Oak Creek Insurance Agency

By

IN: Understanding Your Health Coverage

Dear Valued Customer,

This issue of the “—————-” is focused on understanding your health coverage.

Health coverage pays for provider services, medications, hospital care, and special equipment when you’re sick. It’s also important when you’re not sick. Marketplace coverage includes preventive health services like immunizations for children and adults, annual doctor visits for women and seniors, screening and counseling for people of all ages, and more. The best news – it’s free.

Read on to learn the four  things to know about your health coverage, what to do if your health plan is cancelled, how to save on monthly premiums, and more.

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

Kind regards,

By

Understanding Your Health Coverage

Workers_MatureBusinessMenDiscussionHealth coverage pays for provider services, medications, hospital care, and special equipment when you’re sick. It’s also important when you’re not sick. Marketplace coverage includes preventive health services like immunizations for children and adults, annual doctor visits for women and seniors, screening and counseling for people of all ages, and more. The best news – it’s free.

Here are 4 things to know about your health coverage:

  1. All Marketplace health plans must provide you with a Summary of Benefits and Coverage, which includes coverage examples showing how the plan might help pay for services.
  2. The actual costs and care will vary by your health care needs and your coverage.
  3. You can use our glossary to understand key terms like copayment, deductible, network, and premium.
  4. If you have questions about your coverage, you can contact your health plan, state Medicaid program, or Children’s Health Insurance Program (CHIP) to get more information.

See why it’s so important to have health coverage and share what you learn with your family and friends.

Source: HealthCare.gov, “Understanding your health coverage.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/blog/understanding-your-health-coverage/

© 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.

By

If your grandfathered health plan is changed or cancelled

Health-Wellness_MedicalPapersAndStethescope

Under the health care law, most individual plans must offer new benefits and protections.

But some plans that have existed since before the health care law was passed, known as “grandfathered” plans, do not include some of those new benefits and protections. They are not Marketplace plans.

Some of them are changing to include these benefits. Others are being cancelled. Others are allowing current plan participants to renew through the 2016 plan year.

Note: If you had Marketplace coverage and your plan has been changed or cancelled, your situation is different. Learn about your plan options here.

When your non-Marketplace plan year ends

When your plan year for a non-Marketplace grandfathered plan ends, you’ll get a notice from your insurance company. When your plan year ends, you’ll face one of 3 situations:

If your plan is cancelled

If your insurance company cancels your grandfathered plan, you have several choices. Call our special plan cancellation customer service number and a representative can explain your options: 1-866-837-0677 (TTY: 711) Monday through Friday, 9 a.m. to 7 p.m. ET.

Your options include:

  • Buy a plan the company offers in its place. Your insurer must allow you to buy any of its other plans available to you.
  • Buy a new plan in the Marketplace. You may qualify for lower costs on monthly premiums and out-of-pocket costs based on your income. All Marketplace plans include the new rights and protections. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period. Note: If your plan is cancelled, in some cases you can buy a catastrophic health plan. See “What if my plan is cancelled and I can’t afford a new plan?” for more information.
  • Buy a plan outside the Marketplace. This can be a good option if you don’t qualify based on your income. Most plans outside the Marketplace include the new rights and protections.

If your plan changes to include the new rights and protections

If your insurance company tells you that your plan will change to include the new rights and benefits, you have 3 options:

  • Accept the plan and renew it. The price may go up.
  • Look for other plans in the Marketplace to compare your options. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period.
  • Look for other plans outside the Marketplace. This is a good option if you don’t qualify for lower costs based on your income. If you do qualify for lower costs, you can get those savings only if you enroll through the Marketplace.

If your insurance company lets you renew your plan without the new rights and protections

If you have a grandfathered plan that doesn’t offer the new rights and protections, you may be able to renew it annually until 2016.

  • Each state decides whether to allow insurers to do this, and then each insurer in those states decides whether to let people renew the coverage. Check with your insurance company to see if you can renew a plan that doesn’t offer the new rights and protections.
  • Insurance companies can’t sell these grandfathered plans to new customers. They can only renew the plans for existing customers.

If your plan offers you the chance to renew

If your insurance company offers you the chance to renew this kind of plan, it must send you a notice explaining:

  • Which rights and protections aren’t guaranteed in the plan
  • That you can shop in the Marketplace, where all plans meet the new standards and you may qualify for lower costs based on your income
  • That you may also buy new health insurance outside of the Marketplace, where you can’t get lower costs based on your income but most plans provide the new consumer protections
  • Where you can learn more about all your options

You have all of these options any time of year, not just during Open Enrollment. When your plan ends you qualify for a Special Enrollment Period. This lets you renew, buy, or change plans any time.

More answers: Plan changes and cancellations

Source: HealthCare.gov, “If your grandfathered health plan is changed or cancelled”
http://www.healthcare.gov website. Accessed March 18, 2016. https://www.healthcare.gov/current-plan-changed-or-cancelled/

© 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.

By

How To Save On Monthly Insurance Premiums

Female Doctor with Stethoscope Holding Piggy Bank with Bruised Eye and Bandage.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.