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Newsletter

ACA September 2022

Volume 4, Number 36

IN THIS ISSUE...

  • IMPROVED ACA SUBSIDIES EXTENDED TO 2025


  • FEDERAL POVERTY LEVEL (FPL) CHARTS FOR 2023 ACA PLANS


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Latest News and Updates

The Inflation Reduction Act, signed into law on August 16, has extended tax subsidy calculation percentages that were used in 2021 and 2022 through 2025.


Federal Poverty Level amounts that will be used for calculation of 2023 subsidies have been announced, and a Federal Poverty Level chart is included in the second article. This chart will be used to calculate subsidies for ACA plans (the same subsidy amount applies to any plan selected), as well as eligibility for cost sharing reduction plans (these are silver level plans, and in Florida household income must be between 100 and 250% of the FPL to qualify).


ACA open enrollment will run from November 1 through January 15, 2023. Enrollment by December 15 results in a plan with an effective date of January 1. Enrollment between December 15 and January 15 will result in a plan effective date of February 1. Expectations are that gross premiums will increase between 5% and 10% for 2023, but the October and November newsletters will include more information. Carriers will communicate with policyholders in the Fall about their new plans, premiums, and subsidies based on 2022 income projections. Policyholders are urged to update their income projections and make 2023 plan choices before December 15; otherwise, they will be “passively” enrolled in 2023 plans, and that will lead to inaccuracies. All clients should call us sometime during the first few weeks of November at 877-734-3884 (office) or 786-970-0740 (cell) for help in updating their enrollment information and choosing a plan for 2023.

IMPROVED ACA SUBSIDIES EXTENDED T O 2025

The Inflation Reduction Act signed into law on August 16 has extended the improved subsidies that were provided in 2021 and 2022 through 2025. (Otherwise, these improved subsidies would have ended as of December 31, 2022.)


Not only were subsidies for those with household incomes between 100% (non-Medicaid expansion states like Florida) or 138% (Medicaid expansion states) and 400% of the Federal Poverty Level (FPL) improved starting in 2021, but households earning above 400% of the FPL became eligible for subsidies starting in 2021 if the cost of the second lowest-priced silver plan in their zip code was more than 8.5% of their household income.


Note: calculations are expressed as percentages of the Federal Poverty Level (FPL), but the FPL changes each year. One FPL chart is used for the 48 contiguous states, and Alaska and Hawaii each have their own FPL charts.


The following chart compares how the % income calculations were made before 2021 and how the income calculations will be made through 2025 (starting in 2021). The middle column (labelled “current” income) shows how subsidies were calculated through 2020; the last column (“new income %”) shows how subsidies will be calculated through 2025.


Note that subsidy eligibility begins at 100% of the FPL in Florida and that those earning above 400% of the FPL are eligible for subsidies if the cost of the second lowest cost silver plan in their zip code exceeds 8.5% of their household income:

FEDERAL POVERTY LEVEL (FPL) CHARTS FOR 2023 ACA PLANS

The Federal Poverty Level (FPL) calculations used for determining ACA subsidies in 2023 will increase from $12,880 to $13,590 for a single individual (100% FPL level).



This FPL chart will be used for determining tax subsidies and Cost Sharing Reductions for 2023 plans

Those with MAGI above 400% may qualify for tax subsidies if the cost of the benchmark silver plan in their zip code exceeds 8.5% of their income

 ACA ENROLLMENT ON HEALTHCARE.GOV

Open enrollment for states (like Florida) that participate on healthcare.gov will begin November 1 and run through January 15. Those who enroll on or before December 15 will have plan effective dates of January 1, 2023. Those who enroll between December 16 and January 15 will have a plan effective date of February 1, 2023.


Those who don’t enroll within the period November 1 through January 15 will be permitted to enroll in an Affordable Care Act plan ONLY if they have a “qualifying life event” and thereby qualify for a special election period (e.g., leaving group employment, marriage, moving between service areas, divorce, and losing Medicaid eligibility). 


