NEW Detailed COBRA premium assistance information

The American Rescue Plan Act of 2021 (ARPA) COBRA premium assistance provisions take effect on April 1, 2021.  Even small employers who are usually exempt from federal COBRA regulations may have to comply with the ARPA COBRA premium assistance as State continuation coverage that is comparable to Federal COBRA is included.

Premium Assistance

An “Assistance Eligible Individual” does not owe any part of the COBRA premium for the period of coverage starting April 1, 2021, and ending September 30, 2021.  This includes individuals enrolled in continuation coverage as of April 1 and those who enroll in continuation coverage on or after April 1.  The premium assistance is not available for premiums required to continue participation in a Health Flexible Spending Arrangement (FSA).

An Assistance Eligible Individual (AEI) is a Qualified Beneficiary who is eligible for and elected continuation coverage by reason of an Involuntary Termination or Reduction in Hours qualifying event.

An AEI’s period of premium assistance may expire early for periods of coverage beginning on or after the earlier of:

  • First date individual is eligible for additional coverage under another group health plan (other than coverage consisting of only excepted benefits, including Health FSA plans), a Qualified Small Employer Group Health Reimbursement Arrangement (QSEHRA), or Medicare benefits; or
  • The date following the expiration of the maximum period of continuation coverage required under the applicable COBRA continuation coverage provision.

Special Election Period Extension

An individual who is not enrolled in continuation coverage on April 1 but would be an AEI if an election were in effect will have a new opportunity to elect coverage as of April 1.  This includes individuals who did not originally elect continuation coverage or elected but discontinued coverage prior to April 1, 2021 (called the Lookback Period).  For AEIs who elect coverage during their Special Election Period Extension, coverage will start on April 1, 2021, and will not extend beyond the period of COBRA that would have been required if the coverage had been elected or had not been discontinued.

An AEI’s Special Election Period Extension begins on April 1 and ends 60 days after the group health plan furnishes the Notice of Extended Election Period.

Plan Enrollment Option

If the employer allows, an AEI may elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time of his/her Qualifying Event.  The premium for the different coverage may not exceed the premium for coverage in which such individual was enrolled at the time such qualifying event occurred, and the employer must offer the different coverage to similarly situated active employees at the time at which such election is made.  Finally, the AEI must elect the different coverage within 90 days of receiving the Plan Enrollment Option Notice.

The Plan Enrollment Option does not apply to Excepted Benefits coverage (i.e., Dental Only, Vision Only), a QSEHRA, or a Health Flexible Spending Arrangement.

Required Notice to Individuals

Plan Administrators must modify COBRA Notices to include information on the available premium assistance and the alternate enrollment plan option, if applicable.  Also, Plan Administrators must notify individuals who may be an AEI if an election were in effect as of April 1, 2021, of the Special Election Period Extension no later than May 31, 2021.  With respect to any AEI, a Plan Administrator’s COBRA notice requirement shall not be considered as met unless COBRA notices include this additional information in clear and understandable language.  The requirement may be met by amending the existing COBRA notice or including a separate notice.

Plan Administrators are also required to furnish an Expiration of Premium Assistance Notice to AEIs no later than 15 days prior to the subsidy expiration date and no sooner than 45 days prior to the subsidy expiration date.  With respect to any AEI, the Plan Administrator’s COBRA notice requirement shall not be considered as met until the Notice of Expiration of Premium Assistance Period is furnished to the individual. However, the Expiration of Premium Assistance Notice requirement is waived if an AEI’s period of subsidy expires early due to their eligibility for Group Health Coverage, a QSEHRA, or Medicare.

Model Notices

The Department of Labor (DOL) will provide necessary Model Notices for Plan Administrators’ use.  The DOL will provide Premium Subsidy Availability, Alternate Plan Enrollment Option, and Extended Election Period Model Notices no later than April 11.  The DOL will provide Expiration of Premium Assistance Period Notice no later than April 26.

Full details-American Rescue Plan!

