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What is the 2017 Obamacare Penalty?

Posted Sep 23, 2016
By Jenifer Dorsey

What is the 2017 Obamacare Penalty?

As 2017 approaches, the Affordable Care Act’s individual shared responsibility provision will enter its fourth year of enforcement. Commonly referred to as the individual mandate, the shared responsibility provision requires that most Americans to do one of the following[1]:

Continue Reading: What is the 2017 Obamacare Penalty?


Hispanics Remain Largest Uninsured Population Under Obamacare

Posted Sep 21, 2016
By Jenifer Dorsey

Hispanics Remain Largest Uninsured Population Under Obamacare

While some may speculate about the success and viability of the Affordable Care Act, one thing is certain: The nation’s uninsured rate continues to decrease since its implementation. The U.S. Census Bureau on Sept. 13 released its annual report on health insurance coverage in the United States, and findings show that between 2014 and 2015, the uninsured rate dropped 1.3 percentage points.[1] In 2015, the percentage of people with health insurance coverage for all or part of the year was 90.9 percent.

Continue Reading: Hispanics Remain Largest Uninsured Population Under Obamacare


The Obamacare Term That Might Make You Shudder

Posted Sep 20, 2016
By Jenifer Dorsey

The Obamacare Term That Might Make You Shudder

From the onset, Obamacare skeptics have predicted the Affordable Care Act’s inevitable demise for a number of reasons. As each open enrollment period comes and goes, and health insurance rates increase, it seems speculation of failure intensifies.[1]

Continue Reading: The Obamacare Term That Might Make You Shudder


What Happens When Preventive Care Leads to Medical Bills?

Posted Sep 16, 2016
By Jenifer Dorsey

What Happens When Preventive Care Leads to Medical Bills?

Your Obamacare plan provides you with access to many preventive care benefits at no additional cost beyond your health insurance premium, as outlined by the Affordable Care Act. These covered services include screenings, counseling, and immunizations recommended by the U.S. Preventive Services Task Force and your healthcare provider.

Continue Reading: What Happens When Preventive Care Leads to Medical Bills?


Back-to-School Financial Savvy – 6 Health Insurance Options for College Students

Posted Sep 15, 2016
By Jenifer Dorsey

Back-to-School Financial Savvy – 6 Health Insurance Options for College Students

 

When young adults head off to college, whether it’s freshman year or senior year, there are many things on their minds. And from roommates and majors to tuition and textbooks, health insurance may not be a top consideration.

However, it’s important—not only for financial protection from unexpected medical bills, but also because it’s the law. The Affordable Care Act requires most Americans to have minimum essential coverage. 

Fortunately, there are a number of ways college students can fulfill this Obamacare requirement. It might be fair to say that, of any demographic, young adults enjoy the widest range of health insurance coverage options.  

Whether you are a parent trying to help your child secure health benefits or a young adult making these decisions on your own for the first time, here are six common options to consider: 

Student health plans

Some colleges and universities offer fully insured student health insurance plans to their students (i.e., health insurance plans purchased from a health insurance company).  

These fully insured student health plans should include mandatory Affordable Care Act benefits (e.g., essential health benefits, prescription drug benefits, and certain preventive care services at no additional cost, among others).1 

Minimum essential coverage? Yes, if it is a fully insured health insurance plan, your student health plan should count as minimum essential coverage.  

Self-funded student health insurance plans that started on or before Dec. 31, 2014, may be considered minimum essential coverage; check with your school to confirm2—such plans may or may not have ACA benefits and protections. 

Who might consider this option? Young adults who do not have access to a parent’s health insurance plan or qualify for financial assistance when buying coverage through a state-based or federally facilitated exchange might consider buying a student health insurance plan.  

Whether or not you must be a full-time student to qualify for student health insurance coverage depends on criteria set by your school.

Where can you enroll? Inquire with your college or university to see if it offers ACA-compliant student health insurance coverage and when they hold enrollment. 

A parent’s major medical health insurance plan

The Affordable Care Act requires health insurance companies to allow children to remain on a parent’s major medical health insurance policy through their 26th birthday. This applies to both individual and job-based health insurance plans.  

Young adults are eligible for dependent coverage whether or not they are married, have access to job-based benefits or a spouse’s benefits, live with their parents, or are claimed as a dependent on a parent’s tax return.3 

Minimum essential coverage? Yes. 

Who might consider this option? Young adults that have access to health insurance through their parents may find this option to be easy and cost-effective.

