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All about the premiums.

^C352FB1508D39544E0FD010C25C3E4ECA344BCF96A986AC632^pimgpsh_fullsize_distrIn the past, getting health insurance meant being put through the ringer. You would have to answer an endless stream of questions about your health. Depending on your answers, you could be denied insurance or subject to higher premiums. With the changes introduced in the Affordable Care Act, myriads of health questions and pre-existing conditions are no longer a threat to those seeking health coverage. Your coverage is based solely on the four items listed below.

Individual health insurance eligibility is based on:

  • Where you live
  • Income
  • Age
  • Whether or not you use tobacco products

After considering those four criteria, that’s it. Coverage is guaranteed. You cannot be declined or charged more based on a health condition like in the past, and determining the monthly cost of your insurance plan depends on your needs.

The most important thing to note from the above criteria is that your premium will be partially based on your household income. Those who meet certain criteria may not be aware of ways to save money on their health insurance. Individuals at or below 400% the federal poverty level or who do not have access to a group health insurance plan through an employer are eligible for a Premium Tax Credit. With this tax credit you will receive money to help you pay the premiums for your health insurance. In many cases, these federal tax credits are enough to cover the entire cost of some plans and significantly reduce others.

Do you know if you’re eligible for a federal tax credit? Do you have questions about how your premiums are being calculated? Crosspointe Insurance Advisors will work with you to determine which insurance program fits your needs, while guaranteeing the best price possible. Give us a call today or request for a quote to find the tax credits you are eligible for, and the policy that fits your lifestyle and budget.

So, do I really need health coverage?

In the past buying your own health insurance was difficult. Those looking to get covered would have to answer questions about their age, height, weight, mediations, health history and then at the end of a long underwriting process, premiums would be increased based on these factors or, in some cases, people would be denied coverage all together.

Millions of Americans continue to go without health insurance, hoping they won’t get sick or have an accident. Sure, if you do have a medical emergency, you can go to the emergency room without health insurance and you will be treated. However, you will be expected to cover the entire cost of your treatment yourself.

As you may know, the Affordable Care Act (ACA) has a law in place (often referred to as the Individual Mandate) that now makes enrollment into a “qualified health plan” a requirement.

If you didn’t have coverage in 2014, you’ll have to pay one of these two penalties when you file your 2014 federal tax return:

  • 1% of your yearly household income.
  • $95 per adult and $47.50 per child (under 18).The maximum penalty per family using this method is $285.

Despite the debate, the Affordable Care Act can make getting health insurance easier and more affordable for many Americans. There are two man reasons.

  1. Coverage Is Guaranteed!

Along with the requirement for everyone to enroll in health coverage, the Affordable Care Act also changes the way individuals and families qualify for health insurance. Starting in January of 2014, individual and family health plans were guaranteed issue without underwriting. That’s right! Insurance companies can’t base your premium costs on your health history. The only factors they can use are: age, tobacco use and factors for the area in which you live.

  1. Premium Tax Credits

If you’re an individual or family without access to employer sponsored health insurance, there’s a new tax credit available to that can reduce your monthly premium AND potential reduce your deductibles and copayments on your qualified health plan. To be eligible for the premium tax credit, you’ll need to meet these 5 requirements.

  • Your household income is 100 to 400 percent above the Federal Poverty Level (chart below).Most people in this range will be eligible, but not everyone. We can help you determine eligibility, just request a free quote!
  • Your employer doesn’t offer health insurance that pays for at least 60% of your benefits and costs you less than 9.5% of your income.
  • You are not able to use other government health programs, such as Medicaid or Medicare.
  • You file a joint return if you’re married.
  • Another person does not claim you as a dependent.

