Author: Sherie Bryan

BCBS NC is about to announce that all BCBS NC subscribers who buy their own insurance through the ACA Marketplace are going to be moved in to one of only two (2) LIMITED access networks for 2016.

There will now be only two (2) choices for BCBS members in the Triangle. Blue Local (Duke/Wake Med) or Blue Value (UNC/Rex/Wake Med) with Blue Value being more expensive. There are limited doctors in each of these plans. Many independent doctors will no longer be in either network.  If you choose to go to a non network doctor, you will pay out of network prices. Additionally with this big network change is also coming a big premium increase.

There are two other options in the Triangle. United Healthcare and Aetna/Coventry. We are anticipating both to be at lower premiums. Definitely a year to rethink all your options!

There is also no longer across NC “in network coverage” except in an “emergency” . What that is, is not yet defined clearly. United is in 100 counties and Coventry is also restricted but they have an equivalent network to Blue Local at anticipated lower premiums.

This is the year, you want to work with an Independent local agent to really understand all the new changes and make the best possible choice for you and your family.

 

 

 

The annual open enrollment period for all individuals who buy their own health insurance and are under 65, opens on November 1st. It will remain open from November 1, 2015 until January 31, 2016. This is the only time you can purchase individual health insurance for 2016 or renew or change your existing plan for 2016. Outside of this enrollment window, you must have a special circumstance to enroll.

We are expecting big changes this year from some companies especially in the Triangle. BCBSNC has requested almost a 40% price increase. They are also forcing all Marketplace clients in to one of two restricted networks with no more out of area coverage except for emergencies in NC. We are still waiting for full details as to exactly what these plans will actually look like.

United and Coventry/Aetna are also still on the marketplace. Both requested much smaller price increases for 2016. This may be a year where many families will be open to alternative coverage to dodge the large premium increase.

Remember an independent agent like us are free to use. We can help you whether you are new to enrolling or looking for renewal options. The price is the price for all plans set by the NC Dept of Insurance. We can help you evaluate all three options and truly come up with the best fit for your family.

With the advent of the Affordable Care Marketplace in the last two years, some significant changes are happening for small business in 2015 in regards to health insurance for employees. What is still true is employees expect to get affordable health insurance through their employers despite the rapid increase in pricing to employers especially small business’. What are options for small business to cope with this trend?

Individual health insurance costs through the ACA marketplace are as much as 20% to 60% less expensive for the individual employee. They get more choice in plans and it is their insurance. Can a group of less than 50 employees drop group insurance and move their employees to the ACA Marketplace. Absolutely, any time!

You can replace high group rates for controllable employee reimbursement plans. I can help you set this up and manage your plan. It is often a big win win for both you and your employees. I would be happy to tell you all about this exciting option.

 

 

 

 

 

Here’s a great recap courtesy of Kaiser News By Michelle Andrews  updated March 3, 2015

If you’re uninsured, you may have questions about possible penalties for not having coverage. The fine may be bigger than you expect. Here are the details:

Is everyone required to have health insurance or pay a fine?
Continue reading “Understanding the Tax Penalty for Not Having Health Insurance”

If you were one of the 50,000 people who were sent incorrect 1095-a forms this year, there is some good news.

The agency says it won’t collect any additional taxes from the around 50,000 people filed their tax returns using the incorrect data on their 1095-A forms.

That’s only fitting, since the Health and Human Services Department revealed that the wrong form info was the result of “an intermittent defect in the code that was used to create these forms.” Instead of listing information about Obamacare benchmark plans for 2014, the forms listed 2015 data.

But there is a limit to the IRS’ forgiveness.

Limited to early filers: Although almost a million policy purchasers got error-ridden 1095-A forms, the tax relief only applies to the 50,000 or so who have already filed their taxes using the erroneous 1095-A data.

Corrected documents will be sent to everyone else affected by early March, says the IRS and Healthcare.gov. So wait for that good form before filling out your taxes.

And if you then find that you should have received a smaller tax credit and owe more, you’ll have to pay that amount and ask the IRS for its previously announced relief on any associated penalties.

We thought open enrollment for individual health insurance had ended on February 15 for 2015, but some people have been given a second chance to still enroll.

This second chance  is for consumers who:
1. Did not enroll in coverage for 2015 through the Federally-facilitated Marketplaces (FFMs);
2. Were subject to the Shared Responsibility Payment for 2014 ($95 or 1 percent of income, whichever is greater); and
3. Given that 2014 was the first year for such a requirement, first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes

We know many people are just now really understanding about the tax penalties for not having insurance as they file taxes this year. If you qualify for this special enrollment period, and you enroll on the first day of Sunday, March 15, your insurance will start on April 1, 2015. From March 16th to April 15th, your insurance will start on May 1, 2015. From April 16th to April 30th, your insurance will start June 1, 2015.

