Shop and compare 2016 health insurance Marketplace plans in minutes. Enrollment often takes as little as 15 minutes and the federal subsidy continues to save single persons and families thousands of dollars. You do not have to have prior coverage to qualify and all medical issues will be covered.
Beginning in 2014, individual and family healthcare plans began to be purchased through State and Federal Exchanges. New rates and regulations have changed how we buy medical coverage and the price that we pay for it. Our website provides the lowest available Health Exchange rates, and makes it easy for you to apply and enroll for a policy.
We also help you request and obtain instant subsidy tax credits that reduce your premium and teach you about the Affordable Care Act and the newly-created Marketplaces. Determining your eligibility involves several steps, and we can quickly calculate the amount in about a minute.
What Is Different About Buying Coverage Through An Exchange?
Each policy that is offered must (by law) contain certain provisions or 10 essential health benefits (referred to as EHB), whether you request them or not. Some of these benefits are newborn and maternity, substance use disorder, mental health, treatment of behavioral health, vision and oral care, prescriptions, and management of chronic diseases. Of course, this is just a partial list of ailments that must be covered in advance.
Each year, the Department of Health and Human Services (HHS) adds a few new mandates. Mental illness and preventive coverage are two of the major areas that have made the most progress in recent years. Expansion of newborn expenses and chronic treatment may be the next items that are expanded.
For 2016, viewing a carrier’s formulary and non-formulary drug list will not involve having to register or create a private account. Detailed prescription coverage will be available including specific differences in plans. If any changes are made during the year, they must be posted (in writing) before the changes go into effect. If prior authorization is needed, this information must be included in the drug description.
Also, provider directories must include additional information regarding location of offices, and whether new patients are accepted. Every month, information must be updated, and if specific plans utilize a different network, it must be clearly defined and explained.
When Do Rates Become Available?
Prices are published by each state separately, since costs are different. Usually, carriers officially file their anticipated pricing by June or July. State Insurance Departments typically approve (or disapprove) the requests within 3-5 weeks. Also considered are rates from new companies entering the Marketplace. For instance, in 2015, Aetna and UnitedHealthcare began participating in more states than in 2014. For 2016, Assurant will be exiting in all states.
Vermont was the initial state to publish their premiums. Vermont Health Connect will charge between $750 and $1,750 per month for a family, depending on the plan. Tax subsidies, if available, will reduce these amounts. Blue Cross Blue Shield of Vermont and MVP Health are the two carriers that will offer policies in the state. Although Vt. is preparing to become a single-payer system, it will not be effective until 2017.
Bigger states, such as Texas and California are often able to quickly provide their Marketplace prices, despite the higher number of carriers and plans available for consumers. Larger states will typically feature a combination of HMO, PPO, HSA and Point-Of-Service options, which often allows a broker to custom-fit a plan to meet needs more easily.
All states have published prices for the current or upcoming year, and you can request a free quote from our website. Additional policies are offered “off” the Exchanges and options are especially attractive for households making more than $100,000 per year. There are also several “non-compliant” plans that cost about 40%-65% less than a Marketplace policy, but contain mainly catastrophic benefits.
How Has Enrolling And Applying Changed?
Applications look completely different than from a few years ago. One reason is that there are no medical questions! Although your premium can be adjusted due to your age, smoking status and zip code, your overall health has no impact on prices. So hypothetically, an applicant that is treated for terminal cancer and insulin-dependent diabetes will pay the same rate that a perfectly healthy person pays (assuming same age etc…). Is that fair? That depends on what medical conditions you are being treated for.
We have set up a special section of each page on our website to enter your zip code. That will generate a free online quote so you can easily look at the different plans. Ultimately, if you decide to apply for benefits, we will help, including determining how much money the government will give you in the form of a federal subsidy (tax credit). It is possible that some or all members of your household may become eligible for Medicaid or CHIP (children).
For some individuals and families, your policy may be free, since the subsidy could possibly exceed the cost of the plan you are buying. And of course, certain states (Ohio and Pennsylvania) will be cheaper than other states, such as New Jersey and New York. Also, Medicaid eligibility has expanded in many states, allowing low-income households to qualify for comprehensive benefits.
Will All Of The Big Companies Offer Policies in 2016?
Initially, in the first year, not every company actively participated. This included the “biggies” like Blue Cross (Blue Shield), Aetna, UnitedHealthcare, Humana and Cigna. Although there will be other carriers that join this group, it is expected that several companies will eventually stop offering individual health care coverage to consumers. For example, UnitedHealthcare originally opted out of most states, but offers contracts away from the Marketplaces. NOTE: UHC is participating in more states in 2016 than in 2015.
