And, if you own a business that employs 50 or more people, you’re also required to provide a health insurance plan for your workers.
Looking for health insurance for yourself or your family?
If you aren’t covered by Medicare, Medicaid, or an employer-sponsored health plan, the Affordable Care Act (ACA) now requires you to either purchase health insurance coverage, or pay a tax penalty.
If you’re in the market for an individual or family health plan, Benefit Concepts can help. Let’s get started!
Finding the right health insurance coverage is about finding the right balance.
Many private insurers offer coverage plans. We’ll carefully match up your needs to your budget and to the plans available to you in your market.
Some states, such as Ohio, Indiana, Michigan and West Virginia, have elected to allow the federal government to run their health insurance exchanges. In these states, we’ll go through the Federal Marketplace.
Insurance plans are regulated at the state level, so your choices may look different from location to location. In order to start your health plan search, your Benefit Concepts agent will need to know:
- The names and dates of birth for everyone to be covered under your policy,
- Your ZIP code and county of residence,
- If anyone you intend to cover uses tobacco products an average of 4 times or more weekly.
Your answers will help us zero in on the plans that would fit your needs, budget and lifestyle!
The more information you provide, the more value we can find for you.
There’s plenty to consider when researching your coverage options. In addition to the information above, it would be helpful if you could provide us the following:
- A list of your current healthcare providers. Are there particular doctors, pharmacies and / or hospitals you’ll want or need to have coverage for under your plan’s network?
- Information about your medical needs. What medical treatments do you anticipate undergoing in the coming year? What does your normal plan usage look like? These answers can mean the difference between purchasing the right plan or a less desirable plan. We can even mix and match plans within your family to ensure everyone’s unique healthcare needs are being met!
- A list of the prescriptions you need to cover. Are you, or members of your household, taking regular, prescribed medications for the management of any chronic conditions?
- Your household income and budget information. We’ll need to know how much income you expect your household to earn (you, your spouse and any tax dependents, including children — if you’re claiming them on your taxes, they’re part of your income tax household).
We understand that estimates can be tricky. We can always adjust your income later to reflect any changes. And be assured that we don’t ask you information about your finances in order to pry. It’s helpful for us to know for 2 reasons:
- We want to make sure the plan options we present you with are affordable for your budget.
- Some customers may qualify for need-based, subsidized premiums under the Affordable Care Act. We’ll look to see if you might be eligible for financial assistance.
Applying for financial assistance under the ACA.
If you apply for financial assistance, we’ll need to estimate your household’s total Modified Adjusted Gross Income (MAGI) for the year your insurance will cover.
Your MAGI is your household’s Adjusted Gross Income with a few things added back in:
- Any non-taxable Social Security benefits
- Tax-exempt interest
- For Americans living abroad, foreign income and housing expenses
Here are a few examples of how you can estimate your household’s MAGI for your intended health coverage period:
- Look at last year’s tax return. If you haven’t had a big change in either household size or income, it’s probably safe to use last year’s MAGI to make your estimate.
- Use your best judgement in variable income situations. If your household’s income varies a lot from month-to-month or year-to-year, you’ll want to err on the side of caution and estimate as best you can.
When we complete your application, we may advise you to claim less than the full amount of the subsidy you’d be eligible for — “letting the difference ride” could give you a much-needed safety cushion and reduce the amount of subsidy you’d have to repay if you end up over-income at the end of the year.
And make sure you carefully track your income during the year to see if you’re trending significantly over or under your estimated MAGI. If so, we can easily adjust your application and save you later tax worries!
Enrolling in your new plan.
If you’ve applied for coverage through the Federal Marketplace, enrollment is simply a matter of selecting your plan and clicking “enroll.”
If your coverage didn’t come from a federal exchange-based plan, your Benefit Concepts agent will work with you to complete and submit your application for insurance.
Transitioning to your new plan.
If you switched from one Marketplace plan to another, your old insurance will automatically terminate on the date your new plan goes into effect.
If you’re leaving non-Marketplace coverage, you must contact your previous insurer to end your coverage with them and stop billing. If you fail to do this, you run the risk of being over-charged — especially if you elected to make automatic payments and / or chosen auto-renewal when you bought your former policy.
Make sure you destroy your old insurance card(s), or file them in a secure location. This will help you avoid identity theft.
Inform your doctor(s) and pharmacy about your new coverage right away.
This is especially applicable if you have previously scheduled appointments, or have set up auto-renewal / auto-billing of your regular prescriptions.
Make sure you always take your plan ID card with you to doctor’s visits and when picking up your prescriptions at the pharmacy — just in case!
If your new plan requires doctor referrals for specialist appointments, be sure to contact your primary care physician well in advance, so that he or she can provide the appropriate documentation to your insurer before your visit. Give your primary care doctor at least 48 weekday hours’ notice — or more if you possibly can.
What to expect from your new insurance carrier.
About 10 to 14 days after you enroll in your new plan, you should receive from your insurance company a welcome letter, plan ID cards for all the covered members of your household and details on how to access your benefits and certificate of coverage.
Most insurance carriers now have member websites where you can view your benefits and plan usage, and / or pay online. Many also have a smartphone app that allows you to easily access your insurance information and coverage details on the go.
Paying your Premium
Coverage cannot be issued until your first month’s payment has been received. So, you must submit your first month’s payment before your coverage will begin. You can usually pay this by phone or on the insurer’s website.
Payments should always be made in a timely fashion. If, after your initial premium payment, a monthly payment is missed, insurers usually give you a 30-day grace period to bring your account current before they’ll terminate your benefits.
But to avoid termination after a missed payment, you’ll usually be required to pay the total premium due, not just the past-due portion.
For example, if you miss your July payment, you cannot pay your July payment in August, then pay for August in September. You will have to pay the July (past-due) payment and the August (current) payment, or your coverage may be terminated.
The best course of action is not to get behind on your payments and avoid those headaches altogether.
If your bill is being adjusted (usually due to someone leaving the policy, or due to a change in income that affects your subsidy eligibility) we recommend that you still pay the entire amount due. That’s because changes may take a full billing cycle before they’re reflected in your invoice and any overpayments will be credited appropriately.
Moreover, underpaying your premium could result in an interruption in service or termination of your plan — again, an avoidable headache.
Or, you might just consider pre-paying your coverage 6 months or a year in advance, or enrolling for automatic payments and auto-renewal. Some insurers may offer you a discounts if you do so. Save money and time in the long run!
As always, we’re happy to answer all of your questions and help in any way we can. So, make sure you stay in touch with us after you buy your policy!