tag:www.healthcareshopper.com,2013://6 2013-03-30T17:31:52Z Qualifying for Health Insurance, Affordable Health Insurance, Health Insurance Underwriting, Insuring Children, Health Savings Accounts, COBRA Continuation, and more Movable Type Pro 5.2.3 tag:www.healthcareshopper.com,2013://6.1540 2013-04-01T16:59:10Z 2013-03-30T17:31:52Z

Question: I read an article that said rates of individual insurance would go up as much as 60%. Won’t that erase the savings from subsidies? Answer: A new study released on Tuesday by the nonpartisan Society of Actuaries estimates that...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I read an article that said rates of individual insurance would go up as much as 60%. Won't that erase the savings from subsidies? **Answer**: A new study released on Tuesday by the nonpartisan Society of Actuaries estimates that individual premiums will rise 32 percent over 2013 rates on average nationwide within three years, 2014 - 2016, partly as a result of higher risk pools (more sick people in then insured population). Changes would vary by state, from an 80 percent hike in Wisconsin to a 14 percent reduction in New York. For anybody eligible for subsidies, their contribution to the total premium is fixed on a range between 2% and 9.5% of income. So, for the subsidized, it doesn't make any difference what the final rates are. On an individual basis, age and income will determine how much of an increase. The subsidized group are likely to pay about 47% to 84% less in monthly premiums compared to 2013. The un-subsidized young (below 40) and will see the highest premium increases. Some of older un-subsidized group will have lower premiums than today for better coverage. On a positive note for the un-subsidized, coverage will be more comprehensive for all, meaning less out-of-pocket costs thus reducing the impact of higher rates. tag:www.healthcareshopper.com,2013://6.1538 2013-03-29T14:34:00Z 2013-03-29T14:25:52Z

Question: I’ve opted to have an individual health plan because, being in good health, it’s less expensive than buying into my spouses employer plan. As an independant contractor, will I be eligible for a health insurance tax subsidy if our...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I've opted to have an individual health plan because, being in good health, it's less expensive than buying into my spouses employer plan. As an independant contractor, will I be eligible for a health insurance tax subsidy if our family income is low enough? **Answer**: The ACA says that someone with access to "affordable" employer-sponsored coverage cannot get a premium subsidy from state exchanges in 2014, unless the cost of the employer-based health care coverage for that employee exceeds 9.5 percent of the worker's household income. The IRS ruled recently that the calculation of affordability will be based on the cost of employee-only coverage, not family coverage. For example, if your spouse contributes $300 each month or $3600 for the year for his or her portion of the premium for the employee only, Your family income would have to be less than $37,895 per year no family member would qualify for a subsidy even though they are not covered by the spouse's group plan. tag:www.healthcareshopper.com,2013://6.1533 2013-03-26T22:57:55Z 2013-03-26T23:33:52Z

Question: My child is younger than 26 and i want to remove him from my health insurance. Can i do that under the affordable health care act? Answer: Yes. Covering your child to age 26 is an option provided by...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My child is younger than 26 and i want to remove him from my health insurance. Can i do that under the affordable health care act? **Answer**: Yes. Covering your child to age 26 is an option provided by the ACA. It is not a requirement. In 2014, everyone will be required to have health insurance. If your child does not have coverage, they may have to pay a penalty. tag:www.healthcareshopper.com,2013://6.1532 2013-03-26T22:56:36Z 2013-03-26T23:40:07Z

Question: If i lose my health insurance thru my husband’s employer do i have to take one offered thru my employer or can i take one thru the health care exchange? Answer: If your employer offers group health insurance coverage...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: If i lose my health insurance thru my husband's employer do i have to take one offered thru my employer or can i take one thru the health care exchange? **Answer:** If your employer offers group health insurance coverage that is "affordable" you should take it, because you will not be eligible for a premium subsidy in the state Health Insurance Exchange. tag:www.healthcareshopper.com,2013://6.1520 2013-03-20T01:13:24Z 2013-03-20T02:59:29Z