American Rescue Plan and the Marketplace

The New Law

  • President Biden signed the American Rescue Plan Act of 2021 (ARP) into law on March 11, 2021.  ARP makes major improvements in access to and affordability of health coverage through the Marketplace by increasing eligibility for financial assistance to help pay for Marketplace coverage.
  • The new law will lower premiums for most people who currently have a Marketplace health plan and expand access to financial assistance for more consumers.
  • Under the new law, many people who buy their own health insurance directly through the Marketplace will become eligible to receive increased tax credits to reduce their premiums. Starting April 1, 2021, consumers enrolling in Marketplace coverage through HealthCare.gov will be able to take advantage of these increased savings and lower costs.
  • Premiums after these new savings will decrease, on average, by $50 per person per month or by $85 per policy per month. Four out of five enrollees will be able find a plan for $10 or less/month after premium tax credits, and over 50% will be able to find a Silver plan for $10 or less.

Background on how premium tax credits work

  • For consumers who are eligible for premium tax credits to help purchase a Marketplace plan, an individual or a family’s tax credit amount is calculated based on the following factors:
    • Household’s total expected income for the year
    • Total number of people in the household that file taxes together
    • The premium amount of the second-lowest cost Silver plan in the consumer’s area in the Marketplace. This is the “benchmark” plan cost used to calculate premium tax credits.  It’s not related to which plan a consumer actually chooses to enroll in.
  • The tax credit calculation uses a percentage of the household’s income that they need to contribute (spend) on monthly health insurance premiums. This amount is limited based on how their household income compares to federal poverty levels (FPL).
  • Prior to the American Rescue Plan, households had to contribute up to 9.83% of their income to pay for health insurance premiums to be eligible for tax credits based on the cost of the benchmark plan. Consumers can choose to enroll in plans that cost more or cost less than the benchmark plan, but the amount of their tax credit is based on this percentage of their income and the cost of the benchmark plan’s monthly premium. Households with incomes greater than 400% FPL weren’t eligible for tax credits to help reduce the cost of purchasing a Marketplace plan.
  • After the coverage year, consumers who had a Marketplace plan with premium tax credits during the year will need to file their federal income tax return for that year and reconcile the amount of tax credits they received in advance with the final premium tax credit calculation as a part of their tax return. If their house income turns out to be higher than what they estimated on their Marketplace application, the household may need to pay back some or all of the excess premium tax credit they received in advance as a part of filing their tax return.  Depending on the circumstances the amount owed back may be capped.

Lower costs and expanding access

Under the American Rescue Plan:

  • Individuals and families may be eligible for a temporary increase in premium tax credits for this year, with no one paying more than 8.5% of their household income towards the cost of the benchmark plan or a less expensive plan. Meaning, many consumers will be eligible for higher tax credit amounts to help cover their Marketplace health plan premiums.
    • This new lower cap on the percentage of a family’s household income that goes toward premiums addresses the “subsidy cliff” for those with household incomes above 400% of the federal poverty level (FPL).  Instead of no premium tax credits for individuals and families making more than 400% FPL, the new law will make premium tax credits available to these families and caps how much of a family’s household income the family needs to pay towards their premiums at 8.5%, based on the cost of the benchmark plan.
    • Some consumers making more than 400% FPL may not receive tax credits if the cost of the benchmark plan is less than the 8.5% of their household income that they need to contribute toward the premium.
    • When consumers enroll, they can choose a plan that is the same, costs more or costs less than the benchmark plan. The 8.5% cap is used to calculate this increase in premium tax credit amounts, but the cost of the plan a consumer chooses to enroll in may be higher or lower than the benchmark plan.
  • Individuals and families get a temporary boost in their premium tax credits.
    • The law increases premium tax credits for all income brackets for coverage years beginning in 2021 and 2022. For 2021 and 2022, the law applies a new premium percentage owed by individuals and families at all household income levels.
    • Of note, most people across all household income levels will see lower premiums as a result of receiving more tax credits to reduce plan prices. Many consumers with household incomes from 100% to 150% FPL would have $0 premium plans (after tax credits) available to choose from when considering their options and selecting a plan.
  • Taxpayers who receive unemployment compensation during any week beginning in 2021 may be eligible to receive premium tax credits to help pay for 2021 Marketplace coverage.

Making This Work for You

  • When will the extra tax credits be available on HealthCare.gov?

Increased premium tax credits based on the lower income contribution percentage along with expanding tax credit access to consumers with household incomes above 400%, will be available through HealthCare.gov starting on April 1. This means that new consumers and current enrollees who submit an application and select a plan on or after April 1 will receive the increased premium tax credits for 2021 Marketplace coverage.

Extra tax credits for consumers receiving unemployment compensation will be available starting this summer.

  • If I’m currently enrolled in a Marketplace plan, how do I receive the additional tax credits/lower premiums?