Where can you enroll? This coverage may be available through a parent’s employer, through a state-based or federally facilitated health insurance exchange, or in the private marketplace. You can only enroll during an open-enrollment period unless you qualify for a special enrollment period due to certain life events. 

Catastrophic health insurance

Young adults who are under 30 can buy high-deductible health insurance plans known as catastrophic health plans. Because they tend to have lower monthly premiums, these plans can be attractive to 20-somethings.  

Those insured by a catastrophic health plan typically pay for all medical costs up to their deductible amount; however, these plans do cover three primary care visits per year and certain preventive services before the deductible has been met.4 

Minimum essential coverage? Yes.  

Who might consider this option? Individuals younger than 30 who are in relatively good health and have few medical expenses might consider a catastrophic health plan.  

However, it is important to keep in mind that if you do wind up with medical bills due to illnesses, injuries or other healthcare needs, you will likely be on the hook for thousands of dollars before your plan benefits kick in. 

Where can you enroll? This coverage may be available through a state-based or federally facilitated health insurance exchange, or in the private marketplace. You can only enroll during an open-enrollment period unless you qualify for a special enrollment period due to certain life events. 

Medicaid 

This program funded by state and federal governments provides free and low-cost health insurance coverage to those who qualify based on income and other criteria.  

Minimum essential coverage? Yes.  

Who might consider this option? Young adults that earn up to 138 percent of the federal poverty level and live in a state that expanded Medicaid might consider this program. If you do not live in a state that expanded Medicaid, you can see if you qualify based on other criteria. 

Where can you enroll? You can enroll in Medicaid anytime of year through your state’s state-based or federally facilitated health insurance exchange. You can learn more about Medicaid in your state at http://www.medicaid.gov/medicaid-chip-program-information/by-state/by-state.html.  

Individual health insurance coverage

Individuals who do not have access to job-based health insurance can buy their own major medical health insurance benefits.

As with fully insured student and job-based health plans, these Obamacare plans, as they are often called, include benefits and protections required under the healthcare reform law. For example, plans include essential health benefits and certain free preventive care services, and you cannot be denied coverage based on health history. 

Minimum essential coverage? Yes.  

Who might consider this option? Young adults who do not have access to a parent’s health plan and do not qualify for Medicaid might find an Obamacare plan strikes the right balance when it comes to premium and benefits—especially those who take prescription drugs or require ongoing medical care and therefore would not likely find a catastrophic plan feasible. 

Furthermore, young adults who are not claimed as a dependent and are within certain income limits may qualify for premium tax credits and cost-sharing reductions that help lower monthly premiums and out-of-pocket expenses when they purchase coverage from a state-based or federally facilitated exchange. You can apply for financial assistance through your state’s state-based or federally facilitated exchange to see if you qualify. 

Where can you enroll? You can buy individual major medical insurance through the state-based and federally facilitated exchanges established under the Affordable Care Act as well as in the private marketplace through an agent or broker, directly from a health insurance carrier, or from a website that offers multiple plan options. 

Short term health insurance 

When temporarily uninsured, young adults may consider a short term medical insurance plan. Commonly called short term health insurance, these plans provide coverage for as few as 30 days and up to 364 days, depending on where you live.  

Short term health plans typically have lower premium rates than major medical insurance coverage and include benefits that help pay for unexpected medical expenses—although select plans now offer some preventive care benefits. Short term coverage can be tailored to your healthcare and financial needs. 

Minimum essential coverage? No. 

Who might consider this option? Should an accident or serious illness occur, short term health plans can offer some financial protection to students who are out of a parent’s health insurance plan network, those who turn age 26 and need temporary coverage until they secure an Obamacare or job-based plan, grads looking for a job with benefits or in an employer waiting period, and others in situations that have left them temporarily without ACA-compliant health insurance.  

Where can you enroll? You can get a short term insurance quote, compare plan options, and apply for coverage within minutes online. You can begin coverage as soon as the next day. 

You may find you qualify for multiple options. Make it a point to consider your healthcare needs and budget before you shop, and then compare the plans available to you. Look at rates and benefits to determine which is the best fit. 

Need assistance? Consult a health insurance broker or agent. You can also get quotes for off-exchange Obamacare plans, short term health insurance and supplemental health plans at healthedeals.com and contact a licensed health insurance producer by calling the number at the top of your screen.

 

Originally posted September 22, 2015.


