HEALTH CARE INSURANCE
Deciding on plan options, i.e. HMO, PPO, etc. will become much simpler as a result of the introduction of standardized plans (Platinum, Gold, Silver and Bronze). These plans will be available within and outside of the Health Exchange. You may even qualify to receive a Federal subsidy to help pay the premium on plans within the Health Exchange. However, more plan variations are available outside of the Exchange rather than within. Some medical underwriting has also been eliminated, therefore all applicants will be accepted regardless of any pre-existing health conditions.
The new options require applicants to choose between an employer group plan or an individual plan while verifying if an applicant qualifies for a subsidy. Choosing a plan requires adequate research and careful review. Applicants will also be subject to verifications by the IRS, the Social Security Administration, credit bureaus and other entities to investigate background and eligibility for subsidies.
Be aware of what you need to know in order to make the best health plan selections:
A. Who provides your health plan right now?
Yourself, your employer, your union, your association, your parent, your spouse, your domestic partner, your own business, etc.
B. What coverage do you currently have?
Is it the equivalent of a Platinum, Gold, Silver, Bronze plan, or Catastrophic plan?
C. How much do you have to contribute toward the premium?
Does your employer deduct your portion of the premium from your paycheck before tax? Do you draw from an FSA (Flexible Spending Account) to pay for it? Do you pay for it out of your own pocket, after tax?
D. Do you have an HSA (Health Savings Account)? An HRA (Health Reimbursement Account)?
Do you have or are you eligible for Medicare? Medicaid, Veterans health benefits or TriCare? Are you over 65? Are you a foreign resident?
E. Are you making a change in status?
Such as job termination, retiring, aging out of a parent’s plan at age 26, getting married, getting divorced, moving to another state, moving back into the state ,moving to another country, or moving back into the U.S., having a newborn, adopting a child?
F. What other options do you have access to?
Cobra, HIPAA, Retiree plan, Spouse’s employer plan, Medicare, Medicaid, Tricare or Veterans plan among others?
Once you know the answers and know where you stand, then you can do the following:
1. Obtain comparison rates for plans within the Exchange and plans that are outside of the Exchange.
2. Use the online Subsidy Calculator on the website to estimate if you are eligible for any subsidy based on your income (AGI).
3. Obtain rates and benefit descriptions for all other accessible options : i.e. Employer plan, Cobra, retiree plan, union plan, etc.
With all of this information and the help of your agent M.R.GENERAL SERVICE INSURANCE, you may then make a decision on the best plan for you. Once you have made a decision, the agent or broker may assist you in preparing and submitting your enrollment application.
You may choose to buy health plans either within the Exchange or outside. The difference is that if you want either a subsidy or a tax credit, you have to choose an Exchange plan.