Current enrollees, including those who recently enrolled through the 2021 Special Enrollment Period, can update their applications and enrollments in order to get new eligibility results starting April 1. You will need to reselect your current plan in order for the changes to take effect to reduce your premiums for the remainder of the year.

While the 2021 SEP opportunity is available through May 15, current enrollees can decide during the SEP opportunity if they may want to change to a new plan for the rest of the year. You should consider how much you’ve already paid toward your deductible when deciding whether or not a change in plan makes sense for you.  When you change plans, the amount you’ve paid already towards meeting your prior plan’s deductible may be reset to zero, and you would need to start over paying out of pocket expenses to reach the deductible on your new plan.  If you have made significant payments toward your deductible, check with your insurance company to see how it might impact you and what options are available to keep credit toward what you have already paid.

  • If I live in a state that operates its own Marketplace, what should I do?

Visit your State Marketplace website or call center for more information about when these additional savings will be available through your Marketplace.

  • If I’m currently enrolled through the Marketplace, what will happen if I don’t come back in?

Consumers who enrolled in Marketplace plans prior to April 1 have the choice of waiting until they file their taxes next year in 2022 to receive the additional premium tax credit amount when they file and reconcile their 2021 taxes. However, we recommend all enrollees come in, update their application, and review their plan options during the 2021 Special Enrollment Period through May 15 because you may be able to choose a plan with lower out of pocket costs for the same price or less than what you are currently paying.

  • If I don’t have coverage, when should I apply?

Consumers who need coverage starting April 1 should still apply and select a plan by the end of March through the Special Enrollment Period (SEP) so coverage can start April 1.  Then to get the added benefits, you should come back after April 1, submit your application again, and reselect your plan to have increased tax credits applied to your coverage for May 1 forward.

  • If I am already paying a very low premium, or no premium, should I take any action?

Consumers who are already paying low or no premiums may find plans with more generous cost-sharing and lower out of pocket costs, and benefit from changing plans. Premiums after tax credits will decrease, on average, by $50 per person per month. Four out of five enrollees will be able to find a plan for $10 or less/month with premium tax credits, and over 50% will be able to find a Silver plan for $10 or less with tax credits.

Meaning, you may be able to find plans with lower out of pocket expenses and lower deductibles for a similar premium to what you’re currently paying.

  • If I’m receiving unemployment compensation, should I wait to apply?

You should apply and select a plan by the end of March in order to enroll in coverage starting April 1.  After April 1, you can come back in to update your application and confirm your current plan with the updated tax credits. Later this year, you may be able to receive another increase in the premium tax credits available to you. HealthCare.gov will have more information available in the summer once these additional savings are available for consumers who have received unemployment compensation during 2021.  At that time, you can come back to HealthCare.gov to update your application and current plan with more tax credits to reduce your premiums for the remainder of the year.

  • Will HealthCare.gov automatically update premium tax credits on behalf of current enrollees?

If consumers don’t take action, they’ll still receive the additional benefit as part of their premium tax credit when filing their federal income tax return next year.  Beginning on April 1, consumers must come back to HealthCare.gov to update their application in order to receive these increased tax credits this year. However, we are also exploring whether tax credits can be updated on behalf of consumers during 2021.

For detailed information; CALL- Eric Walters – 602-616-1660

                                Email: ewinsurance@gmail.com

New COBRA benefits in America Rescue Plan!

COBRA benefits in H.R. 1319

The best-known provisions would extend worker access to supplemental unemployment insurance benefits and provide for the federal government to send many Americans $1,400 stimulus payments.

Another provision, in Title IX, Subtitle F, would provide a tax credit that employers could use to help displaced workers keep their employer-sponsored coverage in place, using the federal COBRA benefits coverage continuation rules, from the start of the month after the provision becomes law through Sept. 30.

Normally, employers and insurers can ask workers to pay up to 102% of the full premiums to keep the coverage in place.

Employers often pay 60% or more of the premiums when they offer group health benefits. For displaced workers, the loss of the employer contribution often makes the out-of-pocket cost of continuing benefits look too expensive.

The H.R. 1319 COBRA provision would let workers use COBRA continuation benefits without paying any of the premiums for the coverage.

There is no reason why an employer would choose to opt out of using the proposed COBRA tax credit subsidy.

The bill appears to require an employer that uses the subsidy to make COBRA continuation benefits available without requiring displaced workers to pay a share of the premiums..