Most special election periods run for 60 days, and in many cases applicants must provide proof of having prior coverage. Coverage will begin the first of the month after the individual makes application, but individuals will be enrolled retroactively in some situations (e.g., birth of a child). When a person makes application for a special election period on healthcare.gov or with an agent who uses a web brokerage system, an “enrollment verification notice” will be produced by the system. This notice will indicate the applicant’s projected household income; amount, if any, of any tax subsidy; whether or not the individual is eligible for a cost sharing reduction; whether or not the individual is eligible for a special election period; applicable effective dates; and whether the individual has to provide any verification (e.g., proof of income, immigration status and/or citizenship; and whether the individual has to provide proof of eligibility for the special election period).


(NOTE: “eligibility verification notices” are also produced during open enrollment. Individuals in states like Florida are eligible to enroll in an ACA plan if their household income is at least 100% of the FPL. Eligibility verification notices produced during open enrollment can require applicants to submit proof of income, immigration status, and/or citizenship.)

About Paul Cholak


Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.


He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.

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2022 Schedule
Affordable Care Act Open Enrollment

Affordable Care Act open enrollment began November 1, 2021 and ended January 15 on the Federal Facilitated Marketplace (healthcare.gov).
You can only buy an Affordable Care Act plan for the remainder of 2022 if you have a Qualifying Life Event.

Call us at 561-734-3884 or 877-734-3884 to determine
what kind of plan you may be eligible for.


2023 Schedule
Medicare Annual Enrollment Period

Marketing for 2023 plans runs from October 1, 2022 through October 14, 2022.

The Medicare Annual Enrollment Period runs from October 15 through December 7, 2022 for a January 1, 2023 effective date.

Otherwise, you’re eligible to enroll if you’re first becoming eligible for Medicare or are eligible for another type of enrollment period. Enrollment rules differ between Medicare Supplement plans and Medicare Advantage, Medicare Advantage Prescription Drug, and stand-alone Prescription Drug Plans.

Call us at 561-734-3884 (TTY: 711) or 877-734-3884 (TTY: 711) for details.

family consulting

We offer a comprehensive set of Affordable Care Act (“Obamacare”) plans

to individuals and families qualified to buy health (tax- and non-tax subsidized) insurance and dental/vision and/or hearing plans through the Federal marketplace (this is called buying “on-exchange” or “on-marketplace”) or directly from insurance carriers (this is referred to as buying “off-exchange or -marketplace”). Our Affordable Care Act policies comply with the Affordable Care Act and contain all of the “essential health benefits” required by that law.

The dental/vision and/or hearing insurance

products are available both on an insured or discount basis

We offer short-term health insurance policies

for those who are looking for more inexpensive coverage and shorter term alternatives.

We offer Medicare Supplement, Medicare Advantage, and Part D Drug plans

to Medicare beneficiaries. Our site is compliant with federal, state, and carrier guidelines in selling these policies. See the Medicare section of this site for details.

We represent many carriers that offer supplemental benefits

to both individuals and families and Medicare beneficiaries, and the site contains information about hospital indemnity, cancer, critical illness, gap, accident, and international medical insurance offered by many different carriers. This section of the site also contains valuable information and tools about lowering the cost of prescription medications. Call us if you want more information about or would like to enroll in one of these products.

We also offer Short- and Long-Term Disability products

and can also help you meet the costs of long-term care, nursing home, or short-term (recovery) care needs.

Finally, we have a complete array of Life, Final Expense, and Annuity products

and offer pre-need services in Florida, as we have both life insurance and pre-need licenses in that state.

You pay nothing for our services:

we’re paid directly from the carriers we represent, Premiums are NEVER EVER marked up to include paying us for our services: you pay the same whether you order directly from the carrier or the marketplace on your own or directly through us or from our site.

We ONLY offer alternatives that are suitable for you and for which we feel meet YOUR needs.
When or if we feel a product or service is not appropriate for you from either a cost or benefit point of view we will tell you so.

We’re fully compliant with privacy and security guidelines, have signed all required privacy and security agreements, have developed a privacy and security policy, and take extraordinary steps to safeguard your protected health and personal information.
In short, we’re experts in all aspects of health and life insurance and also have relationships with professionals who can help you with very specialized situations.

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