If we can help, please give us a call. Please remember, agents are free to use, the price is the price no matter how you enroll, but we provide expert advise so you pick the right policy for your individual needs.  Health Plans Raleigh  919-977-1272.

Great answer via Kaiser News:

This week I answered questions from readers who are running into difficulties with premiums and tax credits on their marketplace plans.

My 63-year-old husband has Alzheimer’s disease. Our annual income is $41,000, from a combination of his Social Security disability insurance (SSDI) and a disability policy he had from a previous job. Last year I bought a single policy on the health insurance exchange. My husband gets coverage through the Veterans Administration. The monthly premium was reduced by a $278 tax credit based on our estimated annual income. Now I’m reviewing IRS form 8962 that’s used to reconcile what we received in premium tax credits against what we should have received based on our actual income. It looks like we’ll have to repay $2,500! We can’t afford that. If the marketplace made a mistake in figuring our tax credit, do we still have to pay the money back?

If you received too much in premium tax credits, you’ll generally have to pay some or all of it back. Health policy experts say they know of no provision in the health law or rules that would excuse someone from repayment if  an error that resulted in a tax credit overpayment was made by the online marketplace. An administration official didn’t respond to a request to clarify whether those situations would be handled differently than if someone underestimates their own income and receives too much.

The amount you’ll have to repay is capped based on your income. A couple with an income between 200 and 300 percent of the federal poverty level ($31,460 to $47,190 for a family of two in 2014) would have to repay up to $1,500. (People with incomes above 400 percent of poverty –$62,920 for a couple — would have to repay the entire amount.)

It’s hard to know if or where an error occurred. It’s possible that you or the marketplace calculated your income incorrectly. SSDI counts as income when figuring your eligibility for premium tax credits, but disability insurance payments received from an employer policy may or may not count as income depending on who paid the premium, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

Perhaps you or the marketplace entered information incorrectly, transposed figures or made some other manual or computer entry error.

By early February you should receive Form 1095-A from the marketplace detailing how much you received in tax credits for reconciliation purposes. It will be important to use that to make sure your calculations on Form 8962 are correct.

If you discover there was an error in your premium tax credit last year, you’ll still have time to sit down with an agent to go over your 2015 coverage choices before open enrollment ends Feb. 15.

http://kaiserhealthnews.org/news/do-i-have-to-repay-premium-tax-credits-if-the-marketplace-miscalculated-them/

A common question we get asked is when I turn 65 and become enrolled in Medicare, can I keep my silver policy when I am enrolled in Medicare? And, if I do, will I automatically lose my premium subsidy? Do I have to cancel the policy or will the insurer do it automatically?

A. You don’t have to give up your marketplace policy when you turn 65, but financially it probably doesn’t make sense to keep it, says Tricia Neuman, director of the program on Medicare policy at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation.)

Once your eligible for Medicare, you will no longer qualify for premium tax credits on the marketplace, making that coverage more expensive. In addition, you may face higher Medicare premiums if you don’t enroll in that coverage once you becomes eligible. “Those who delay could face a lifetime premium penalty for late enrollment,” Neuman says. The penalty could be 10 percent for every year you delay enrolling in Medicare Part B, which covers outpatient services, and 1 percent for every month you delays enrolling in Part D, which covers prescription drugs.

You should cancel your marketplace plan yourself as soon as you move to Medicare. You could be charged for the full monthly amount of coverage if you do not.

This KHN story can be republished for free (details).

Keep an eye on your mail in the coming weeks! If you or anyone in your household enrolled in a health plan through the Health Insurance Marketplace in 2014, you’ll get Form 1095-A—Health Insurance Marketplace Statement.

You’ll get this important tax form in the mail by early February. The 1095-A provides information you’ll need to complete your 2014 Federal income tax returns. Keep it with your important tax records, like the W-2 you get from your employer.

And later this month, you can also get a copy of your 1095-A by logging into your Marketplace account on HealthCare.gov.

If you need additional information about the 1095-A or want tips on health coverage and your income taxes, visit www.healthcare.gov/taxes.

The next deadline for health insurance in North Carolina is right around the corner on January 15th.

What that means for you

In order to have health insurance coverage by February 1, 2015, you need to sign up for a plan by January 15th. If you don’t sign up for a plan by the 15th you can still purchase an individual health insurance plan, but your earliest coverage start date will be March 1, 2015.

Open enrollment deadlines

• January 15 for a February 1 coverage start date
• February 15 for a March 1 coverage start date

Open Enrollment Closes for the year on February 15^th, 2015

To make sure your application goes through for the February1st start date be sure to seek help from an experienced agent. A few wrong answers could lead to your application or tax credit getting denied. Working with a licensed health insurance agent will help you successfully navigate the complex health insurance marketplace in North Carolina. We are free to use, get you the same price as if you did it yourself, and we do the application for you. We make it easy with great customer service!