“The bill says that, for eligible individuals, the COBRA premium is treated as being paid in full

Implications

For financial professionals, one implication is that clients who lose their jobs might not have to worry about paying their health coverage premiums for a few months.

Another implication is that companies selling inexpensive COBRA alternatives, such as short-term health insurance, might face tougher competition from COBRA while the extra COBRA subsidy is still in place.

Read more: 

HHS extends the COVID-19 Public Health emergency!

HHS Officially Extends COVID-19 Public Health Emergency Declaration
July 24, 2020
Yesterday, Health and Human Services has officially extended the COVID-19 public health emergency declaration for another 90 days.
Secretary Alex Azar endorsed the renewal on Thursday night, ahead of its expiration on Saturday, July 25. With it comes several policy implications for physicians that would have disappeared over the weekend.
The Secretary of the Department of Health and Human Services (HHS) may, under section 319 of the Public Health Service (PHS) Act, determine that: a) a disease or disorder presents a public health emergency (PHE); or b) that a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists.
Duration and Notification: The declaration lasts for the duration of the emergency or 90 days, but may be extended by the Secretary. Congress must be notified of the declaration within 48 hours, and relevant agencies, including the Department of Homeland Security, Department of Justice, and Federal Bureau of Investigation, must be kept informed.
 
For a copy of the renewal, click on the link below:
 

Coronavirus FAQ.

Today, the Centers for Medicare & Medicaid Services (CMS) is posting Frequently Asked Questions (FAQs) on Essential Health Benefits Coverage in response to the 2019 Novel Coronavirus (COVID-19) outbreak.

This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease

The FAQs are shared to ensure individuals, issuers and states have clear information on coverage benefits for COVID-19, detailing existing federal rules governing health coverage that apply to diagnosis and treatment of COVID-19.

You can access the FAQs here:

For further information contact:- Eric Walters –  Cell -602-616-1660 or email: ewinsurance@gmail.com.

 

2019 Medicare Parts A & B premiums, etc

 

 

Centers for Medicare & Medicaid ServicesCMS.gov News Room

CMS NEWS

FOR IMMEDIATE RELEASE
October 12, 2018

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

 

CMS announces 2019 Medicare Parts A & B premiums and deductibles

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.

 “CMS is committed to empowering beneficiaries with the information they need to make informed decisions about their healthcare,” said CMS Administrator Seema Verma.  “In addition to the information we recently released for Medicare Advantage, the program through which private plans provide Medicare benefits, today we are releasing information for fee-for-service Medicare, so enrollees understand their options for receiving Medicare benefits.”

As announced earlier this month, CMS launched the eMedicare Initiative that aims to modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families. Ahead of Medicare Open Enrollment – which begins on October 15, 2018 and ends December 7, 2018

CMS is making improvements the Medicare.gov website to help beneficiaries compare options and decide if Original Medicare or Medicare Advantage is right for them. Among the tools released as part of the eMedicare Initiative is a stand-alone, mobile optimized out of pocket cost calculator that will provide information on both overall costs and prescription drug costs.

Medicare Part B Premiums/Deductibles

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. An estimated 2 million Medicare beneficiaries (about 3.5 percent) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries’ increase in their Part B premium to be no greater than the increase in their Social Security benefits.

CMS also announced that the annual deductible for Medicare Part B beneficiaries is $185 in 2019, an increase from $183 in 2018.

Medicare Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,364 in 2019, an increase of $24 from $1,340 in 2018.

Medicare Advantage Premiums

Medicare beneficiaries can choose to enroll in fee-for-service Medicare (Parts A and B) or can select a private Medicare Advantage plan to receive their Medicare benefits. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.

Last month, CMS released the benefit, premium, and cost sharing information for Medicare Advantage plans in 2019. On average, Medicare Advantage premiums will decline while plan choices and new benefits increase. On average, Medicare Advantage premiums in 2019 are estimated to decrease by six percent to $28, from an average of $29.81 in 2018.

For a fact sheet on the 2019 Medicare Parts A & B premiums and deductibles, please visit: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-parts-b-premiums-and-deductibles.

For more information on the 2019 Medicare Parts A and B premiums and deductibles (CMS-8068-N, CMS-8069-N, CMS-8070-N), please visit https://www.federalregister.gov/public-inspection.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

Qualifying Life Event for a Special Enrollment Period (SEP)!!

Qualifying Life Event for a Special Enrollment Period!!