The Henry J. Kaiser Family Foundation. “Health Reform FAQs: Young Adults and Students.” http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/#section-young-adults-and-students

HealthCare.gov. “Plan Types That Count as Coverage.” https://www.healthcare.gov/fees-exemptions/plans-that-count-as-coverage/

3 HealthCare.gov. “Health Coverage for Children Under 26.”

4 HealthCare.gov. “Catastrophic Health Insurance Plans.” https://www.healthcare.gov/choose-a-plan/catastrophic-plans/

SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.

About The IHC Group

Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual disability, specialty and supplemental health, pet, and life insurance through its subsidiaries since 1980. The IHC Group owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company) and IHC Specialty Benefits, Inc., which is a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.

About IHC Specialty Benefits, Inc.

IHC Specialty Benefits, Inc., doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products via general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit http://www.HealtheDeals.com

Continue Reading: Back-to-School Financial Savvy – 6 Health Insurance Options for College Students


Your Guide to the Federal Poverty Level

Posted Sep 09, 2016
By Jenifer Dorsey

Your Guide to the Federal Poverty Level

The Affordable Care Act’s subsidies—both tax credits and cost-sharing reductions alike—are based on one’s income in relation to the federal poverty level. This also applies to Medicaid eligibility in states that expanded their programs. 

Continue Reading: Your Guide to the Federal Poverty Level


You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017

Posted Aug 31, 2016
By Jenifer Dorsey

You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017

 

Continue Reading: You Need Health Insurance Now — A Plan Option with Temporary Benefits for One Month or Until 2017


Competition, Choice Dwindle as Aetna and Others Exit Obamacare

Posted Aug 29, 2016
By Jenifer Dorsey

Competition, Choice Dwindle as Aetna and Others Exit Obamacare

Editor's note: This is the first segment in a series about how the ACA’s state-based and federally facilitated health insurance exchanges are changing as 2017 open enrollment nears.

Continue Reading: Competition, Choice Dwindle as Aetna and Others Exit Obamacare


Mouthguards: Add One to Your Student Athlete’s Back-to-School List

Posted Aug 24, 2016
By Jenifer Dorsey

Mouthguards: Add One to Your Student Athlete’s Back-to-School List

 

Continue Reading: Mouthguards: Add One to Your Student Athlete’s Back-to-School List


Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?

Posted Aug 23, 2016
By Jenifer Dorsey

Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?

 

As we approach the 2017 open enrollment period, the Affordable Care Act continues to face scrutiny and challenges. Last summer’s Supreme Court Decision in the King v Burwell case determined the fate of advanced premium tax credits—they remain in place for coverage purchased both the state-based and federally facilitated exchanges.

This year’s case: House v. Burwell. On the line this time: the cost sharing reductions that lower out-of-pocket healthcare costs for consumers who earn up to 250 percent of the federal poverty level and purchase silver plans through state-based and federally facilitated exchanges.

 

 

Legality of cost sharing reductions in question

Here is how cost sharing reductions currently work:

  • A consumer purchases a silver plan through a state-based and federally facilitated exchange and applies for Obamacare subsidies to help reduce her monthly premium and out-of-pocket expenses. Because she earns less than 250 percent of the federal poverty level, she qualifies for both an advanced premium tax credit and a cost sharing subsidy.
  • Her plan’s cost sharing subsidy further reduces her out-of-pocket share of covered healthcare expenses, including deductible, coinsurance and copay amounts. When this consumer visits the doctor, she is billed by her health insurance plan according to her plan’s usual benefits as well as the percentage of cost sharing reduction for which she is eligible.
  • Her health insurer picks up the tab and rather than pass the extra costs on to other consumers. The company then bills and is reimbursed by the federal government.[1]

So, what exactly is the key issue in House v. Burwell? The U.S. House of Representatives brought forth the lawsuit, claiming that, according to Article I of the Constitution, the executive branch cannot spend money without congressional appropriation.[2]

House v. Burwell decision

On May 12, 2016, Judge Rosemary Collyer of the federal district court for the District of Columbia ruled in favor of the House.[3] However, she has allowed for an appeal to a federal court of appeals or the Supreme Court and has not yet put a stop to the spending. As such, cost sharing reductions (i.e., CSRs) remained available at the time this article was published.

CSRs available now, but what about 2017?

With the administration currently appealing the decision, there is no way of knowing what the future holds.

 

 

What could happen if cost sharing subsidies go away?

If Collyer’s decision is upheld, the impact could affect consumers, health insurance companies, and the federal government.

