy on your tax return.  Both for tax year 2019 and earlier. If you have NOT done so, you may not qualify for the subsidy.  

  • For BCBS customers in Western North Carolina -  The “ select “ plans will not be renewed for 2020.  You will be assigned a similar Advantage plan. AND you will have to re-verify your subsidy for 2020 as it will not show on your renewal. 
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  • NEW Options for “ Short Term Health Insurance “  - we have coverage that can extend for just under three years. If you do not quality for subsidy , it can be a more affordable option  

Short Term Health Care
  • As in 2019– No tax penalty for individuals not having qualified health insurance.

 APTC Income 2020 &  Tax Form 1040

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.
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What will vary from plan to plan are the copays - what you pay for a doctor visit or Rx drug - and deductibles - the amount paid before insurance will cover anything else. 

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.  The 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 not be covered at all- wherein you would pay the entire bill (except in a life threatening emergency).

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

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 2018 tax return, any changes in number of dependents, the 2020 baseline Silver plan and income guidelines. 

If you believe your income will change in 2020 as compared to 2019 -  you should contact your agent- Dave Trout, Jessica Cody or Jeremy Sheridan to update this-  starting November 1, 2019.  

As an agent certified to work on The Marketplace and having helped over 800 clients- we have the experience and training to guide you thru the process. 

All Insurance Plans Renew January 1  2020 

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's relatively easy to log on, create an account and buy insurance– just like any other website.
 
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. So many details, so little time!
 
As an independent agent with over twenty 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 zero  additional premium or fees for my services.

Contact me today to get set up with the most effective coverage. 
Dave Trout
Managing Agent
​828.658.1472

Agent for Life & Disability, Commercial Property & Liability, Medicare Supplement and Long-Term Care