When the Affordable Care Act went into effect, it guaranteed that everyone who applied for individual health insurance would be approved for and enrolled in coverage. However, to prevent people from signing up for insurance only when they get sick, the ACA restricted enrollment to specific open enrollment periods—typically a period of three months from November to January.

If you want to purchase an individual health insurance policy, either on your own or because your employer offers a Qualified Small Health Reimbursement Arrangement (QSEHRA), you usually must wait until the next open enrollment period.

However, if you experience a qualifying life event, a special enrollment period will go into effect, and you can sign up for health insurance immediately.

These special enrollment periods apply to qualified health policies purchased through both the state and federal health insurance exchanges and outside the exchanges through a broker or health insurance website.

Qualifying life events that open a special enrollment period

A qualifying life event is an event in your life that makes you eligible for a special enrollment period. The special enrollment period generally lasts 60 days before or after the qualifying life event.

There are four basic types of qualifying events: loss of health coverage, changes in household, changes in residence, and other.

Here’s a full list of all life events that qualify for a special enrollment period, organized by those four categories. We’ll examine each of the events in the first two categories in more detail below. The events listed under the second two categories are self-explanatory.

  • Loss of health insurance
    • Losing job-based coverage
    • Losing COBRA coverage
    • Losing individual health coverage for a plan or policy you bought yourself
    • Losing eligibility for Medicaid or Children’s Health Insurance Program (CHIP)
    • Losing eligibility for Medicare
    • Losing coverage through a family member
  • Changes in household
    • Getting married
    • Having a baby, adopting a child, or placing a child for foster care
    • Getting divorced or legally separated and losing health insurance
    • Death of someone on your individual health insurance policy
  • Changes in residence
    • Moving to a new home in a new zip code or county
    • Moving to the United States from a foreign country or U.S. territory
    • Moving to or from the place you attend school, if you’re a student
    • Moving to or from the place you both live and work, if you’re a seasonal worker
    • Moving to or from a shelter or other transitional housing
  • Other qualifying changes
    • Changes that make you no longer eligible for Medicaid or CHIP
    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
    • Leaving incarceration
    • AmeriCorps VISTA members starting or ending their service

Losing job-based coverage

If you lose health coverage through your company or a family member’s company, you might qualify for a special enrollment period.

Common reasons for losing job-based coverage are:

  • Your company drops coverage.
  • You quit or were fired from a job where you had coverage.
  • You experienced a reduction in work hours that caused you to lose your job-based coverage.
  • Your job-based coverage doesn’t qualify as minimum essential coverage (MEC) and you’re eligible for a premium tax credit.

You won’t qualify for a special enrollment period if you lost your job-based coverage because you voluntarily dropped coverage during the plan year or you lost your coverage because you didn’t pay your premium.

Losing COBRA coverage

If you’re losing COBRA continuation coverage because the coverage ran out or your former company stops contributing, causing you to pay the full cost, you qualify for a special enrollment period.

However, you won’t qualify if you decide to end COBRA early and are paying the full cost yourself or if you lost your COBRA coverage because you didn’t pay your premiums.

Remember, you don’t need a special enrollment period if you voluntarily end COBRA during open enrollment. At that time, you can drop your COBRA policy and enroll in an exchange policy.

Losing individual health coverage for a plan or policy you bought yourself

If you lose individual health coverage, you may qualify for a special enrollment period in the following circumstances:

  • Your insurance carrier stops offering your individual policy
  • You lose eligibility for a student health policy
  • You lose eligibility for a policy because you no longer live in the policy’s service area
  • Your individual or group health policy’s coverage year ends in the middle of the calendar year and you don’t renew it

If you voluntarily drop coverage or lose your coverage because you didn’t pay your premiums or provide required documentation to the exchange when prompted, you won’t qualify for a special enrollment period.

Losing eligibility for Medicaid or CHIP

If you lose eligibility for Medicaid or CHIP, you might qualify for a special enrollment period. This could be due to a change in income, or because you become ineligible for pregnancy-related or medically needy Medicaid.

Additionally, if your child ages off CHIP, you may qualify.

Losing eligibility for Medicare

You may access a special enrollment period if you lose eligibility for premium-free Medicare Part A.

You won’t qualify, however, if you lose Medicare Parts B, C, or D only, or if you lose Medicare Part A because you didn’t pay your premium.

