ALERT ALERT ALERT….
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The Affordable Care Act (ObamaCare) reform law enacted on March 23, 2010, has thousands of pages and hundreds of provisions. Some provisions are already in place. Others will not take effect until a future date and before they do, additional laws and regulations will be developed. The next milestone with the greatest impact to individuals and/or families will come on January 1, 2014. On that date provisions for Advance Premium (subsidy) Tax Credits; Health Insurance Exchanges/Marketplace; Guaranteed Coverage and a Personal Responsibility Requirement for individuals to obtain health insurance or pay a Tax penalty will become effective.
Open Enrollment will begin on October 1, 2013 and individuals and/or families may start applying for premium subsidies. at that time Under the health care law the federal government will offer Advance Premium (subsidy) Tax Credits to Individual and/or Families based on size of household and with income between 133% — 400% of the Federal Poverty Guidelines. Health Insurance Exchanges/Marketplace, both private and government sponsored will become available for quoting beginning October 1, 2013 to start offering individual and/or family medical plans (in addition to private insurance companies operating separately outside the new exchanges/Marketplace) with an effective date of 1/1/2014. Insurance companies in both the private and public Exchanges/Marketplace , as well as private insurance companies operating separately outside the new exchanges/Marketplace, will offer new comprehensive medical plans that include the required ten essential benefits mandated by the Affordable Care Act.
Applying for individual and/or family health insurance under the Affordable Care Act is a two stage process. The first step is to determine if you are eligible for an Advance Premium (subsidy) Tax Credit and the second step is selecting the insurance plan you want to purchase, regardless if you qualified for the Advance Premium (subsidy) Tax Credit or not. The subsidy will assist you in lowering your premium should you qualify. If you are eligible for a Advance Premium (subsidy) Tax Credit, the online income Calculator , included in our web site will help you estimate your actual Advance Premium (subsidy) Tax Credit.
The difference between the four level of choices will boil down to something called “actuarial value“. Simply put, it’s how much of the total costs of covered benefits the insurance company will pay for the average person. If a plan has an actuarial value of 60 percent, the insurance company will cover roughly 60 percent of the cost and you will pay 40 percent out-of-pocket. Your out-of-pocket cost include the amount of the deductible, co-insurance (the percentage of the medical bill you pay after the deductible is met) and office visit co-payments. The premiums you pay for insurance don’t count as part of the out-of-pocket percentage. Here’s how the four basic types of plans break down:
- Bronze – Pays 60 percent of the cost. You pay 40 percent
- Silver – Pays 70 percent of the costs. You pay 30 percent
- Gold – Pays 80 percent of the costs. You pay 20 percent
- Platinum – Pays 90 percent of the costs. You pay 10 percent
Premiums will generally be lower for bronze and silver plans than for gold and platinum plans, but you’ll pay higher deductibles and co-payments for medical care. Besides the bronze, silver, gold and platinum plans, health insurance companies can offer a catastrophic plan, which will pay for the lower percentage of costs than the bronze plan. Catastrophic plans will carry lower premiums than bronze, silver, gold or platinum plans, but will have higher out-of-pocket cost for medical care. Catastrophic plan will be available only for people under age 30 and people who are exempt from the individual mandate because the cost of a standardized health insurance plan will exceed 8 percent of their income.
Additional key point of interest you may want to review are highlighted below:
- Premium Subsidy (Advance Premium Tax Credit)
- Apply for Advance Premium (Subsidy) Tax Credit
- Subsidy Application
- Insurance Companies we Represent
- Apply for Health Insurance
- About US
We recognize that what works for one individual doesn’t necessarily work for another person. We frequently save our clients money and/or improve the level of health insurance benefits. To request a free, no obligation, online quote, simply click on the blue quote bar. Should you have questions or need assistance with the online quoting process or like a personal consultation regarding your situation or help in completing your online application for health insurance please give Laura, an RN and experienced career broker a call at (936) 321-6286 in The Woodlands and Greater Houston Area or 1 (888) 780-1215 toll free from anywhere in Texas.
Please note information on our web site is not complete and could change as the government, at this date, has not yet released all the regulations to the implementation of the Affordable Care Act.