Question: My son turns 26 next year and is disabled with lyme disease and cannot work (no financial income). Currently, he is covered under my work insurance plan. What options does he have when he can no longer be on...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My son turns 26 next year and is disabled with lyme disease and cannot work (no financial income). Currently, he is covered under my work insurance plan. What options does he have when he can no longer be on my plan. **Answer**: Your son will be eligible for coverage in your state health insurance exchange on January 1, 2014, as would any legal resident of your state regardless of medical conditions. You don't have to wait until he is 26. His income will determine whether he is eligible for Medicaid or subsidized private coverage. tag:www.healthcareshopper.com,2013://6.1509 2013-03-15T22:23:13Z 2013-03-15T22:38:27Z

Question:I am 60 and retired. I kept the retiree insurance offered by my previous employer while waiting for a response from an individual insurance application for a plan that was half the cost. I was denied insurance based on pre-existing...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:**I am 60 and retired. I kept the retiree insurance offered by my previous employer while waiting for a response from an individual insurance application for a plan that was half the cost. I was denied insurance based on pre-existing conditions. It is VERY difficult to continue paying these premiums ($600)and would like to know if I will be able to enroll through an exchange in the fall of 2013 for the 2014 implementation of the health care act, or will I have to be uninsured to do so? **Answer**: Yes. You will be able to enroll in a ACA conforming health plan through your state exchange anytime after 10/1/13 and your new coverage will be effective on 1/1/14. tag:www.healthcareshopper.com,2013://6.1528 2013-02-22T21:04:41Z 2013-03-21T20:17:38Z

Question: I am a single mom with 2 children. I make about $20,000. We don’t have insurance now. We don’t qualify for Medicaid because I have some savings. Can we get health insurance through the exchange if we do not...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I am a single mom with 2 children. I make about $20,000. We don't have insurance now. We don't qualify for Medicaid because I have some savings. Can we get health insurance through the exchange if we do not qualify for medicaid due to assets? **Answer**: Starting in 2014, Medicaid will no longer consider assets, only income. So based on your income you will be eligible for free public health insurance from Medicaid. If you choose to opt out of Medicaid in favor of Exchange coverage, you cannot also be eligible for subsidized coverage. You would have to pay the full premium and I don't think that will be practical for you. tag:www.healthcareshopper.com,2013://6.1527 2013-02-19T20:43:04Z 2013-03-21T19:55:18Z

Question: We currently have an Aetna PPO through my employer. My spouse is 53 and has a chronic illness. So far she is doing okay, but our fear is that when I retire next year, and we shop from the...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: We currently have an Aetna PPO through my employer. My spouse is 53 and has a chronic illness. So far she is doing okay, but our fear is that when I retire next year, and we shop from the exchange, the potential treatment she may need won't be as good as what I currently have with Aetna. That our options for treatment will be limited. Are these fears unfounded? Will the latest treatments be available? **Answer**: The quality of health insurance coverage in 2014 will actually be better - more comprehensive and with fewer restrictions - than it is now as a result of health insurance reforms imposed by the Affordable Care Act.. You can still purchase an Aetna PPO plan if you so choose, either in the state exchange or the outside marketplace. tag:www.healthcareshopper.com,2013://6.1524 2013-02-12T03:48:18Z 2013-03-16T02:55:08Z

Question: Will the SHOP exchange will offer the same qualified health plans as the individual exchange? Answer: The ACA leaves this up to the states. In some states, like California, there will be two separate exchanges one for individuals and...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Will the SHOP exchange will offer the same qualified health plans as the individual exchange? **Answer**: The ACA leaves this up to the states. In some states, like California, there will be two separate exchanges one for individuals and one for small-businesses and both exchanges must offer the same standardized plans. In some states the two exchanges may be combined. tag:www.healthcareshopper.com,2013://6.1523 2013-02-05T19:36:01Z 2013-03-16T02:45:57Z

Question: Who will be eligible for premium subsidies in the health benefit exchange in 2014? Answer: Legal residents, under 65, and not incarcerated will qualify for subsidies called advanced premium tax credits in 2014, if their taxable household income (AGI)...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Who will be eligible for premium subsidies in the health benefit exchange in 2014? **Answer**: Legal residents, under 65, and not incarcerated will qualify for subsidies called advanced premium tax credits in 2014, if their taxable household income (AGI) is between 133% percent and 400% percent of the federal poverty level. The amount of the subsidy decreases as income increases. tag:www.healthcareshopper.com,2013://6.1522 2013-02-01T17:28:01Z 2013-03-16T02:34:59Z

