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Newsletter

ACA October 2022

Volume 4, Number 37

IN THIS ISSUE...

  • WHAT IS ACA OPEN ENROLLMENT? 



  • AFFORDABLE COVERAGE DEFINITION FOR THOSE OFFERED EMPLOYER GROUP COVERAGE LIBERALIZED FOR 2023
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Latest News and Updates

ACA Open Enrollment Begins November 1, and next month’s newsletter will contain more information about 2023 Open Enrollment, information on premiums for 2023, general information about plans, and additional information on enrolling for 2023 plans.


This month’s newsletter contains three articles that are all pertinent to preparing for Open Enrollment which begins on November 1 and ends on January 15. We suggest you read these articles so you know what you’ll need to do when open enrollment begins.


Please call us at 561-734-3884 if you have any questions.

WHAT IS ACA OPEN ENROLLMENT?

The following summary was written by Louse Norris and appeared in the 2023 Open Enrollment Guide published by HealthInsurance.org.


Open enrollment is the annual window during which individuals and families may sign up for ACA-compliant individual and family health insurance – or make changes to their existing coverage. It’s the only time during the year – other than a special enrollment period – that eligible individuals or families can sign up for a plan or switch to a different health plan.


During the open enrollment period for 2022 coverage, enrollment reached a record high, with more than 14.5 million people signing up for coverage through the exchanges (marketplaces). The record-high enrollment was driven in large part by the subsidy enhancements created by the American Rescue Plan Act (ARPA).


The ARPA's improvements to the ACA's subsidy structure have allowed an unprecedented number of Americans to qualify for premium tax credits that are larger than they used to be. And the Inflation Reduction Act, signed into law in August 2022, extends the current subsidy enhancements through 2025.


So, during the open enrollment period for 2023 coverage, the enhanced subsidies will still be available. And depending on the price of coverage, subsidies will still be available to households with income above 400% of the poverty level.


For 2022, additional insurers entered or expanded their presence in the marketplaces, increasing health plan options for consumers around the country. For 2023, we're seeing a bit of a mix: In some areas there are new insurers joining the marketplace or expanding their coverage area, but there are also some insurers that are exiting the marketplaces in some states. Insurer exits and entries can result in changing benchmark premiums, which can change premium subsidy amounts. Here’s what you need to know about how that works.


ENROLLMENT INFORMATION FROM HEALTHCARE.GOV

Your 2023 Insurance Status---Two Letters


By November 1, 2022, you should get two letters – one from your current insurance company and one from the Marketplace (i.e., healthcare.gov).


  • Together they'll explain:


  • Your 2023 coverage status
  • Which plan (if any) you’ll be enrolled in or matched with if you don’t act by December 15, 2022


(Editor’ Note: it’s especially important to update your income and other information for 2023. If you don’t, your subsidy will be calculated on outdated information, and you won’t receive the correct subsidy or even be eligible for the most appropriate plan to meet your current needs. Call us at 561-734-3884 for help in making this update. If you don’t act before December 15, you’ll be what is called passively enrolled into a 2023. Plan. Again, you should be looking at all available plans and make an ACTIVE decision to enroll in a plan. We’re also available to help you in this endeavor (call us at 561-734-3884 for help.)


We use an enhanced direct enrollment system through a company called Health Sherpa that helps us in this process and expedites the time it takes to update applications and enroll in plans. Healtthcare.gov and other systems are still debugging problems the first week of open enrollment, so we suggest you delay this process at least until the second week of November:.


  • Any changes in your coverage and financial help
  • Directions if you need to send the Marketplace any documents

 

  • If you don’t get your insurance company letter by November 1, contact your insurance company.



Update And Compare Plans For 2023


Starting November 1 (note: We suggest delaying this for at least a week because of computer debugging problems), update your Marketplace application with your expected income and household information. Then compare your current plan to what's available in 2023. No matter what plan you want to enroll in, we strongly recommend you update your Marketplace application with your expected income and household information. Then compare your current plan to what’s available for 2023. Select a plan by December 15, 2022 for coverage that starts January 1, 2023. 


  • New, affordable plans may be available this year. Plans and prices change every year. Your situation may have changed too. You may find 2023 plans with coverage and features that better meet your needs — especially if you had or expect income or household changes.


  • Update your application so your 2022 Marketplace savings are correct. Marketplace savings are based on your expected income for 2023 (not 2022). If you don't update your income and household information, your premium tax credit and other savings could be wrong for 2023. If this happens:


  • You could wind up paying more for your monthly premium than you have to.


  • You may use more advance payments of the premium tax credit than you qualify for. You would then have to pay back some or all the difference when you file your federal taxes.

 

  • You may be eligible for automatic re-enrollmentfor 2023, BUT we strongly suggest you still update your application and check out other insurance plans. Make sure you're getting the plan that meets your needs. If you don't renew or enroll in a plan by December 15, you might be enrolled in the same plan or a different plan with similar coverage. That coverage will start January 1, 2023. But the best way to make sure you have a 2023 plan that meets your current needs, and with the Marketplace savings you qualify for, is to log in to update your information and see all the plans available to you for 2023. You should do this even if you want to keep the same plan.


  • In some cases, you won't be automatically re-enrolled. Enroll in a plan by December 15, 2022, to make sure you have coverage starting January 1, 2023.


NOTE: the above describes the process for applying for plans through the Marketplace (i.e. healthcare.gov). If you have a plan that you bought directly through an insurance carrier, you will receive communications and instructions directly from that carrier. Please call us at 561-734-3884 for help in re-enrolling or changing plans if you're buying your plan directly through a carrier (i.e., buying off the exchange).


AFFORDABLE COVERAGE DEFINITION FOR THOSE OFFERED EMPLOYER GROUP COVERAGE LIBERALIZED FOR 2023

Generally, if an employee is offered group coverage s/he is not eligible for subsidized ACA health coverage. HOWEVER, if the employee’s portion of the premium for the lowest- priced “self-only” plan the employer offers is more than 9.12% (decreased from 9.61% for 2023) of his or her household income, s/he CAN qualify for an ACA tax subsidy.


Many employers offer dependent coverage, but adding dependents to employer plans can be prohibitively expensive because in many states employers can offer coverage to dependents without subsidizing any of their premium. Unfortunately, family members who are offered dependent coverage by employers are not eligible for premium subsidies if the amount the employee must pay for employee-only coverage on the group plan is deemed “affordable” – defined as less than 9.12% of household income. It doesn’t matter how much the employee would have to pay to purchase family coverage. Employees and any family members who are offered employer group coverage are not eligible for premium tax credits if a job-based-plan is deemed “affordable” and meets the “minimum value” standard. (Note: this is referred to as the “family glitch.” There have been several legislative attempts to remove this provision, but none have been successful. President Biden attempted to do this by Executive Order, but it was determined that he didn’t have the authority to make this change in this manner.)



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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