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IT’S THAT TIME OF YEAR AGAIN…

By July 31, 2019 No Comments

INDIVIDUAL HEALTH INSURANCE UPDATE 2018

Open enrollment starts November 1st and goes through December 15th. This is half of the time we had last year.

We can help complete most enrollments or renewals over the phone and the internet. We are happy to have you come into the office if you’d prefer it. We like to meet face to face if it makes sense.

Changes for 2018

Things are changing again this year. Rates are going up again which will make it very important to review your plan choices and take a look at if you qualify for tax credits and subsidies. You may need to change plans to have the best option for 2018.

If you currently have tax credits and subsidies, the automatic renewal info you receive from your insurance company or The Marketplace is likely wrong. They don’t always correct income amounts and tax credits correctly.

Molina Healthcare is exiting the Utah market at the end of 2017. This will change the market quite a bit but should be for the best. Someone losing Molina coverage may have more time to enroll in a plan if done properly.

CMS and Health and Human Services have really tightened up the rules and procedures in the last two years. It is much more difficult to enroll or change plans outside of the open enrollment period.

Deadlines

If you’re enrolling or renewing for a January 1st effective date, you need to be finished by December 15th.

After December 15th, you will need to qualify for a special enrollment period to make changes or enroll in a new plan. Any special enrollment period or SEP will require documentation to be submitted at the time of the application. Income changes in the marketplace can be done anytime but it will be difficult to change plans after December 15th.

If you’re losing coverage from an employer or are being involuntarily cancelled, you have 60 days to enroll in another plan but must be enrolled by December 31st for a January 1st effective date. If enrolled by January 31st, your plan would start February 1st. Healthcare.gov counts the 60 days in the least favorable way, which means you have less than 2 months to apply if you lose coverage involuntarily.

How can I be prepared?

If you have an account on healthcare.gov, verify that you have the current login information in case we need to log in. Please Log in before we meet to make sure it’s working.

Don’t update or change anything before speaking with a professional and never call the marketplace without first consulting with us or another capable agent. Marketplace and insurance company call centers are full of people who don’t know you and your situation and have less experience than we do.

Please think about if there are specific doctors, medication, or treatments that you need covered by your plan.

Renewing

To renew an existing enrollment, we need your estimated Adjusted Gross Income for 2018. Please check line 37 on your 2016 personal taxes if you aren’t sure. Healthcare.gov counts the income of everyone in your tax household. Have you had other changes that we need to know about?

New Applications

To complete a new application, we need everyone’s names, birthdates, social security numbers, and income information. If there is immigration or citizenship paperwork, we will need those documents and numbers.

If your income has changed dramatically since your 2016 taxes, we may need to provide documentation of that change.

 

Frequently Asked Questions

What is the penalty for not having health insurance?

The penalty for 2017 is $695 per adult and $347.50 per child up to a maximum penalty of $2085/family or 2.5% of gross income over the filing threshold. You pay whichever calculation is higher. The 2.5% penalty is limited to the cost of the average Bronze plan sold in the marketplace nationwide. The 2.5% penalty will stay the same for 2018 and beyond but the flat fee for 2018 hasn’t been released yet.

There is an exemption from the penalty if you are extremely low income or if the gap in coverage is 2 months or less. There are other exemptions such as hardship exemptions and waivers if you participate in an approved Christian Health Sharing ministry.

The worst penalty of all is not having health insurance protection if something horrible happens to you or someone you love. You would be stuck waiting until the next year to get covered.

Is there REALLY a penalty? I heard the IRS isn’t enforcing those.

The Trump administration asked the IRS to make things easier for the public. What that means is that they won’t hold up your tax return if it is missing health insurance information. They will, however, come back to you at a later date to follow up. The individual penalty is still the law of the land.

This also applies to someone who gets subsidies from the marketplace even though their employer offers insurance. I would be very cautious if someone recommends that you take subsidies while you are eligible for an employer plan. The IRS has all sorts of documentation and will pursue you once their ducks are in a row.

What if I don’t qualify for subsidies?

