Health Insurance Archives - Page 3 of 5

Which States Run Their Own Health Insurance Exchanges?

The Open Enrollment Period is almost over: you only have until January 15 to purchase or change your plan! With that being said, though, some states have chosen to extend their deadline; they can do this because, under the Affordable Care Act (ACA), each state can run its own health insurance exchange, or Marketplace, in which people can shop for health insurance.

This state-based Marketplace is a government agency that is created and maintained by the state, and that offers subsidized ACA plans for residents of that state. You can buy a plan from your state’s Marketplace, or you have the option of buying off-exchange coverage from an insurance company; if you do this, you will not get premium subsidies and cost-sharing reductions– those are only available through the exchange. So which states run their own Marketplaces and what does that mean for you?

State-Run Vs. Federally Run Exchanges

When the ACA was passed in 2010, it provided funding and laid out rules for states to be able to establish their own exchanges; if states chose not to have their own exchange, the federal government would then step in and offer insurance for that state’s residents. So, many states chose to do it themselves so they could have more control of their Marketplace, and make it more profitable and sustainable. The federally run exchange, accessible through Healthcare.gov, is used in 36 states. The other 14 states (and Washington D.C.) have their own exchanges.

States With Their Own Exchanges:

California (Covered California)
- Deadline is January 31
Colorado (Connect for Health Colorado)
Connecticut (Access Health CT)
District of Columbia (DC Health Link)
Idaho (Your Health Idaho)
Maryland (Maryland Health Connection)
Massachusetts (Massachusetts Health Connector)
- Deadline is January 23
Minnesota (MNsure)
Nevada (Nevada Health Link)
New Jersey (Get Covered NJ)
- Deadline is January 31
New York (New York State of Health)
Pennsylvania (Pennie)
Rhode Island (HealthSource RI)
- Deadline is January 31
Vermont (Vermont Health Connect)
Washington (Washington Healthplanfinder)

If you live in a state that has its own exchange, your health insurance plan options and prices might be a little different than if you only have the option of using Healthcare.gov or going off-exchange. In addition, depending on where you live, your OEP might be extended! But just because your state is in control of the Marketplace, that doesn’t mean you can’t find a great affordable ACA-compliant health insurance plan that is right for you by working with an EZ agent.

Looking For Insurance?

The best way to get the right plan for you and your needs is by working with a licensed health insurance agent. At EZ, our agents are highly trained and work with the top-rated insurance companies in the nation, in every state! We will connect you with a local agent who will go over your medical needs and budget, and sift through all the available plans in minutes. We’ll quickly find you a plan that will save you money – especially now, with the premium subsidies President Biden has extended to all Americans. You could save hundreds of dollars a year! No hassle and no obligation. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.

What Happens If I Don’t Do Anything During The Open Enrollment Period?

The ACA Open Enrollment Period only comes around once a year, usually lasting from November 1- December 15, although this year the deadline has been extended to January 15. During this period, you can enroll in a new health insurance plan, or make changes to your current plan. If you’re happy with your current plan, though, you might opt to not do anything at all during the Open Enrollment Period – but not doing anything can have certain consequences, depending on your situation.

You Could Get Stuck With Your Current Plan

This might not necessarily be a bad thing if you are happy with your current plan, but if your plan isn’t quite right for you, you will unfortunately be stuck with it until the next Open Enrollment Period opens up again.

You’ll Miss The Opportunity To Change Your Plan

If you don’t take the opportunity to review your current plan and do nothing during the Open Enrollment Period, you won’t be able to change your plan. What this really means is that your health insurance might:

Not provide enough coverage for the following year, which will cost you money.
Have too much coverage that you don’t need, essentially leaving you to pay for insurance that you don’t need.
Be too expensive. If you don’t change your plan during the OEP, you’ll be stuck with the rise in rates and costs for the following year.

