HOLLYWOOD, Fla.--(BUSINESS WIRE)--With the Feb. 15 open enrollment deadline looming for March 1 coverage under the Affordable Care Act, the time to do your homework is right now, says Steve Dorfman, CEO of Health Benefits Center, a nationwide insurance provider based in Hollywood, FL.
The inevitable starting point is the ACA website at www.healthcare.gov.
“We certainly advise that you explore the site for research, but we strongly recommend that you not do this alone,” Mr. Dorfman says. “You can certainly contact a trained health care navigator, or – better yet – a trusted insurance agent licensed under Florida statutes. While a navigator is neutral and cannot make a recommendation, an agent can determine which plan is a better fit for your budget, your needs, and your family, as that agent is trained to have a deeper, surer feel of the policies, companies, and networks, and how they compare.”
That said, Mr. Dorfman also counsels patience. The ACA website has vastly improved since the traumatic 2013 rollout, but it still suffers glitches and shutdowns from time to time.
Mr. Dorfman says his office has also noticed a strong, steady gain from the response a year ago. One reason is that second-year enrollees are noticing premium jumps in their renewals and are looking for a better deal. Once you sign onto a policy, you are locked in for a year, and the policy automatically renews unless you indicate otherwise during the enrollment period.
Many people do not know this. So here are some questions that might surprise people who think they are already familiar with the Affordable Care Act.
What happens if I do not enroll?
You face a higher penalty this year, of 2 percent of your income or $325 per adult and $162.50 per child – whichever is more. That’s more than triple the penalty for 2014, of 1 percent of your income or $95. Translation, if you are an individual or family of four making $50,000 a year, your penalty is $1,000. If you are making $100,000, your penalty is $2,000.
If I am insured through my employer or through a plan off the exchange, do I pay any penalty?
Not if it is a regular PPO or HMO. But here’s one important twist: Limited-liability policies will go off the market effective Jan. 1. Many people either unable to pay high insurance premiums or rejected for coverage altogether because of pre-existing conditions opted for such policies. Because Obamacare is designed as an umbrella of choices for most income levels – from modest “bronze” HMO plans to “platinum” PPO plans.
If I am unhappy with my insurance plan, can I change it over the next year?
Not unless you can prove a “life-changing event” – such as loss of a job, a drastic pay cut, or a move to another state. Then, you can go back on the exchange. Otherwise, you are locked into your policy. To change it, you must wait until the next open enrollment period begins in November 2015. You should also realize that, as policy now stands, you will automatically be re-enrolled in your current policy when the next open enrollment period comes. The premium could well change, too. Therefore, it is important to stay on top of your insurer and the healthcare.gov website.
What happens if an automatic deduction bounces and I lose my policy?
You can seek another insurance policy in the open market, but not through the exchange.
Other than avoiding penalties, what are the advantages for signing onto Obamacare?
One big advantage is that any pre-existing conditions are included in your coverage. Even people with routine medical issues in recent years have been denied insurance, and Obamacare helps that. You will pay higher premiums as you get older, or if you smoke. Aside from that, a healthy 45-year-old nonsmoker pays the same premium as an ailing 45-year-old nonsmoker, but a smoker pays more, whether healthy or sick. Perhaps the great advantage is that an Obamacare plan, from bronze to platinum, covers your annual exam and such vital preventive procedures as pap smears, breast exams, and colonoscopies.
I am a single male. Does my insurance policy still need to cover maternity costs?
Yes. Under the mandates of the Affordable Care Act, maternity has to be included, even if, as a male, you have no reason to pay maternity costs. Hence, your insurance rate is higher than it might be otherwise.
My employer is charging me a very high rate. Should I try Obamacare?
You should certainly consider it. With your insurance plan, you can qualify for a subsidy, if your annual health care premium is more than 9.5 percent of your household income. So, if you make $50,000 a year, your insurance rate needs to exceed $4,750 a year, or about $396 a month.
What is my income limit to qualify for a subsidy?
A family of four making $95,400 or less can get a tax subsidy under the program. The lower the income, the bigger the subsidy. A family making $50,000, for instance, can get a rate break approaching 70 percent. The uninsured in particular stand to benefit, especially if they qualify for Medicaid.
My children in college are on their university insurance plan. Can I keep that plan and still have Obamacare for the family?
Not if you want a subsidy. For your children, it must be one policy or the other, as many college parents are discovering to their surprise. One option is to keep your children on their individual plans through their colleges or universities, while insuring the parents as an individual or couple. The rates are structured to encourage full family participation.
Are costs higher this year?
Generally, premiums are averaging about 7-9 percent more than last year. Catastrophic policies are as much as 18 percent higher. There is wide variation, however, and certain policies have remained static or even dropped slightly in price. If you have an existing policy that automatically rolled over Jan. 1, do check your premium!
Where can I go for more information?
Before you connect with a well-informed agent, it’s best to be armed with information. Two good places to start are the federal government’s healthcare website at www.healthcare.gov. To calculate your subsidy, the Kaiser Family Foundation offers an excellent interactive website at: http://kff.org/interactive/subsidy-calculator/. If not, call a trusted insurance broker, who can tailor a plan to your budget and your needs.
Steven Dorfman is Chief Executive Officer of Health Benefits Center in Hollywood, Florida, a brokerage with nearly 100 agents serving clients around the country, at 800-492-1834 and hbcinsure.com.