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Questions about COBRA insurance or losing your employer provided insurance? [Return to the top]

COBRA is a federal law that may let you pay to keep you and your family on your employee health insurance for a limited time (usually 18 months) after your employment ends or you otherwise lose coverage. If you lose your job and with it your job-based health insurance coverage, you may have the option of keeping your health insurance for a limited time through COBRA continuation coverage or you may buy an individual plan through the Marketplace.
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What is the Affordable Care Act? [Return to the top]

The Affordable Care Act, is a federal law that passed in 2010 which makes sweeping changes to the health insurance industry. Some of the major changes include:

  1. Creation of a Health Insurance Marketplace
  2. Consumers can shop and compare health plans through the Health Insurance Marketplace. Consumers may be eligible for tax credits to help pay parts of their health insurance premium if they purchase a plan on the Marketplace.

  3. Expansion of Medicaid
  4. In some states, Medicaid will expand to cover people whose household income is below 138% of the Federal Poverty Line.

  5. Requirement to have Health Insurance
  6. The Affordable Care Act requires nearly all Americans to purchase and maintain minimum essential health insurance coverage or pay a penalty when filing their federal income tax returns.

Who is required to buy health insurance?

As of January 1, 2014, most U.S. citizens and legal residents will need to have minimum essential coverage in order to avoid the tax penalty. If you have insurance through your employer or through a government sponsored program like Medicare or Medicaid, then you may not need to purchase coverage through the Marketplace.

If you are currently uninsured or are losing your current coverage, then you may benefit from shopping on the Marketplace. There may be government assistance available for you to lower your premiums and out-of-pocket costs.

Who is eligible for premium and other financial assistance?

You may be eligible for premium tax credits on the Marketplace if you meet the following criteria:

  1. You are not eligible for any “affordable” employer sponsored coverage, Medicare, or Medicaid
  2. You have an annual household income between 100%-400% of the Federal Poverty Line
  3. You file federal income taxes
  4. You qualify for coverage in a Qualified Health Plan (QHP) on the Marketplace
  5. 2016 Poverty Chart

If you select a Silver Level QHP then you may also be eligible for cost-sharing reductions which can lower your out-of-pocket costs. See more about the Metal Levels below.

Where can I purchase health insurance?

People can go on the health insurance marketplace to view their health insurance options. Some states created their own marketplace, while other states are relying on the federal government’s marketplace.

PHIS.com (www.PHIS.com) can connect you to health plans available both on and off the health insurance marketplace. Our agency has licensed and certified representatives who can help you select the best plan for you and any of your family members.

To quote plans, click here

To speak with an enrollment representative, call 1 (800) 342-0631.

What types of plans are available on the Marketplace?

The Marketplace has both individual and small group plans. Each individual plan is associated with a metal tier based on its actuarial value. The Actuarial Value level can help you estimate how much you will pay after you pay your premiums.

METAL LEVEL AVG. AMT. PLAN COVERS AVG. AMT. YOU COVER
PLATINUM 90% 10%
GOLD 80% 20%
SILVER 70% 30%
BRONZE 60% 40%

Can insurance companies charge extra premium based on previous treatment for health conditions?

No! Beginning January 1, 2014, individual and small group health plans can no longer charge additional premium based on pre-existing conditions or gender. They can, however, change your premiums based on your age, whether or not you use tobacco, and your geographic region.

What else has changed for health insurance?

In the individual and small group markets, non-grandfathered health insurance plans will have to cover Essential Health Benefits. These include:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization
  • Rehabilitation
  • Maternity Care
  • Mental Health and Substance Abuse Treatment
  • Prescription Drugs
  • Laboratory Services
  • Preventive Services
  • Pediatric Dental and Vision coverage

Who qualifies for Medicare? [Return to the top]

Medicare Hospital Insurance (Part A), as well as Medicare Supplementary Medical Insurance (Part B) is available to three basic groups of "insured" individuals: those over the age of 65, the disabled, and those with End-Stage Renal Disease (ESRD).

Who qualifies for Medicare Part C (Medicare Advantage plan)?

Individuals with Part A and eligible for Part B either through age or Disability can typically qualify for Medicare Part C (Medicare Advantage).

Can I qualify for Medicare if I am under age 65, but on Disability?

Yes, a person on Disability becomes eligible for Medicare in their 25th Month of Disability regardless of their age.

Can I purchase a Medicare Advantage plan with Drug coverage and a stand-alone Drug plan?

No. If you have a Medicare Advantage plan and enroll in a stand-alone Prescription Drug plan it will dis-enroll you from your Medicare Advantage plan. The only exception to this rule is if you have a Private Fee for Service Medicare Advantage plan without prescription coverage.

I am on Medicare and I am a Veteran. My neighbor said I had to buy a Part D prescription drug plan or I would have a penalty, is this true?

No. If you are a Veteran, you can use your VA benefits and you will not be penalized because the formulary is equivalent to the standard.

I am a healthy senior and I don’t take Medicine. Why should I purchase a Part D prescription Plan?

The Centers for Medicare and Medicaid Services are depending on all Medicare-eligible people to have a prescription plan to ensure the program works. If you do not purchase a Part D plan, you will have a penalty of 1% of the average drug plan cost. This penalty is cumulative and does not go away. The best solution is to purchase a low cost Prescription drug plan to avoid a penalty.

Do you want help shopping for insurance?[Return to the top]

Preferred Health Insurance Solutions (PHIS.com) is an enrollment firm that can provide valuable assistance to help you shop for the following products:

  • Major Medical insurance coverage
  • Short Term Major Medical insurance coverage
  • Medicare Supplement products
  • Ancillary Products such as Critical Illness, Cancer, Disability Plans, and More

Call 1 (800) 342-0631 or email info@PreferredHealthInsuranceSolutions.com so we can help you find the plan that best fits your needs today!

Why work with an Agent?

Shopping for health insurance is difficult. PHIS.com has agents and Customer Service Representatives who are specially trained to make your health insurance enrollment experience easier. We can:

  • Help determine your eligibility for premium assistance & calculate your premium tax credit
  • Shop plan options to find the best plan coverage and insurance company for you
  • Walk you through the enrollment process for the health plan you select

If you would like a representative to call you with plan quotes, please click here and fill out the form.

The information contained on this page is meant to provide general information regarding certain parts of the Affordable Care Act and should not be construed as legal or tax advice. Federal and state regulations are subject to change and individuals should seek counsel regarding specific legal or tax issues