Options Are Limited Afterwards

If you don’t have health insurance and are looking to enroll in a plan, but you do nothing during the Open Enrollment Period, you won’t be able to get a Marketplace or exchange health insurance plan – in other words, you won’t be able to get an ACA-compliant health plan. With that being said, you do have other options even if you miss the OEP, but you should be aware that they are very limited. For example, you can opt to get a short-term health insurance plan that covers the essentials and nothing more; this type of insurance is temporary and not ideal for those who require more comprehensive coverage, or have health conditions. Short term plans are not guaranteed issue, meaning they do not cover pre-existing conditions.

You Will Need To Qualify For an SEP

The only way to get an affordable health insurance plan that is ACA-compliant outside of the OEP is to qualify for a Special Enrollment Period, or SEP. A Special Enrollment Period is only available to those who have a qualifying life event, including: movers with boxes and a truck and houses in the background

Change in residence (moving to a different zip code or county)
Change in household size (having a baby or adopting a child, getting married, or getting divorced)
Loss of health insurance (losing employment, turning 26 and getting kicked off of a parent’s plan, or a death in the family)
Changes in income

Don’t Do Nothing…

Compare plans! There’s no harm in comparing plans and seeing your options before the Open Enrollment Period ends. But we get that it can be a headache to try and research all the different plans around, so we’re here to help! Our highly trained agents will take the time to talk with you and thoroughly explain all of your options. Once you are ready to enroll, they will search through all the plans in your area and find the right plan for you, making sure the plan fits your needs and budget. EZ always provides you with your own personal agent, so there’s never any need to worry about bouncing around from agent to agent or getting hassled by endless sales calls. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

Health Insurance Open Enrollment FAQ

The Open Enrollment Period for health insurance is a very important time, when you can change or enroll in a health insurance plan for coverage beginning the following year. It runs from November 1 to December 15, and is the only time during the year when you can purchase a plan, unless you qualify for a Special Enrollment Period. To better prepare you for the Open Enrollment Period, including what to expect and how to find a great plan, we’ve answered some FAQ below.

When Is The Annual Open Enrollment Period?

calendar with the date on november 1 — *Health insurance Open Enrollment begins on November 1st every year.*

The Open Enrollment Period is the one time of the year that you can buy or change your health insurance; if you do not buy health insurance during the Open Enrollment Period, you will have to wait until the following year to do so, unless you experience a qualifying life event.

The Federal Open Enrollment Period starts on November 1st and ends December 15, which gives you just about six weeks to choose a health insurance plan and sign up for one. However, some states have permanently extended their Open Enrollment Period until January 15th or 31st, with coverage beginning February 1st.

Am I Eligible To Enroll In Marketplace Health Insurance?

To be eligible to enroll in ACA Marketplace health insurance, you must:

Be between the ages of 18 and 64
Live in the United States
Be a U.S. citizen
Not currently be incarcerated

envelope in a blue circle — Be sure to review the ANOC letter you will receive about your current plan’s coverage for next year.

What Changes Can I Make During Open Enrollment?

If you currently have a health insurance plan, you will receive an annual notice of change (ANOC) letter in the mail prior to Open Enrollment; you’ll need to carefully review this because there might be changes being made to the price or coverage of your plan. But if your plan is not changing and you are happy with it, you will be automatically re-enrolled for next year.

If you are unhappy with your health insurance plan, you can switch to a new one, but you will have to review all of the plans in your area, including new ones that might have been added. If you don’t review plans in your area during the Open Enrollment Period, you won’t know if there is a better plan for you; the best way to do this is by working with one of EZ’s licensed local agents, who can compare plans easily for you in minutes.

What If I Miss The Open Enrollment Period?

If you miss the Open Enrollment Period, your choices will be very limited until next year’s Open Enrollment Period, unless you qualify for a Special Enrollment Period. To qualify for a Special Enrollment Period (SEP), you’ll need to have experienced one of the following qualifying life events:

Getting married or divorced
Death of a spouse or policyholder
The birth or adoption of a child
Loss of health insurance coverage
Moving to a new area where the health plans are different from what you currently have

If you are looking for health insurance temporarily until the next Open Enrollment Period, you have the option of short-term health insurance, which will cover you for up to 36 months, but this type of plan has limited coverage.

Can I Afford Health Insurance?

