A Health Insurance Audit

As you think about your health insurance coverage it’s important to know that one size definitely does not fit all. In my experience, most people sign on with a company and take what they’re given, regardless if it fits or not. When I work with a client, my goal is to customize her plan to fit with her needs. Most of the time I can get her better coverage for less money!

Think about your current coverage and consider these options:

  • Dental/Vision – Although I can write dental coverage with most major carriers, the one I overwhelmingly recommend covers you up to $2,000/year instead of most plans which only go up to $1,000/year. No waiting periods and you choose your own Dentist and Eye Care Doctor.
  • Accident Plan – Covers you in case of an accident, (Car accident, sport injuries, biking accidents, etc.) It pays the first (Your Deductible Amount) in case of an accident and also wipes out your deductible). With 87% of hospital related incidents coming from Accidents, it really pays to have this plan in place, especially those of you with children.
  • Critical Illness – Pays you cash in case of a Major Illness (Heart Attack, Cancer, Stroke, such as AFLAC). You should figure how much you would need if you lost 3 months of income which is the average time it takes for treatment from a Heart Attack, Cancer, or Stroke. Coverage amounts from $10,000 – $50,000 are available at really low premiums. It will help you sleep better knowing you are covered for these life events with this plan.
  • Life Insurance – What would your family do if all of a sudden you and your monthly income were gone? How would they make it financially without you? You can get a plan in place that would take care of the ones you love in the event you can no longer provide for them. We have very affordable plans available.

Let’s be wise about your coverage and make sure you’re not paying more than you have to for something that’s inadequate. You never know what a day can bring!

You Still May Have Options

The Open Enrollment period for most health plans has ended, but if you’re healthy and don’t have coverage, or just want better coverage, there are still options available.

You might consider an annual plan, otherwise known as Short Term Medical insurance. It’s a major medical policy, often with $1 million in coverage, available with or without copays and deductibles as low as $1000. There are pros and cons to this option so let me explain:

Pros: The premium for most STM plans are significantly cheaper than ACA plans at full price. The doctor networks are usually much better and they are PPO plans.

Cons: Some who take the STM plan may still pay an extra tax for not having ACA coverage. The plans do not cover preexisting conditions nor pregnancy and some preexisting conditions can cause a denial of coverage.

That said, many people find that the savings in premium save money at the end of the year even with the extra tax. These plans are a great way for some people to keep their doctor and get excellent coverage year after year, or at least until Open Enrollment begins again later this year.

Call me. I’d be happy to discuss whether a Short Term Medical plan is right for you.

Annual Enrollment Period Now Open

November 1st is upon us and the new rates are published. There are a few changes this year from last year in two main areas: subsidies and rates.

Rates:

Most carriers are increasing their rates substantially, particularly those who kept their rates low last year in hopes of attracting new policyholders. Since rates change nearly every year these days the times of setting your coverage and forgetting it are gone. Now it’s important to check your policy every year and compare them with the new rates published by other companies. Since part of the law now includes the ability to enroll without fear of denial due to pre existing conditions, this makes it easy to switch from year to year, though it’s still a hassle to keep up with. That’s where I come in! The rates from some carriers this year will jump as much as 30% so let’s take a look at what you currently have and how much it will change come January first. There’s plenty of time to make adjustments and explore your options.

Subsidies:

In the past, subsidies mainly pertained to premiums, which left many people frustrated with a low premium, but a deductible that was still prohibitive. This year cost reductions for many will extend beyond premiums to co-insurance as well. I found a policy for one of my clients with a major carrier whose rates, including the subsidy, were a $15/month premium and a $500 deductible! I’m not guaranteeing I can find that for everyone, but it’s possible for some.

Other miscellaneous changes:

Blue Cross and Blue Shield of Texas is doing away with their PPO. If you currently have that plan with BCBS you’ve probably already received a letter informing you of this. If you live in Texas and prefer PPOs there are still some available to you depending on where you live.

In addition to that, I have expanded my list of appointments to include Blue Cross Blue Shield of Texas, and Scott and White to go along with Humana, United Healthcare, Aetna, Cigna and Assurant. Keep in mind however that I am able to help you with any marketplace plan even if it’s with a company with which I am not appointed. Just refer me to your friends!

As one of my mentors is famous for saying: “You can have everything you want in life if you just help enough other people get what they want.”

For Life, Health, and Peace of mind,

Phil

Special Enrollment Period Now Open

Excerpted from CNN.com

OK, let’s try this one more time. Again.