 Household Size

 100%

 133%

 150%

200%

250%

 300%

400%

 1

$11,670

$15,521

$17,505

$23,340

$29,175

$35,010

$46,680

 2

15,730

 20,921

23,595

  31,460

39,325

47,190

62,920

 3

19,790

 26,321

29,685

  39,580

49,475

59,370

79,160

 4

23,850

 31,721

35,775

  47,700

59,625

71,550

95,400

 5

27,910

 37,120

41,865

  55,820

69,775

83,730

111,640

 6

31,970

 42,520

47,955

  63,940

79,925

95,910

127,880

 7

36,030

 47,920

54,045

  72,060

90,075

108,090

144,120

 8

40,090

 53,320

60,135

  80,180

100,225

120,270

160,360

Chart c/o http://familiesusa.org/product/federal-poverty-guidelines. Source: Calculations by Families USA based on data from the U.S. Department of Health and Human Services.
*If you find your income outside of the above chart there are many options for health coverage but you just won’t qualify for the premium tax credits. The guarantee issue laws still apply and you will have access to purchase plans on or off the marketplace in your state.

Now that you know a little more about ACA and some ways it can help your family, knowing when and how to enroll can be tricky. Most people will enroll in a new 2015 health plan during the Open Enrollment Period starting November 15th, 2014 and ending February 15th, 2015. If you miss the enrollment period, you may not be eligible to enroll again for a while.

You can apply for coverage outside of open enrollment periods due to: getting married, having a baby, a loss of coverage, moving from one state to another, adoption, divorce, a significant change in income and a few other reasons. All of these situations are called Qualifying Life Events. Typically–you only have 60 days to make a change or enroll in a plan due to a Qualifying Life Event.
Have you decided to get covered but aren’t sure how to find a plan? That is where Crosspointe Insurance Advisors can help. Our advisors are here to work with and for you to determine the insurance program that best fits your needs. The consultation and great advice come at no cost to you. Give us a call today at 888.788.1565 or request a quote online and we’ll find the best plan for you!

 

How are health insurance premiums calculated?

Q4: How are your premiums calculated?

A: In the past, it was necessary for you to answer questions about your health and everything from family history, lifestyle, jobs you’ve had, to the kitchen sink! With the new laws and ACA, premiums are calculated based on: Age, where you live, smoker or not, and household income. If your household income is at or below four times the federal poverty level, ($46,680 for a household of one, $62,920 for a household of two, $95,400 for a household of four, etc.) the cost of your plan will be reduced to make it more affordable. You also won’t have to worry about seeing your rates increase or being denied coverage based on a preexisting health condition. You cannot be turned down or charged more. Only the above four factors apply.

Why do I need a health insurance broker?

Q3: Why do I need a health insurance broker to help me with my insurance policy?

A: The internet puts a lot of information and several choices at your finger tips. With health insurance, where the stakes are higher and legislative complexities abound, it can be very difficult for consumers to sort out the best option on their own. The new health care laws impact how tax credits work and without the help of an agent, it can be hard to figure out how to use them to your advantage. Crosspointe makes the process of finding the right insurance plan simple and guides you through the entire enrollment process. Purchasing a plan with the aid of an advisor has NO ADDITIONAL COST, so there’s no reason not to consult an expert.

If you’re not ready, if you haven’t read all the fine print, you could miss something important. Having an insurance broker, knowledgeable in all aspects of insurance, makes it easier for you to find the plan that perfectly fits your lifestyle. We help you by building a plan tailored to your life, your needs.

Medicare Enrollment: 3 Things You Need to Know

Medicare Enrollment and Social Security Navigating the Medicare program can be confusing. If you’re like most people, reading the fine print is not how you’d like to spend your time. Medicare is the federal health insurance program available to individuals 65 and older and covers more than 40 million Americans. Medicare is also available for younger individuals with disabilities recognized by the Social Security Administration and for individuals with certain types of kidney failure, namely End-Stage Renal Disease (ESRD). Although Medicare covers millions of Americans—the majority of eligible individuals have additional plans to help improve their health coverage under Medicare.

Working with an agent from Crosspointe will make the process easy and ensure you get the additional coverage you or your Medicare-qualified loved one needs.

Understanding Medicare

There are two main parts of Medicare: the first (Medicare Part A) covers inpatient hospital stays and the second (Medicare Part B) covers a host of medical services outside of the hospital.

Some examples of covered services would be:

  • Part A: inpatient hospital visits, hospice care, Skilled Nursing Care, and some home health care benefits
  • Part B: outpatient care, some medical equipment and preventive services, primary doctor visits and specialist outpatient services etc.