The first thing you should do if you’re looking to save money is work with an agent who can compare plans for you and find one that fits your budget. Next, check to see if you qualify for subsidies, such as premium tax credits and cost-sharing subsidies. Premium subsidies are available in every state, and help make health insurance more affordable. Eligibility for subsidies is based on your household income; it’s definitely worth checking to see if you qualify, since President Biden recently extended premium subsidies to millions of Americans, making them easier to get, even for those with an income of 400% of the federal poverty level or higher.

How Do I Find A Plan?

If you have any further questions, or need help finding a plan during the Open Enrollment Period, an EZ agent can help you. We will provide you with a local licensed agent who will search all available plans in your area and find the best one for your medical and financial needs. We will also double check to see if you qualify for any subsidies to save you even more money. All of our services are done in minutes and at no cost to you. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local license agent call 888-350-1890.

Breaking Down Insurance Premium Costs

In order to keep your health insurance plan active, you need to pay an insurance premium every month. Premium prices depend on variables such as your age, the area where you live, and the amount of coverage you choose. But what actually happens to the money you give to your insurance company every month? How is it broken down and used?

Medical Expenses

Health insurance works on a risk-sharing model: insurance companies collect premiums from all of their customers so that they have enough money to pay any claims made. What they do with that money is regulated by the government. The 80/20 rule, also known as the medical loss ratio, is a law created by the Affordable Care Act that requires insurance companies to spend a set amount of the money they collect from customers on medical care. It was meant to make insurance more affordable for everyone, and encourage insurance companies to put more money towards improving care. According to the rule, 80% of each dollar you pay per month has to go towards healthcare costs and quality improvements. The other 20% can be used to cover the health insurance company’s administrative and marketing costs.

How Is Each Premium Dollar Broken Down?

The 80/20 rule requires insurance companies to spend at least 80% of the money they take from premiums on healthcare costs and quality improvement, and the other 20% can go towards administrative, overhead, and marketing costs. According to Healthcare.gov, the breakdown of the 80% and 20% is as follows:

The 80% is broken down per dollar in the following way:

hundred dollar bill broken down into pieces — *Insurance premiums are broken down by a 80/20 rule.*

21.5¢ for prescription drugs, which include outpatient, physician- and self-administered medications.
22.2¢ for inpatient hospital costs and emergency room costs.
19.8¢ for outpatient services, like ER care, labs, imaging clinics, physical therapy, urgent care, etc.
12.1¢ for doctor visits.
6¢ for other outpatient care.

The 20% is broken down per dollar in the following way:

17.8¢ for operating costs, including cost containment, taxes and business expenses, quality improvement, data analysis and other activities.
3¢ of every dollar is profit for the insurance company.

If your insurance company does not meet its 80/20 targets for the year, then you will get a rebate on some of the premium dollars that you paid.

Lowering Your Monthly Premiums

Insurance companies tend to raise their monthly premiums every year, which can become a bit too much sometimes. But there are ways to lower your premiums, such as choosing a high deductible plan with lower monthly rates. You can also come to EZ and let us help you find a new plan that can offer more coverage for less.

Don’t get stuck paying more money for the same amount of – or even less – coverage. EZ can help you find a plan with more coverage and flexibility for less money. We have highly trained, licensed agents who work with the top-rated insurance companies in the country. We have access to hundreds of plans that we can compare for you in minutes. Let us do the hard work for you and save you money. There is no obligation, just free quotes. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with one of our agents, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: Employer Checklist for Open Enrollment

Open Enrollment for health insurance has begun. This period gives employers and employees the opportunity to change their benefit options, and many companies use this time to review their employees’ health insurance plans to see if they can find ways to save money or improve coverage. The opportunity for business owners to save money during Open Enrollment is especially important this year because the coronavirus has hit many companies hard financially. Now is the time to speak to an EZ agent to see if you should renew your current plan or switch to a more affordable plan that offers just as many benefits.

