Dear Valued Customer,

This issue of the “—————-” is focused on health coverage for the self-employed.

If you’re self-employed with no employees, you’re not considered an employer. You can use the individual Marketplace to find coverage that fits your needs. You can use the Marketplace to find affordable health coverage that works for you. When you apply, you’ll find out whether you qualify for lower costs on your monthly premiums and out-of-pocket costs on private health insurance in the Marketplace.

Read on to preview plans available to you and see how much you may pay based on your income, and more.

We appreciate your continued business and look forward to serving you.

Kind regards,

If you’re self-employed with no employees, you’re not considered an employer. You can use the individual Marketplace to find coverage that fits your needs.

How to know if you’re “self-employed”

If you run an income-generating business with no employees, then you’re considered self-employed (not an employer) and can get coverage through the Marketplace. You’re not considered an employer even if you hire independent contractors to do some work.

If you have employees (generally, workers whose income you report on a W-2 at the end of the year) you’re considered an employer. Then you could get coverage for yourself and your employees through the SHOP Marketplace. Learn more about how to determine if you have employees.

Marketplace coverage for the self-employed

You can use the Marketplace to find affordable health coverage that works for you. When you apply, you’ll find out whether you qualify for lower costs on your monthly premiums and out-of-pocket costs on private health insurance in the Marketplace.

Important. Marketplace Open Enrollment ended March 31. You can still buy a Marketplace health plan only if you qualify for a special enrollment period.You can apply for Medicaid and CHIP any time. Learn about special enrollment periods and other coverage options after Open Enrollment. Open Enrollment for 2015 coverage starts November 15, 2014.

You can use this tool to preview plans available to you and see how much you may pay based on your income.

All Marketplace plans cover essential health benefits, pre-existing conditions, and free preventive services.

If you have individual coverage now

If you already have individual insurance–a plan you bought yourself, not the kind you get through a job–you may be able to change to a Marketplace plan. Learn more about changing individual insurance plans.

Lower costs for coverage

You may qualify to get lower costs on your monthly premiums when you buy private health insurance in the Marketplace.

When you fill out a Marketplace application, you’ll learn if you qualify for these lower costs. Depending on your income, you may also qualify to for lower out-of-pocket costs, so you won’t have to pay as much for deductibles, copayments, and coinsurance.

Medicaid and CHIP

When you fill out a Marketplace application you’ll also learn if you or your children qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You may qualify for these programs right now.

Source: HealthCare.gov, “Health coverage for the self-employed.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/what-if-im-self-employed/

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.

If you have an individual health plan you want to replace, your options will depend on what kind of coverage you have and whether enrollment is open.

If you have a plan you bought through the Marketplace

You can enroll in new Marketplace coverage outside Open Enrollment only if you have a qualifying life event that qualifies you for a special enrollment period.

Find out if you qualify for a Special Enrollment Period or Medicaid and CHIP.

If you don’t have a special enrollment period, you must wait for the next Open Enrollment period to enroll in a Marketplace plan to replace your current plan.

The Open Enrollment period for 2015 coverage is November 15, 2014 through February 15, 2015. Coverage can start as soon as January 1, 2015.

Cancelling your Marketplace coverage

While you can’t replace your Marketplace coverage outside Open Enrollment without a special enrollment period, you can cancel your coverage. To cancel coverage you bought through the Marketplace, log in to your Marketplace account and select the red “Terminate/end all coverage” button.

Important: If you cancel coverage without replacing it, you may have to pay a fee for the months you’re not covered. You’ll also have to pay all of your medical expenses yourself.

If you have a plan you bought outside the Marketplace

If a health insurance plan you bought outside the Marketplace is ending or being cancelled, you may qualify for a special enrollment period to buy a new plan through the Marketplace.

• Most health plans are sold by “plan years.” If you bought a plan outside the Marketplace it may end outside the Open Enrollment period. If it does, when the plan year ends you qualify for a special enrollment period.

Important. Voluntarily ending your plan, or being terminated for not making your premium payments, doesn’t qualify as losing your coverage. You don’t get a special enrollment period that would allow you to enroll outside Open Enrollment.

Learn about your options if your plan is being cancelled.

If you voluntarily end your health insurance plan and have no health coverage, you may have to pay a fee for the months you don’t have coverage.

Change plans with a special enrollment period

If you have a special enrollment period you usually have 60 days from the qualifying life event to enroll in a new plan.

You can change plans with a special enrollment period 2 ways:

• Online. Create an account in the Marketplace or log in to your existing account and report your life changes on your application by selecting the “Report a Life Change” button. If your new eligibility notice says that you qualify for a special enrollment period, you can then shop for plans and change to a new one.
• By phone. Contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)

You can appeal a Marketplace decision to deny you a special enrollment period. Learn how to file an appeal.
Source: HealthCare.gov, “Replacing an individual health insurance plan.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/what-if-i-want-to-change-individual-insurance-plans/

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.

When you buy health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums.

This will depend on your household size and income.

Pay lower costs for premiums each month

In the Health Insurance Marketplace you may be able to pay less for health coverage every month if you qualify for a premium tax credit.

• When you fill out a Marketplace application you’ll report your household size and income. Learn how to count your income and household size.
• If your income falls between the amounts shown in the chart below, you’ll qualify for a premium tax credit that you can apply directly to your monthly premiums. This means you’ll pay less money to your insurance company each month.

Learn more about the premium tax credit from the Internal Revenue Service.

Savings depend on income and family size

If your income falls within the following ranges you’ll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit.

• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8

Incomes that qualify for tax credits are higher in Alaska and Hawaii. See Alaska and Hawaii information.

Get an estimate of your premium tax credit and plan costs

You can view plans and prices available in your area right now by using a simple tool. Provide some basic income and household information and you’ll see how much you’d pay for each plan. Prices shown account for any tax credit you’re eligible for.

Your final tax credit will be determined when you finish your Marketplace application.

Coverage savings at lower income levels

If your income falls below the amounts shown on the chart, you may qualify for coverage under your state’s Medicaid program. This is true if you live in a state that’s decided to expand Medicaid to cover more people.

But if your income falls below the amounts shown on the chart, your state is not expanding Medicaid, and you don’t qualify for Medicaid under your state’s rules, you can’t get premium tax credits that reduce what you pay for a private insurance plan.

Learn if your state is expanding Medicaid and what this means for you.

If your income is too high for premium tax credits

If your income is too high to qualify for premium tax credits, you can buy coverage 4 ways.

Source: HealthCare.gov, “How to save on monthly insurance premiums.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.