Question: Will there catastrophic coverage under Obamacare? Answer: Yes. But the catastrophic plan can be offered only only for young adults, those under age 30 before the plan year begins. The catastrophic plan will be the lowest priced health plan...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Will there catastrophic coverage under Obamacare? **Answer**: Yes. But the catastrophic plan can be offered only only for young adults, those under age 30 before the plan year begins. The catastrophic plan will be the lowest priced health plan available within the guidelines of essential benefits. Catastrophic plans will have an actuarial value of about 60% (bronze level). The deductible and out of pocket maximum will be $6400 per year. tag:www.healthcareshopper.com,2013://6.1521 2013-01-25T03:14:59Z 2013-03-16T02:26:50Z

Question: What is the individual mandate health care reform amount of tax? Answer: The Affordable Care Act (ACA) specifies that the “applicable dollar amount” of the tax is $695 per adult to be phased in and adjusted as follows: In...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: What is the individual mandate health care reform amount of tax? **Answer**: The Affordable Care Act (ACA) specifies that the "applicable dollar amount" of the tax is $695 per adult to be phased in and adjusted as follows: - In 2014, the penalty is $95 per adult and $47.50 per child (up to $285 per family) or 1% of family income, whichever is greater. - In 2015, the penalty is $325 per adult and $162.50 per child (up to $975 per family) or 2% of family income, whichever is greater. - In 2016, the penalty is $695 per adult and $347.50 per child (up to $2,085 per family) or 2.5% of family income, whichever is greater. tag:www.healthcareshopper.com,2013://6.1498 2013-01-10T20:06:22Z 2013-01-10T19:52:53Z

Question: Who is primary when there is adult dependent on both parents policy and parents are divorced? Answer: Coordination of Benefit Rules were codified by the National Association of Insurance Commissioner in 1986 and each state uses this model with...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Who is primary when there is adult dependent on both parents policy and parents are divorced? **Answer**: Coordination of Benefit Rules were codified by the National Association of Insurance Commissioner in 1986 and each state uses this model with some modifications. The rules cover how the primary payer is determined when an insured employee or dependent has double coverage. To determine who pays first on dependent children's claims, the plan covering the parent whose birthday is earlier in the calendar year is primary. tag:www.healthcareshopper.com,2012://6.1495 2012-12-22T18:03:20Z 2012-12-21T17:54:24Z

Question: I have an employee in Pennsylvania that is recently divorced and was covered under his spouse’s policy. He is currently uninsured and wants to choose the “opt out incentive” and remain uninsured. Are there any legal consequences to this...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I have an employee in Pennsylvania that is recently divorced and was covered under his spouse's policy. He is currently uninsured and wants to choose the "opt out incentive" and remain uninsured. Are there any legal consequences to this or does he have to accept the coverage since he is uninsured? **Answer**: If you have elected to pay 100% of the cost-sharing for existing employees he cannot opt out. Otherwise, he can. tag:www.healthcareshopper.com,2012://6.1488 2012-12-06T01:52:23Z 2012-12-06T01:27:55Z

Question: My employer just distributed a new copy of the “Summary Plan Description” that says our Cafeteria Plan contributions are limited to $2,500 per year. It used to be higher. They say it’s Obamacare. True? Answer: Under the ACA, employee...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My employer just distributed a new copy of the "Summary Plan Description" that says our Cafeteria Plan contributions are limited to $2,500 per year. It used to be higher. They say it's Obamacare. True? **Answer**: Under the ACA, employee contributions to health care flexible spending accounts or Cafeteria Plans will be reduced to $2,500 per year for any plan year starting in 2013. The Plan Year is the 12-month period specified in your Summary Plan Description (SPD) that determines the beginning and ending dates of plan contributions. The plan year should not be confused with the "Claim Period" which is the period specified in the SPD of at least 12 months that determines the beginning and ending dates of expenses eligible for reimbursement. In other words, it is the period of time that claims can be incurred and reimbursed from current plan contributions. The beginning date always coincides with the beginning of the plan year, but the end date may not.