As you review your options, you also have to be aware of any legal changes affecting the design and administration of your current plan or any other plan you choose. Go through the following checklist, share it with your employees, and use it to help you choose your plan for the coming year.

change written on many freen arrow signs pointing in different directions. — *Healthcare plans change every year, including the price and coverage, so you need to be aware to be better prepared.*

Plan Design Changes

Healthcare plans and the rules surrounding them change every year. The cost of your plan may go up, so you need to be aware of changes to your costs. But you also need to be aware of changes to certain limits in your plan. Some changes to know for 2021 include:

Affordable Care Act (ACA) affordability standard– The affordability percentage for 2021 is 9.83%. Employer-sponsored coverage for next year’s plan will be considered affordable under the employer shared responsibility rule if the employee’s required contribution for self-only coverage does not exceed 9.83% of the employee’s household income for the tax year.
Out-of-pocket maximum– The annual out-of-pocket maximum limit for 2021 is $8,550 for self-only coverage and $17,100 for family coverage.
FSA contribution limit: This has not been announced yet, so watch for IRS guidance on the FSA contribution limit for the 2021 plan year.
High deductible health plan (HDHP) and health savings account (HSA) rules for 2021:
- HSA contribution limits: $3,600 for individuals and $7,200 for families
- HDHP minimum deductible: $1,400 for individuals and $2,800 for families
- HDHP out-of-pocket-maximum: $7,000 for individuals and $14,000 for families

Make sure to confirm that your plan’s out-of-pocket maximum complies with the ACA’s limits for next year. If you offer a HDHP, make sure that the plan’s deductible and out-of-pocket maximum are also in compliance with next year’s rules. Remember to communicate these changes to your employees.

Notices To Pass On To Employees

You should provide certain benefits notices to your employees during the Open Enrollment Period. Benefit notices that you should review and provide to your employees include:

Summary of Benefits and Coverage– The ACA requires healthcare plans and health insurance issuers to provide a summary of benefits and coverage to enrollees. This has to be given to your employees who enroll or re-enroll during Open Enrollment.
Summary Plan Description (SPD)– Plan administrators have to provide a SPD to new participants within 90 days after plan coverage begins. In addition, any changes that are made to the plan should be communicated to employees in an updated SPD booklet.
COBRA General Notice– Group health plan administrators have to provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. It can be included in the SPD.
Grandfathered Plan Notice– If you have a grandfathered plan, then make sure that you provide any information about the plan’s status and any changes to the plan.
Children’s Health Insurance Program (CHIP) Notice– Group health plans that cover residents in a state that provides assistance subsidies under a Medicaid plan or CHIP have to send an annual notice about the available assistance to all employees residing in that state.
Notice of Patient Protections– This notice needs to be provided if you are offering non-grandfathered group health plans that require designation of a participating primary care provider. If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice.
Individual coverage HRA (ICHRA)– This applies to employers who sponsor ICHRAs for specific classes of employees, or all employees. You must provide the written notice to each participant at least 90 days before the beginning of each plan year.
HIPAA Privacy Notice– Employers with self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Wellness Program Notices- There are 2 notices that you will need to provide employees if you offer a workplace wellness program:
- HIPAA Wellness Program Notice– HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards.
- Americans with Disabilities Act (ADA) Wellness Program Notice– Employers with 15 or more employees are subject to the ADA. Wellness programs that include health-related questions or medical exams must comply with the ADA’s requirements, including an employee notice requirement.

shopping cart with money held in a paperclip inside of it. — *Comparing plans with an EZ agent can help you save hundreds of dollars a year!*

Finding An Affordable Plan

Whether you are considering renewing your current group plan, or finding a new plan or insurance company to work with, you will have to do some researching and comparing. There are hundreds of group insurance plans to compare in order to find the one that best suits you and your employees. By combing through these plans, you will be able to save hundreds, and maybe even thousands of dollars a year! The first step in figuring out what kind of plan to look for is to conduct an employee health survey.