Aetna and Cigna originally followed the same path by writing business in selected states that they felt would be profitable to them.
Why? The toll of having to guarantee unlimited benefits to anybody who applies for a policy is a tremendous financial risk. And not every insurer can sustain paying out higher than expected claims every year. Both UnitedHealthcare and Aetna have stated that one reason they did not initially participate in many State Exchanges was because of profit concerns.
Consolidation and attrition also must be considered. Assurant is exiting the business and is not participating in the 2016 Markertplace. Also, with the recent takeovers of Humana by Aetna, and Cigna by UnitedHealthcare, two fewer companies will be available to consumers starting about 2017 when regulatory approval is achieved.
Will I Be Able To Keep My Current Plan?
Although in 2012 President Obama said you can, actually, the majority of plans were not able to be kept. Since there were requirements (by law) to include maternity, mental health coverage, drug addiction treatment and contraceptive coverage in all policies, any existing plans that did include them, had to be scrapped. Exceptions were “grandfathered” plans that were issued in April 2010 or earlier.
While it is possible that some of these plans can be revised to include these benefits, that will force premiums up. Also, many employers opt to pay a small fine instead of offering healthcare to their employees. This often saves millions of dollars, and it would be hard to explain to company shareholders why they did not do this. And certainly, the number of part-time employee hires increases, since benefits paid are often a fraction of what full-time employees will receive.
Our Household Income Is More Than $100,000. Will We Receive Instant Tax Credits?
It depends. The older the ages of family members, the more likely you are to qualify for a federal subsidy in the form of an instant tax credit. A major variable (other than age) is where you live. Each state has a slightly different method of calculating the Obamacare subsidy, and often, the differences are thousands of dollars each year.
Below, we have illustrated several examples in random US cities. The dollar amount shown is the annual tax credit per year given to each household to help pay premiums. We used an exact income of $100,000 in all situations. Incomes lower than $100,000 will result in bigger subsidies and lower rates.
$4,380 – Harrisburg, Pa. Family of 5 (55, 55, 15, 17, and 18)
$3,000 – Harrisburg, Pa. Family of 4 (55, 55, 15, and 17)
$3,760 – Dayton, Ohio. Family of 5 (50, 50, 14, 17, and 20)
$2,664 – Dayton, Ohio. Family of 4 (50, 50, 14 and 17)
$1,572 – Chicago, Il. Family of 5 (50, 50, 11, 13, and 16)
$0 – Chicago, Il. Family of 4 (50, 50, 11 and 13)
$2,304 – St. Louis, Mo. Family of 5 (42, 42, 11, 9, and 7)
$3,540 – St. Louis, Mo. Family of 5 (47, 47, 20, 18, and 16)
Can I Buy A Plan Outside Of The Exchange?
Yes, you can. But you will not be eligible for tax credit reimbursements by purchasing an outside policy. However, assuming it is a reputable plan from one of the large insurers, the premium you pay could be slightly less than what is typically available. In that situation, it may benefit you to choose coverage outside of the Exchanges, especially if your household income exceeds the threshold needed to qualify for a subsidy. And often, you can expect a richer network provider list.
Commonly referred to as “off-Marketplace” or “off-Exchange” policies, one important concern is that these plans meet Affordable Care Act regulations by including the 10 “essential health benefits” that were earlier discussed. If they don’t (short-term contracts don’t), you could pay up to 2.5% of your household income in penalties. And yes, that’s $1,250 for a $50,000 household.
Are HSA Plans Available?
Fortunately, they are, and all tax advantages of these types of contracts remain. We anticipate that the usage of HSAs will substantially increase in 2016 and continue. Many of the other plan options will be very expensive to consumers that are in excellent health and thus, may not utilize many of the benefits that will be required to have. Blue Cross, UnitedHealthcare, Humana and Aetna (and perhaps some other carriers) will be some of the companies offering the best options.
The minimum HSA deductibles for 2016 are $1,300 for single plans, and $2,600 for a family. These remained unchanged from 2015. The maximum amount of contributions that can be made are $3,350 and $6,750 respectively. Maximum out-of-pocket limits slightly increased to $6.550 for single policies and $13,100 for family policies.
What Type Of Scams Should I Look Out For?