In addition to Medicare, there are two types of plans to help improve your Medicare benefits.

Option 1: Traditional Medicare Supplement

With this option, Medicare will remain your primary coverage and you will have an additional plan option to help pay for your deductibles and co-insurance not covered by Medicare. Some of the more popular Medicare supplement plans are: Plan F, Plan G and Plan N. If you’re 65 years old, these supplement plans can start out around $80 to $100 monthly depending upon the plan and state where you live.

At Crosspointe Insurance, we have access to the most reputable and competitive insurance carriers that offer Medicare supplement plans in Indiana, Kentucky, Ohio, Illinois, Missouri, Michigan, and Tennessee. If you’re interested in a quote for a Medicare Supplement complete our online request form and you’ll be connected with one of our experts.

Option 2: Medicare Advantage (Part C)

Medicare Advantage Plans (Part C) are plans provided through private organizations approved by Medicare. With this type of coverage, the private insurance company becomes the primary insurance provider. Medicare passes the responsibility to manage your health care needs to the insurance company. This means that an Advantage Plan can be crafted to meet your needs and provide coverage with the government helping to reduce the premium costs. Medicare Advantage plans typically cost less per month that a traditional supplement, but you have co-pays and cost sharing when you use your plan.

It is important to note that if you’re already covered by Medicare you can review and enroll in Medicare Advantage plans each year during the Annual Enrollment Period (November 15th through December 7th). Connect with us to review your plan options during this year’s enrollment period.

Now that you know about some options to consider regarding, Medicare, what are the key things to know?

3 Key Things to Know about Medicare

  1. Let Us Help Determine Your Needs. Each Medicare option, parts A, B, and C, contains different solutions. Combining the Medicare plans with the right additional coverage will allow you to ensure you aren’t missing out on coverage you need. We can help you determine which plan elements you need and find providers that meet your health and budget requirements, contact us to get help!
  2. Enroll Sooner Than Later. Most people join Medicare at age 65. If you’re approaching age 65 or retirement, let us help you start the enrollment process. Even if you’re already covered by Medicare and enrolled in another plan option – it never hurts to review. We suggest reviewing your coverage every year.
  3. Understand Your Coverage. Are there any deductibles for your coverage? When it comes to medication, how much will you have to pay? Can you see a specialist? What is the most you could pay out-of-pocket for a major medical condition or treatment? Every situation is different but after speaking with one of our experts, you’ll be able to answer each one of these questions with confidence.

How much does it cost to work with an agent at Crosspointe Insurance? $0.

Yes, that’s right! You can pursue a plan on your own or allow us to make the process easier, and have the experience of a team of insurance experts on your side with no additional cost.

Give us a call at 888.788.1565 today or submit a request for a quote online.

Reference Information:

Affordable Care Act and Small Businesses

Q2: How does the Patient Care and Affordable Care Act (ACA) impact small businesses?

A: In 2015, businesses with 50 or more employees will be required to offer health insurance, but less than 50 holds no similar obligations. Many small businesses (less than 50 employees) find that health insurance is their largest expenditure second to payroll. By offering their employees a group insurance plan, they may be preventing them from taking advantage of premium tax credits, only offered to those who do not receive health benefits with their job and meet certain guidelines on household income. Both employers and employees may benefit from individual insurance plans.

For more information about the Affordable Care Act and your small business, contact Crosspointe Insurance Advisors.

Why do I need an Insurance Broker?

Shopping for health insurance can be frustrating.  If you’re like most people, reading the fine print is not your idea of fun.  However, when it comes to finding a health insurance plan you shouldn’t pass over those important details.  Working with an agent from Crosspointe will make the process easy.  We understand that every situation is different and there’s not one plan that will work for everyone.

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If you work with an agent from Crosspointe, they will…

1. Find out if you’re subsidy eligible: The Affordable Care Act changed everything about insurance. Yes, coverage is guaranteed and the insurance companies won’t ask about your pre-existing conditions BUT arguably the most important and most impactful part of the new law is the federal subsidies made available to individuals and families within 400% of the Federal Poverty Level.