Losing coverage through a family member

Losing coverage through a family member, such as a parent or spouse, also qualifies you for a special enrollment period.

This could happen if:

  • You turn 26.
  • You are no longer a dependent of your parent or guardian.
  • Your family member’s employer cuts health coverage for dependents.
  • Your family member dies.
  • You divorce or legally separate from the spouse through whom you have health insurance.

If you voluntarily drop coverage you have as a dependent, you won’t qualify for a special enrollment period. Similarly, you won’t qualify for coverage if neither you  nor your family member pays the premium.

Getting married

If you’ve gotten married in the past 60 days, you can apply for coverage through a special enrollment period. Pick a policy by the last day of the month for your coverage to begin the first day of the next month.

Having a baby, adopting a child, or placing a child for foster care

Apply for coverage within 60 days of having a baby, adopting a child, or placing a child for foster care. Your coverage will be retroactive to the day of the event.

Getting divorced or legally separated and losing health insurance

You only qualify for a special enrollment period if divorcing or legally separating from your spouse caused you to lose health insurance.

Death of someone on your individual health insurance policy

If someone on your policy dies and, as a result, you’re no longer eligible for your policy, you’ll be eligible for a special enrollment period.

Other cases that may qualify you for a special enrollment period

There are other special circumstances that may qualify you for a special enrollment period. Though these circumstances aren’t considered qualifying life events, they could open a special enrollment window for you.

We’ll list these complicated cases and explain them in more detail below.

  • Experiencing an “exceptional circumstance”
  • Experiencing an enrollment or policy information display error
  • Previously having lived in a state that hasn’t expanded Medicaid and you became newly eligible for help paying for an insurance plan because of an increase in household income or move
  • Being determined ineligible for Medicaid or CHIP
  • Gaining or becoming a dependent due to a child-support or other court order
  • Experiencing domestic abuse or violence or spousal abandonment
  • Getting an appeal decision that’s in your favor

Experiencing an “exceptional circumstance”

If you faced a serious medical condition or natural disaster that kept you from enrolling during open enrollment, you’re entitled to a special enrollment period. Healthcare.gov lists as examples: unexpected hospitalization; temporary cognitive disability; or a natural disaster like an earthquake, massive flooding or a hurricane.

Experiencing an enrollment or policy information display error

You’re entitled to a special enrollment period if someone working in an official capacity kept you from enrolling in a policy, enrolling in the right policy, or getting the premium tax credit or cost-sharing reduction you were eligible for.

Potential individuals or groups in error could be an insurance company, an exchange navigator, or an insurance agent or broker. Misinformation, misrepresentation, misconduct, or inaction all qualify as enrollment errors.

You’re also entitled to a special enrollment period if you experienced a technical error when you applied on your public exchange. If you saw an error message when completing your application that prevented you from enrolling in a policy or your carrier from receiving your enrollment information, you can access a special enrollment period.

Similarly, if the wrong policy data was displayed on the exchange—such as benefit or cost-sharing information—when you selected the policy, you’ll qualify for a special enrollment period.

Previously having lived in a state that hasn’t expanded Medicaid and you became newly eligible for help paying for an insurance plan because of an increase in household income or move

If you previously lived in a state that hasn’t expanded Medicaid and you weren’t eligible because your income was too low, you can qualify for a special enrollment period if you moved or had an increase in household income that makes you newly eligible for Medicaid or advance payments of your premium tax credit within the last 60 days.

Being determined ineligible for Medicaid or CHIP

If you applied for Medicaid or CHIP during the open enrollment period and were deemed ineligible after open enrollment ended, you may qualify for a special enrollment period. This is true whether you applied through your local exchange or your state Medicaid or CHIP agency directly.

Gaining or becoming a dependent due to a child-support or other court order

You can access a special enrollment period if you either gained a new dependent or became a dependent of someone else due to a court order. Your coverage will start the effective date of the court order, even if you enroll in the policy up to 60 days afterward. In other words, your coverage would be retroactive to the date of the court order.

 

Experiencing domestic abuse or violence or spousal abandonment

The federal government grants special enrollment periods to survivors of domestic abuse and spousal abandonment who want to enroll in their own health policy. Dependents may also be eligible.

If you want to claim this special enrollment period, you need to contact the Marketplace Call Center. If you’re married to your abuser or abandoner, you can fill out your application as unmarried without being penalized for misstating your marital status. You’ll also be able to collect a premium tax credit if you qualify based on your income.

