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Newsletter

ACA November 2022

Volume 4, Number 38

IN THIS ISSUE...

  • ACA OPEN ENROLLMENT BEGINS TODAY


  • “FAMILY GLITCH” ELIMINATED FOR 2023



  • BRIGHT HEALTH LEAVING ACA MARKET NATIONALLY


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Latest News and Updates

The 2023 open enrollment period begins today and runs until January 15. We plan to start contacting all our clients between November 7 and 15 and to encourage them to actively enroll in 2023 plans by December 15.


The Biden Administration has issued regulations that eliminate the “family glitch” for 2023 plans, and it's estimated that about five million formerly ineligible people will be eligible to enroll nationally for ACA subsidized plans for 2023.


Bright Health has elected to leave the ACA market throughout the country for 2023. Bright members should be receiving communications about this decision shortly, and we encourage members to choose new plans by December 15 to avoid being automatically enrolled into a new plan by another carrier selected by the

FloridaState Insurance Commission.

AFFORDABLE CARE ACT OPEN ENROLLMENT BEGINS TODAY

Affordable Care Act open enrollment begins today and ends January 15, 2023. Individuals and families can enroll in plans without showing evidence of insurability. Those who enroll by December 15 and who make their first premium payment before January 1 will have January 1 effective dates, whereas those who enroll between December 16 and January 15 and make their first payment before February 1 will have February 1 effective dates.


Individuals who are planning to qualify for ACA tax credits should project their 2023 modified adjusted gross income ("MAGI") and actively enroll for 2023 plans before December 15. This chart will be used as a guideline to determine tax subsidies and cost sharing reductions for 2023 plans.  Note that eligibility is based on age and zip code of residence, so some individuals (generally younger people) who fall into one of the levels of the chart will not qualify and some who fall outside the levels (generally older people) will qualify for subsides.  Actual qualification will be determined by healthcare.gov software.


ACA subsidy enhancements that were made because of the American Recovery Act and were scheduled to sunset December 31, 2022 have been extended for an additional three years.


Those who are already enrolled and receive tax subsidies should plan to project their 2023 modified adjusted gross incomes and actively enroll in 2023 plans prior to December 15. Otherwise, they'll be automatically enrolled in their present plan (these are called "passive enrollees") and will likely receive lower subsidies than if they update their incomes on healthcare.gov and choose their 2023 plans before December 15.


We’re available to help individuals enroll in both on- and off-exchange plans and can be reached at 561-734-3884 or 877-734-3884 at any time.


Nine carriers (including one new carrier) will be offering plans in South Florida for 2023. We’ve identified which carriers will be the most competitively priced and  applicable to former Bright enrollees (see third article), and are available to help individuals/families calculate their earnings (based on modified adjusted gross income) and update their previous applications or apply for the first time for tax subsides (premium tax credits). We utilize an enhanced direct enrollment (“EDE”) platform provided by Health Sherpa and can expedite the enrollment application and subsidy calculation process.


From our experience, the first week of open enrollment is always a period to debug systems, and we suggest clients wait until after the first week of open enrollment to update their applications and enroll for new plans (or to elect to stay in their present plans). We will be contacting all our existing ACA clients prior to November 15 to help them enroll in 2023 plans.

“FAMILY GLITCH” ELIMINATED FOR 2023

Through 2022 employees AND families could only become eligible for a tax subsidy if the EMPLOYEE’s portion of the premium for the lowest-priced “self-only” coverage was more than 9.62% (2022 calculation; this number is indexed annually) of his or her HOUSEHOLD income and/or if the plan didn’t meet the “minimum value” standard. This was called the “family glitch” and roughly five million people could not qualify to receive a tax subsidy.


The IRS finalized a rule change last month, just in time for the start of the 2023 open enrollment period. It's estimated that between 800,000 and 2,000,000 current members of group plans and 80,000 to 700,000 currently uninsured individuals will enroll in subsidized plans under the new rules.


Instead of basing the affordability determination for a family’s employer-sponsored health insurance on just the cost to cover the employee, the determination will now be made based on the cost to cover the employee plus family members, if applicable. Here are the important points to understand about this:


  • The family glitch fix will be in effect as of 2023. So, when families apply for 2023 coverage during the open enrollment period in the fall of 2022, the new rules will be used to determine whether anyone in the household qualifies for a premium subsidy.


  • If a family must pay more than 9.12% of household income in 2023 for the employer-sponsored plan, they’ll potentially be eligible for premium tax credits in the marketplace. The same would also be true if the coverage offered to the family does not provide minimum value (i.e offer at least one plan that is actuarially equivalent to a bronze plan). So, if an employer offers, for example, separate coverage to family members that is affordable but doesn’t provide minimum value, the family members would potentially still be eligible for a subsidy to buy a marketplace plan.


  • There will be a separate affordability determination for the employee (based on self-only coverage), and for family members (based on the total cost of family coverage). So, depending on how an employer subsidizes the cost of family coverage, it’s possible that coverage could be considered affordable for the employee but not for family members. In that case, the family members would potentially be eligible for a premium tax credit in the marketplace, but the employee would not.


Calculations will be different where all family members are eligible for ACA coverage than they are for families partially composed of individuals who are eligible to enroll in other plans such as Medicare.


Our Health Sherpa EDE enrollment system will contain logic to make marketplace eligibility determinations for people who were formerly affected by the family glitch.


Read more about the change here.

BRIGHT HEALTH LEAVING ACA MARKET

A considerable number of our clients are members of Bright Health ACA plans, and Bright has decided to exit the ACA market for 2023 and concentrate on marketing Medicare Advantage products in Florida and California.


As of the date of scheduling this newsletter for distribution Bright members have not been notified of this decision, but they'll be receiving notice shortly if they have not already been notified.


We’ve identified those carriers that will be appropriate alternatives for our Bright clients and will be prepared to discuss options when we contact clients by mid-November. We highly encourage Bright clients to review their options and to plan to make 2023 enrollment decisions prior to December 15.


It’s our understanding that the Florida State Insurance Commission is concerned about the possibility of Bright members not taking steps to enroll with different carriers by December 15 and that such members who don’t act by December 15th will lose insurance coverage as of January 1. Accordingly, the State is taking steps to parcel out Bright clients to the other carriers in the market and to have those carriers automatically enroll these people into one of their plans. To avoid being enrolled in a plan they might not like, we strongly advise all Bright clients to make decisions to enroll in new plans no later than December 15.

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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2023 Schedule
Affordable Care Act Open Enrollment

Affordable Care Act open enrollment began November 1, 2022 and ends January 15, 2023 on the Federal Facilitated Marketplace (https://www.healthcare.gov).
You do NOT need a Qualifying Life Event if you buy a 2023 plan during Open Enrollment.

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

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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