If you don’t qualify for subsidies and tax credits, we will help you shop all of the available options. There are plans available to purchase directly that aren’t available in the marketplace. We represent all of the insurance companies available in Utah. We can also explain the pros and cons of all of the choices including “Health Share” plans. It is crucial to understand the tax implication of health insurance and how an HSA account can really help and could even help you qualify for subsidies.

Should I keep my adult children on my plan until they turn 26?

This is a tricky question due to the ACA (affordable care act). Your children can stay on your plan until they turn 26 even if they are married. Even though you can keep them on your plan, it may not be the best option. If you aren’t claiming them on your taxes or won’t be able to for the 2018 plan year, you should consider cutting them loose. If they aren’t tax dependent, you will pay full price for them regardless. A low income single adult can often qualify for tax credits and cost sharing reductions if they apply for their own plan based on their own income.

Even if they don’t get assistance, individual health plans today charge per person based on age. In 2018, you will pay for the oldest three children under 21 and then pay for each dependent 21 and up based on their age. Let us help your adult children understand the health insurance world and get them truly financially independent.

Does my whole family have to enroll on the same plan?

No. If you need different plans due to providers, health needs, or another reason, you can split up onto the most favorable options. There can be a benefit to doing this but you need to be aware that your potential out of pocket costs could be much higher if you have a catastrophic year on multiple plans.

What should I do if I can’t afford my employer’s plan?

If your employer is offering a plan, you probably won’t qualify for tax credits and subsidies. We can help you understand what they’re offering and compare those prices and benefits to what you can buy on your own. The government measures “affordability” based on the rate to enroll the employee only. As a result, employers are paying more toward the employee and less toward the dependents. We have seen quite a few examples where one member of the family is on an employer plan and everyone else is enrolled in something less expensive privately.

It’s important to note that the State of Utah has a sister program to the CHIP system that can help you pay to enroll your dependents on your employer’s health plan. It’s called UPP or Utah’s Premium Partnership. You qualify based on income and family size. Send us a message or give us a call and we can let you know if it might benefit you and how to apply.

What if I haven’t had insurance for a while?

It doesn’t matter if you currently have insurance. You can enroll for any reason during open enrollment. There are no waiting periods for pre-existing conditions or even for treatments that you currently need. Insurance companies can’t deny you based on medical or family history. Open enrollment is from November 1st, 2017 to December 15th, 2017.

If you need to enroll outside of the open enrollment period, you will need to document a qualifying life event to be allowed to enroll during a Special Enrollment Period. Qualified events are things such as an involuntary loss of coverage, birth or adoption in the family, or the death of a family member. There are also other reasons such as a change in immigration status, death, divorce, marriage, or being released from incarceration. Call us to see if your situation will allow you to enroll.

Why won’t healthcare.gov work for me?

The Health Insurance Marketplace or healthcare.gov is complicated and often experiences glitches that will mess up your application and your health insurance as a result. If you are experiencing problems that are driving you crazy, let us try to help. We know of alternate ways to enroll and can often talk to the marketplace on your behalf to resolve these issues.

What if my income is higher or lower than I estimated on my application?

Let’s start with the easier of the two. If your income ends up lower than estimated, you will either get more money back or there won’t be a penalty when you file taxes. If your estimate is too high to get help but ends up lower, you could get tax credits if your plan was purchased through the health insurance marketplace. If you’re close to getting help, it’s best to apply through healthcare.gov just in case. This is especially important for the self-employed that have fluctuating incomes.

If your income is higher than you estimated, the IRS calculates what you should have received and you will pay that back at tax time. There are limits on how much can be taken back unless your income is over four times the poverty level. There are quite a few strategies to lower your taxable income which can help if you are lucky enough to make more than you thought…and Congratulations on having an increasing income!

What if I don’t qualify to enroll?

There are short term health plans available if you can’t enroll or if you have to wait to enroll. There are also Health Share programs and children can still qualify for Medicaid or CHIP. Let us work on your situation. Maybe we can get you enrolled by making an appeal or finding an SEP (special enrollment period) that will work for you.

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