Getting an appeal decision that’s in your favor

You can enroll in or change policies if you file and win an appeal with your exchange after receiving an incorrect eligibility determination for a special enrollment period or an incorrect coverage effective date.

Applying for a special enrollment period

If you’ve experienced one of the events above and want to apply for a special enrollment period, you’ll need to do so through Healthcare.gov or your state exchange.

How you apply depends on whether you’ve had a qualifying life event or another special circumstance.

If you have a qualifying life event, you can apply online. If you’re not sure whether you qualify, Healthcare.gov can screen you by asking you a few questions on any events you’ve experienced that would open a special enrollment period.

Once you’ve determined you’re eligible, you can start a 2017 application for insurance coverage or log in to your existing account.

If you have a special circumstance rather than a qualifying life event, contact the Marketplace directly. You can reach the call center at 1-800-318-2596. The representative will ask about your situation and help you determine whether it qualifies you for a special enrollment period.

Filing an appeal

If your request for a special enrollment period is denied and you feel the decision is wrong, you can file an appeal.

To do so, select your state’s appeal form through Healthcare.gov, download it, and fill it out. If possible, attach a copy of your eligibility determination notice and any other official notice you received.

Mail the appeal to:

Health Insurance Marketplace

Attn: Appeals

465 Industrial Blvd.

London, KY 40750-0061

Be sure to include the last four digits of the zip code as this helps your appeal arrive faster.

Verifying your qualifying life event and enrolling in coverage

In most circumstances, you’ll have 60 days following your qualifying life event or special circumstance to choose and enroll in a policy. As part of this process, you may need to verify your qualifying life event or special circumstance through documentation.

You’ll be told whether you need to submit documentation before you submit your application for coverage. In some cases, you may not need to provide anything at all.

If you are asked, however, Healthcare.gov advises you to pick a policy first and submit documentation afterward. Once you pick a policy, you’ll have 30 days to submit the verifying documents.

Details and instructions on the type of documents you need to submit will appear on your eligibility results screen and in a notice you can download or get in the mail.

Once you’re ready to submit documents, upload them to Healthcare.gov or send photocopies of the original documents to:

Health Insurance Marketplace

Attn: Supporting Documentation

465 Industrial Blvd.

London, KY 40750-0001

In general, the documentation required depends on your qualifying life event. We’ll go over two common reasons people qualify for a special enrollment period, the documentation they should submit, the timeline for submitting that coverage and picking a policy, and the time coverage starts once the first premium payment is made.

For all other documentation concerns, as well as a full list of acceptable documents to verify special enrollment periods, see Healthcare.gov.

Losing health coverage

Whether you already lost your health coverage or you will in the future, you’ll have 60 days following the end of your coverage to choose a policy.

You’ll need to submit documents verifying that your coverage has ended or will end, along with the date it ends. Acceptable documents may be notices from your previous insurance company or your employer. You should submit these within 30 days of choosing a policy.

If your coverage has ended, your new coverage will begin the first day of the month after you choose the new policy. If your coverage will end in the future, your new coverage will begin the first day of the month after your old coverage ends and you choose a new policy.

Remember, your coverage won’t be go into effect unless your eligibility is confirmed and you make your first premium payment.

Moving to a new address and previously had insurance

If you’re moving to a new address, you’ll need to choose a policy within 60 days from the date you moved.

You’ll also need to provide documents confirming both your move and proof of former coverage. To verify your new address, you can submit government correspondence, utility bills, rental or mortgage documents, or homeowner’s insurance. The documents must include your new address and the date of your move.

To verify that health coverage, you must submit documents showing that you were covered at least 1 day during the 60 days before your move. These documents may be correspondence from your insurance company, employer, or health coverage provider. If you’re moving from a foreign country or U.S. territory, you don’t need to provide this documentation.

You must submit all documents within 30 days of choosing a new policy.

If you choose a policy between the first and fifteenth of the month, your coverage will start on the first day of the next month.

If you choose a policy between the sixteenth and the last day of the month, your coverage will start on the first day of the second month following policy selection. For example, if you choose a policy on July 20, your policy will go into effect August 1.

What to do if you don’t have a qualifying life event or special circumstance

If you want to sign up for health insurance outside of open enrollment and haven’t experienced an event on this list, then you’ll have to wait until the next open enrollment period starts.