Next, you should speak to an EZ agent. It can be time consuming to sit down and compare plans, and with Open Enrollment coming to an end soon, the whole process can become overwhelming. Running a business means that you have a lot on your plate, so let EZ.Insure do all the work for you. You can speak to one of our agents free of charge. They will ask you questions regarding your budget and employees, and will then begin comparing quotes. EZ will present you with the best option that will offer the most benefits and savings. To get instant quotes, simply enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-998-2027.

How Much Should You Be Contributing To A Health Savings Account (HSA)?

How much money have you put into your health savings account recently? If the answer is “not much,” then you should put contributing to it at the top of your to-do list. As long as you are enrolled in a high-deductible health plan, you can put aside money on a pre-tax basis into your health savings account, or HSA, and withdraw these funds (also tax-free) to cover current and future medical expenses. The money you save also accrues tax-free interest! So the question isn’t should you be contributing to your HSA, the question is only how much.

First, You Must Qualify For An HSA

piece of paper with checklist checked off and a blue pen on the clipboard — *In order to utilize savings for an HSA, you have to be eligible.*

Not everyone qualifies for an HSA, so in order to be eligible for one, you must:

Be covered under a qualified high-deductible health plan (HDHP). For 2020, a HDHP is a health insurance plan with a deductible of at least $1,400 for self-only coverage or $2,800 for family coverage.
Have a HDHP which meets the minimum deductible and the maximum out of pocket threshold for the year. For 2020, the out-of-pocket maximum for an HSA-qualified health plan cannot be more than $6,900 for self-only coverage or $13,800 for family coverage.
Not be covered by any other medical plan.
Not be enrolled in Medicare
Not be claimed as a dependent on someone else’s tax return
Not be enrolled in TRICARE or covered by medical benefits from the Veterans Administration

Max Out Your Contributions

The IRS places a limit on how much you can contribute to your HSA each year. In 2020, as an individual, you can put in up to $3,550, and if you have a family, you can contribute up to $7,100. If you can, you should try to max out your contribution to your HSA. The more you contribute, the more you can benefit from your HSA’s triple tax advantages:

3 full jars of coins — *If you can, max out your yearly contributions.*

Pre-tax contributions
Tax-free earnings
Tax-free withdrawals

If you’re worried about contributing too much money to your HSA, and not using up all of the funds, you should know that whatever money you do not use at the end of the year rolls over to the next year and keeps growing. In addition, any interest earned from these investments is completely tax-free, so it makes sense to contribute as much as you can. But if you cannot afford to max out your HSA you can still reap the benefits.

If You Can’t Max Out…

When it is time to decide your yearly contribution, you have to take into account how much you think you will spend on medical expenses for the year. Consider that you are responsible for paying your deductible and other out-of-pocket expenses, so try to put as much of these costs as you can into your HSA.

For example, if you have a set deductible, put that amount into your HSA. Or, if you have prescriptions that you need to purchase on a monthly basis that cost $200, contribute $2,400 (a year’s cost of the medication) into your account. That way you can enjoy the tax advantages on the money that you need to spend on that prescription drug anyway.

Consider Your Age

While you should always consider putting as much money into your HSA as you can, it may not be as important to max out your contributions if you are young and healthy. In this case, you will have fewer health care expenses than someone who is older or who has a chronic condition. But when you’re approaching retirement age, the likelihood that you will need more money for medical costs is greater. It makes more sense in this case to put as much money as you can into your HSA so that you can build interest on it, and use it tax-free for your out-of-pocket medical expenses. Taking advantage of your HSA is another way to help save your money, as well as to have spending money for any medical costs that may come up throughout the year.

If you are enrolled in a high-deductible health insurance plan, you should absolutely be utilizing your HSA. Not only are you putting money into an account that accumulates interest, but you will also be able to use it without paying taxes on it. And, because accidents or medical emergencies can happen, having a health savings account is important for helping you prepare for the unexpected.

Have questions? Need some guidance? We can help! EZ.Insure understands that insurance can be confusing, but we can go over any questions that you have and help you make an informed decision. We will go over how it all works, let you know what plans are available in your region, and offer help on how much you should contribute to your HSA if you have a high-deductible plan. And we offer all of our services for free! To view our accurate quotes within minutes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Tag: Health Insurance