For example, a family of four in Indiana with a household income of $50,000 could qualify for more than $514 a month in subsidies to reduce the cost of their health plan. This same family could enroll in a Bronze plan for $96 per month or a Silver plan for $247 per month.

By not understanding how these subsidies work, many Americans missed out on subsidies to help reduce their health insurance costs in 2014. Our agents are licensed by each state and certified to help you navigate the new laws. Contact us to find out if you’re subsidy eligible.

2. Help you compare plans and enroll in coverage: Not sure if you should you enroll in a health maintenance organization (HMO) or preferred provider organization (PPO)?  Maybe you’re not even sure what those terms mean.  That’s OK!  It’s our job to ask you questions and help you enroll in the right plan.  Need to know if your doctors and prescriptions are covered. We’ll do that, too.  As an independent broker we work with all the top carriers in each state to determine which plans work best for your lifestyle.

3. Make sure you understand your coverage: Do you know what you’re going to pay for your medication? When you visit a specialist? What the most you could pay out-of-pocket for a major medical condition is?  When you’re finished speaking with one of our experts, you’ll be able to answer each one of these questions with confidence. At Crosspointe, we want each of our clients to be educated consumers about insurance.

I’m sure by now you’re wondering what working with Crosspointe Insurance will cost you. Crosspointe Insurance Advisors work at the low rate of $0 an hour. Yes, you read that right—$0.

Whether you buy a plan on your own or allow us to facilitate the process, you’ll pay the same premium cost for your health plan. All our fees are included in that premium by the carrier to help them manage your health plan throughout the year, so you owe us $0 for our consultation.

The 2015 Enrollment Period is fast approaching and finding the right health insurance is tough. Crosspointe Insurance Advisors will work with you to determine which program fits your needs, while keeping it affordable for you. Give us a call at 888.788.1565 today or submit a request for a quote online.  Don’t wait for the deadline to act!

Are you concerned about how the new laws impact your business?  Read our recent post on how the Affordable Care Act impacts Group Health Plans.

 

A Better Way for Employers to Offer Health Coverage

Second only to payroll expenses, the largest expense for most employers who offer benefits is their group health insurance plan. It is important for employers to offer health coverage and remain competitive to attract the talent they need, but this cost has grown to an unsustainable level.

Fortunately, there is a solution.  The Affordable Care Act changed many things in the health insurance industry and if your business is still offering health insurance the same way it did in 2013, money is being left on both sides of the table.

Read on to learn more about how to reduce health insurance costs.

What exactly is group health insurance coverage?

Group health insurance is an employer-sponsored plan typically offered to full-time employees who have been with the company for at least 90 days.  The employer selects the benefits and other plan details of the group plan, and options are often limited to one or two plans for the employee to choose.  By law, the employer must pay a minimum of 50% toward the cost of the employee-only premium. But, there is a problem with group health insurance.

The odds are stacked squarely against an employer trying to select the elusive “one-size-fits-all” health plan for their employees.  Granted, years ago the process was easier because costs allowed the employer to choose a plan with great benefits at a reasonable price. Those days are gone.

Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage, 2003-2013.

Average Annual Health Insurance Premiums and Worker Contributions for Family Coverage, 2003-2013.

With plan benefits getting worse, an increasing amount of the cost has been passed on to employees as companies struggle to remain profitable.  Not to mention, when it comes to health insurance there truly is no such thing as a “one-size-fits-all” plan.

What is the solution?

Individual health insurance plans have been less expensive than group plans for decades.  However, a primary challenge for individuals who shopped for their own coverage was qualifying based on health.  In the past, applying for an individual health insurance plan included a myriad of health questions that could yield a higher rate or a denial for coverage altogether.

The Affordable Care Act eliminated this obstacle.  In addition, individuals and families may qualify for federal tax credits further reducing their health insurance costs if they meet a few requirements including:

  • No access to a group health insurance plan through an employer.
  • Household income at or below 400% of the Federal Poverty level.

In many cases, the federal tax credits available are sufficient to cover the entire cost of some plans and reduce other options down to only a few hundred dollars a month.