There is a range of possible scenarios. Among them, it is said that if the decision is upheld on appeal, high-level Obamacare officials could face criminal charges if a subsequent President or Attorney General were to pursue them.[4] As far as insurance companies go, experts speculate that they may raise premiums if government reimbursement ceases.[5]

The Commonwealth Fund estimates that, in 2016, as many as 7 million Americans have health insurance with cost-sharing reductions.[6] HHS data shows the following breakdown for consumers receiving cost sharing reductions[7]:

  • 59 percent live in states with federally facilitated exchanges
  • 46 percent live in states with state-based marketplaces that use the HealthCare.gov platform

No comprehensive estimate for the 13 states with entirely state-based exchanges is available at this time.[8]

Obamacare changes for 2016

It is unlikely changes that result from an upheld decision would immediately impact consumers or 2017 open enrollment.[9] However, consumers who face increased out-of-pocket costs—whether due to a future House v. Burwell decision or 2017 plan changes—may want to consider supplemental products such as a medical gap, critical illness, and telemedicine plans.

These products are available year-round and can be combined with Obamacare plans to help you pay your out-of-pocket share of medical bills and healthcare your plan doesn’t cover.

How much are supplemental plans? Get a free, no-hassle quote.

No contact information required unless you apply.

Call the number at the top of your screen to speak with a licensed health insurance producer who can answer your questions and help you find additional benefits.

 

 



[1] Chandler, Seth. “The Impact Of Judge Collyer’s Ruling In House v. Burwell.” Forbes. May 15, 2016. http://www.forbes.com/sites/theapothecary/2016/05/15/the-impact-of-judge-collyers-ruling-in-house-v-burwell

[2] Blasé, Brian. “Judge Rules Administration Illegally Delivering Funds to Insurers Participating In Obamacare.” Forbes. May 12, 2016. http://www.forbes.com/sites/theapothecary/2016/05/12/judge-rules-administration-illegally-delivering-funds-to-insurers-participating-in-obamacare

[3] Denniston, Lyle. “Judge: Billions Spent Illegally on ACA Benefits.” SCOTUSblog. May 12, 2016. http://www.scotusblog.com/2016/05/judge-billions-spent-illegally-on-aca-benefits/

[4] Chandler, Seth. “The Impact Of Judge Collyer’s Ruling In House v. Burwell.” Forbes. May 15, 2016. http://www.forbes.com/sites/theapothecary/2016/05/15/the-impact-of-judge-collyers-ruling-in-house-v-burwell

[5] Schencker, Lisa. “House Republicans Won Their ACA Lawsuit. Here’s What Happens Next.” Modern Healthcare. May 12, 2016. http://www.modernhealthcare.com/article/20160512/NEWS/160519949

[6] S. R. Collins, M. Gunja, and S. Beutel, How Will the Affordable Care Act's Cost-Sharing Reductions Affect Consumers' Out-of-Pocket Costs in 2016? The Commonwealth Fund, March 2016. http://www.commonwealthfund.org/publications/issue-briefs/2016/mar/cost-sharing-reductions

[7] U.S. Department of Health & Human Services. Office of the Assistant Secretary for Planning and Evaluation. “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report.” March 11, 2016. https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report

[8] Ibid.

[9] Schencker, Lisa. “House Republicans Won Their ACA Lawsuit. Here’s What Happens Next.” Modern Healthcare. May 12, 2016. http://www.modernhealthcare.com/article/20160512/NEWS/160519949

This document is for general informational purposes only. While we have attempted to provide current and accurate information, this information is provided "as is" and we makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.

SHORT-TERM MEDICAL EXPENSE (STM)
THIS IS A SHORT TERM HEALTH BENEFIT PLAN THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. THIS POLICY INCLUDES A PRE-EXISTING CONDITION EXCLUSION PROVISION.

About The IHC Group
Independence Holding Company (NYSE: IHC) is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual disability, specialty and supplemental health, pet, and life insurance through its subsidiaries since 1980. The IHC Group (including through its 92% ownership of American Independence Corp. (NASDAQ: AMIC)) owns three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company), a majority of Ebix Health Administration Exchange, Inc., a fully insured third party administrator, and IHC Specialty Benefits, Inc., which is a technology-driven insurance sales and marketing company that creates value for insurance producers, carriers and consumers (both individuals and small businesses) through a suite of proprietary tools and products (including ACA plans and small group medical stop-loss). All products are placed with highly rated carriers.

IHC Specialty Benefits, Inc.
IHC Specialty Benefits, Inc., doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products via general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit http://www.HealtheDeals.com.

Continue Reading: Will Obamacare Cost Sharing Reduction Subsidies Be Available in 2017, Or Are They Ending?