A month after Obamacare’s open enrollment season closed, the federal government Sunday starts a special enrollment period for people who only now are finding out they face a penalty for failing to have obtained some form of health insurance in 2014.

“We clearly are very hopeful that people will avail themselves of the chance to get covered, to get insurance during this period,” said Kevin Counihan, CEO of HealthCare.gov, the federal Obamacare insurance marketplace that serves 37 states.

But it’s unclear how many people will take advantage of that offer and end up adding to the 11.7 million people or so who already signed up for 2015 health plans on government Obamacare exchanges.

“We haven’t set a projection,” Sylvia Burwell, secretary of the U.S. Department Health and Human Services, said Thursday when CNBC.com asked her about the number of sign-ups she expected to see, during an event at Montefiore Medical Center in New York.

A survey released Monday by the Jackson Hewitt Tax Service suggested that many eligible people might not even know about the offer of what will amount to their third bite at the Obamacare enrollment apple.

The study found that 48 percent of adults believed the deadline to sign up for health coverage this year had expired, and another 27 percent “don’t know” if the deadline had expired. While open enrollment for Obamacare insurance ended in most of the country on Feb. 15, special enrollment periods for tax season were announced in the week following that initial deadline.

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A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, in Miami last month.

Getty Images
A man holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, in Miami last month.

Counihan, in a conference call with reporters Friday, also said officials were working on getting corrected tax forms out to more than 800,000 Obamacare customers who had previously been sent forms that contained some incorrect information. But officials did not reveal how many of those corrected forms have been sent.

The forms are necessary for those tax filers to reconcile what they received in subsidies with what they are actually entitled to; 50,000 or so people who received the incorrect 1095-A forms had already filed their taxes at the time the error became public.

The grace period for signing up for a health plan this year is available to people who didn’t have coverage last year and didn’t know until this current tax season that there’s a fine for not having such coverage. People using the special period also must not already be enrolled in an insurance plan for 2015. Those eligible for the grace period still have to pay any Obamacare penalty they are assessed for 2014.

The special enrollment period for customers of HealthCare.gov will run from Sunday through April 30. A top federal official said the grace period is a onetime deal: It will not be offered in future years.

Six other state-run insurance marketplaces, have already begun their own special enrollment period. Four others are starting such periods Sunday, and Connecticut is beginning its own special season on April 1.

Just three states, Colorado, Idaho and Massachusetts, are not having a special enrollment period.

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The decision to grant the special sign-up season reflects still-high levels of ignorance about Obamacare among uninsured Americans, and a lag in the timing of some of the law’s provisions.

Beginning in 2014, most Americans were required to have some form of health coverage or pay a tax penalty equal to the higher of $95 per adult, or 1 percent of taxable household income. But that penalty is only being collected starting this year, with the filing of 2014 tax returns.

As a result, many people are becoming aware of that penalty only after the close of enrollment for 2015 health plans. If there were no special enrollment period available this year, some people would not only owe a penalty for 2014, they’d also next year would owe a penalty for failing to have insurance in 2015. The penalty for the 2015 tax season rises to the greater of $325 per adult or 2 percent of household income.

“We do know that there are people who still don’t know about the fee,” said Andy Slavitt, acting administrator of the federal Centers for Medicare and Medicaid Services, the agency that oversees Obamacare.

Slavitt cited a McKinsey study from earlier this week that found that about 40 percent of uninsured people were aware of the Obamacare penalty.

“We do know that are some people … that didn’t learn about open enrollment and didn’t learn about the requirement to have coverage until they paid their taxes,” Slavitt said. “For many people, this will be the first time they discover they have the opportunity to get coverage for themselves and their families.” 

This tax season is the first time that filers must declare their health coverage status.

Most filers, about 75 percent of them, will only be required to check a box on their tax returns to indicate they have some form of coverage, said Mark Mazur, assistant secretary for tax policy at the U.S. Treasury Department.

For people who do not have health coverage, “We expect the majority of them will qualify for exemptions” from the Obamacare penalty. Those exemptions can include not having the option to buy “affordable” insurance as defined under the law, having recently filed for bankruptcy, religious reasons and other categories.

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People who received federal subsidies, or tax credits, to help pay the monthly premiums for plans purchased through Obamacare marketplaces are required to file forms reconciling the subsidies they received to what they ended up being actually entitled to given their income and the price of the plans.

While some of those people will have to pay the IRS some of their subsidies, “We expect the overwhelming majority of these taxpayers to still receive a net tax payment” in the form of a refund, Mazur said.