 An employer-sponsored group plan is not only costing a fortune for the employer, it places an incredible and unnecessary burden on the employee who needs affordable coverage for their family. Now that one’s health status is no longer cause for being denied for health coverage, individual coverage could be the best option for your business.

Finding the right insurance for your business is tricky.  Crosspointe Insurance Advisors will work with you to determine which program fits your needs, while keeping it affordable for you. Give us a call today or submit a request for a quote to find the best coverage for your business.

 

Q: So What’s the Truth, Can I Keep My Current Health Coverage or Not?

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Q: So what’s the truth, can I keep my current health coverage or not?

A: Well, there’s a very technical term we use in the insurance industry as a response to this question … “kinda sorta.”  All kidding aside, there has been a lot of mention in the media over the past week about people receiving letters from their insurance carrier notifying them their coverage is ending.

In some cases you can take this at face value.  There are carriers who have decided not to offer plans that comply with the new Affordable Care Act guidelines.  In this case, you will be forced to make a change in your coverage and timing is everything.  If you determine you are not subsidy eligible (you can read more about that here), it is important to change to a new plan before January 1st, 2014.  If you are going to be eligible for a federal tax credit subsidy, you’ll likely wait to start your coverage until January 1st to capture the additional savings.

The carriers that are not offering ACA compliant plans in 2014 are in the minority.  In most cases, you will have the option to elect an early renewal for your current plan which will extend the ability to keep your current coverage in place through the end of 2014. For individuals and families who are not subsidy eligible due to income or access to coverage through their employer, this will likely be the preferred option.  This is because new ACA compliant plans will be significantly more expensive than current costs. Unfortunately, we can only delay the inevitable rather than avoid it entirely. Everyone will be forced to change to an ACA compliant health plan in 2015, but we are optimistic there will be some legislative fixes to provide relief by then.

Decisions like these are complicated and the stakes are VERY high to make the right call.  We specialize in helping you put the right strategy in place and keeping the process simple.  Don’t fight through the headaches of Healthcare.gov and the state marketplaces, we can do it for you quickly and easily … and we don’t cost you a dime.

Health Insurance – What to do now?

As we’re sure you’re aware, the Federal Marketplace Website has been having significant issues not allowing people to view quotes and enroll in coverage as advertised.  Hopefully, it will be fixed in the next month, but there’s plenty of work to do now.

At a very basic level, the law can be boiled down to two main changes:  

  • Your eligibility for coverage and rate you pay will no longer be determined based on your health.  All plans will be “community rated” and priced according to the following three factors: Age, Area of Residence, and Tobacco Use
  • If your 2014 household income is below 400% of the Federal Poverty Level and you do not have health coverage available through your employer, you will likely be eligible for a federal tax credit subsidy to offset some or all of the cost for your plan. The following graph illustrates where the household incomes fall based on household size (up the left) and percentage of the federal poverty level (across the top).

Chart

If you are subsidy eligible, we can help you enroll in a plan that takes full advantage of the federal subsidies available to you once the marketplaces are operational.  If you decide on a plan and are able to start and application on your own, you’ll find my broker information below.  It doesn’t cost you anything to add an agent to your policy, but will be very valuable in helping you navigate questions, coverage issues, etc.

If you determine from above that you and your family are NOT subsidy eligible, YOU SHOULD NOT use the marketplace website.  There are likely better options available for you outside of this marketplace.  Many major insurance carriers have opted not to participate in the marketplace and you will not see those options available if you search there exclusively.

You have until December 15th, 2013 to make the right decision.  If you don’t have the right information you could end up paying thousands more for your coverage.  That’s where we come along side and advise you on the best strategy for your situation … and our compensation comes directly from the carrier at no cost to you.

If you decide to start a new application on healthcare.gov or kyenroll.ky.gov (in Kentucky) without me, please add my information on the page that asks, “Tell us if you’re getting help from one of these people.”  Select “Agent or Broker” and fill in all four of the applicable following fields:

  • First Name: Joshua
  • Last Name: Mushlock
  • FFM User ID: jmushlock
  • NPN Number: 8181538

 

Actively working for you,

Josh Mushlock

Co-Founder, Crosspointe Insurance Advisors