The Better Business Bureau and State Attorney Generals are already watching very closely how consumer confusion with the legislation continues to give scammers some ideas, especially with seniors who are already a big target. Both telemarketing boiler room operations that make calls, and questionable mail that is sent in bulk, seems to increase during Open Enrollment periods.
Releasing your social security number should always be a top concern. When comparing and reviewing different plans, you do not need to provide your social security number. You should also never provide your checking account, debit account or credit card information when visiting a website. The exception, of course, is when you are applying for coverage through a respected and recognized broker or government website. If you’re uncertain, ask us and we will investigate.
Also, if you receive a call (phone) from a federal worker that is offering to send you a new “federal medical card,” but needs personal information, it is probably a bogus call. Simply hang up. This type of card does not exist and no legitimate person will call you about it. If you have concerns or questions, please contact us and we will investigate the source.
Are The Establishment Of The Health Insurance Exchanges The First Step Towards Socialized Medicine?
That depends on who is answering the question. We have 35 years of experience in this field, so we believe we are fairly informed and unbiased. Based on the large number of unanticipated claims that will be filed by previously uninsured persons, there will be a lot of financial pressure on the health insurers, especially the smaller regional carriers.
Not all of them will survive. And what happens if only a few are left…or perhaps even one? Ironically, we have begun to see consolidation with the Aetna/Humana and Anthem/Cigna mergers. This could create a very gloomy outlook, which would almost guarantee that federal intervention will be required, and probably a single-payer socialized medicine health care system. But let’s give the Exchanges a chance. The concept might work. We’ll know by 2018 or so.
December 2013 – Was your health insurance policy canceled? If it was, you’re getting a slight reprieve since you now ill not have to pay the tax (mandate) for not purchasing qualified coverage. Also, you will now be eligible to buy “catastrophic” plans, that are often the cheapest option on the Exchanges. However, they do have very limited benefits in some areas.
The timing is helpful since December 23rd is the deadline for securing a January 1 2014 effective date. Applications received after December 23rd will be issued with a February 1 effective date. Open Enrollment ends in the Spring, and will start over again later in the year.
March 2014 – Open Enrollment is scheduled to end at the end of the month. However, it is possible an extension will be announced (despite contrary rumors). For 2015, an additional 30 days was added. Also, it was announced by the White House that if you own an existing policy that does not meet ACA guidelines, you may keep it an additional two years.
Annual limits for out-of-pocket costs (cost-sharing) has now been increased to $6,600 for individuals and $13,200 for families.
June 2015 – Open Enrollment for 2016 plans begins on November 1st and continues through January 31st.Originally, the start date was going to be on November 15th. The extra two weeks will help consumers shop and compare policies that will be more expensive than 2015 prices in most areas. Also, in selected states, new carriers will enter the Marketplace. Co-ops, however, are suffering financially in many areas.
September 2015 – Montana is the first state to officially publish their 2016 Marketplace rates. Average increases are between 22% and 34%, and more than 40,000 residents will be impacted. However, persons that are covered through a work group plan or Medicaid will not be affected by these price hikes.
The three carriers offering individual plans are PacificSource, Montana Health CO-OP, and Blue Cross Blue Shield of Montana. Small business-owner group plan rates offered by the most popular companies, are expected to only increase approximately 6%-7%. Insurance Commissioner Monica J. Lindeen published individual and group rates this week.
October 2015 – Only two companies will be offering 2016 Marketplace plans in Oklahoma after three carriers announced they will not be participating. UnitedHealthcare (new for 2016) and Blue Cross Blue Shield of Oklahoma, the biggest insurer in the state) will be available.
Assurant is no longer writing individual business in any state. GlobalHealth, an HMO based in Tulsa, also will not be offering any Exchange coverage to state residents. And CommunityCare of Oklahoma will be terminating existing plans and not returning. Most carriers were not profitable in either 2014 or 2015, so these recent departures were expected.
October 2015 – The New York Health Plan Marketplace will feature 16 companies offering individual plans. The only non-returning carrier from 2015 is troubled CO-OP Health Insurance Republic of New York. Federal regulators forced them to cease operations because of severe financial and insolvency concerns.
Last year, Health Republic covered one out of every five persons that purchased Exchange plans (more than 80,000). For 2016, some of the larger carriers include Excellus BlueCross BlueShield, Fidelis Care, EmblemHealth, and North Shore.
January 2016 – Congress passed several budget and tax agreements that impact the Affordable Care Act legislation. The Excise (Cadillac) tax has been postponed for an additional two years and will not be effective for 2020. The medical device tax has also been delayed, and the standard ACA tax has been eliminated for 2016.