There is some relief for people whose companies offer a QSEHRA, though. If you’re looking for a health insurance policy because your company is offering a QSEHRA, you won’t be able to purchase one until open enrollment—but you will be able to submit your qualified medical expenses for reimbursement. The only thing you need to do is include these reimbursements as part of your gross income. Once you get a policy, you’ll be able to receive these reimbursements tax-free.

 

Further information from:    Eric Walters

                                                     Cell: 602-616-1660

WEB: www.ewconsultant.biz

Axe the Pre-existing shield for Aca and other plans?

States Attacking ACA Would Suffer Most If Preexisting Conditions Shield Gets Axed

“These states have been opposed to the ACA from the beginning,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They’re hurting their most vulnerable citizens.”

Twenty Republican state attorneys general and governors challenged the constitutionality of the ACA in federal court in February. Last month, U.S. Attorney General Jeff Sessions and the Department of Justice made the unusual decision not to defend key portions of the law against this legal challenge.

The states’ lawsuit argues that because Congress eliminated the Obamacare tax penalty for not having insurance coverage, effective next year, the entire law is unconstitutional. By extension, the suit calls on federal courts to find the health law’s protections for people with preexisting conditions unconstitutional — and Sessions agrees.

Nine of the 11 states with the highest rates of preexisting conditions among adults under 65 have signed onto the lawsuit to strike down the ACA, according to data from insurance companies and the U.S. Centers for Disease Control and Prevention. The 2015 data, the most recent available, were analyzed by the Kaiser Family Foundation in 2016. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

Those who support the lawsuit contend that there are other means of protecting people with preexisting conditions.
“If a court strikes down the constitutionality of the ACA, there are ways to repeal and replace without Arizonans with preexisting conditions losing their coverage,” said Katie Conner, a spokeswoman for Arizona Attorney General Mark Brnovich.

Conner said her boss, who is party to the lawsuit, believes preexisting conditions should “always be covered.” In Arizona, more than 1 in 4 adult adults under 65 have a preexisting condition, according to the data.

The state with the highest rate of adults with preexisting conditions is West Virginia — 36 percent of those under age 65. That means that about 1 in 3 of them could have a hard time buying insurance through the individual marketplace without the ACA protections.

The office of West Virginia Attorney General Patrick Morrisey, who joined the legal challenge against the ACA, declined to comment. But a spokesman for Morrisey’s re-election campaign told PolitiFact last month that “help should be provided to those who need it most, including those with preexisting conditions.”

Plaintiffs in the lawsuit “are paying lip service to these critical protections for people, but they are in fact engaged in a strategy that would get rid of those protections,” said Justin Giovannelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms. “Frankly, it’s hard to square what they’re saying on the one hand and what they’re arguing in the courts on the other.”

According to a poll released in June, also by the Kaiser Family Foundation, three-quarters of Americans say that maintaining protections for people with preexisting conditions is “very important.” This includes majorities of Democratic, Republican and independent voters.

Before the health law was adopted, insurance companies routinely denied coverage to millions of people with preexisting conditions who purchased insurance through the individual marketplace. If they didn’t deny coverage outright, some health plans charged consumers exorbitant premiums, or offered policies that excluded coverage for pricey conditions. (Although many people got insurance through their employers or public plans that covered preexisting conditions, they could have been left vulnerable if their employment status or other circumstances changed.)

The ACA ended those practices.

Common conditions that led insurance companies to deny coverage included high blood pressure, cancer, obesity, diabetes and depression, among many others. Some people were denied for having acne, asthma or for being pregnant.

The KFF analysis estimated that at least 27 percent of adults under 65 — more than 50 million Americans — had at least one preexisting condition that would have jeopardized their coverage pre-ACA. The foundation said its estimates were an undercount because some diseases that insurers cited when declining coverage are not in the survey data. Also, each insurance company set its own rules and conditions for denials, making accurate counts of those who could be affected hard to nail down.

Less precise estimates by other researchers and the Department of Health and Human Services show that up to half of all adults under age 65 have at least one preexisting condition.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

 

 

New HSA contribution limits for 2019!

2019 HSA contribution limits released: IRS

Contribution limits to HSAs have been announced for 2019, the IRS says.

Contributions to HSAs are made on a pre-tax basis, grow tax-free over time, and withdrawals are not taxed when they are used for qualifying health expenses. They must be used with qualifying high-deductible health plans. Here are the 2019 contribution limits.

 Investors in health savings accounts will see a small bump in contribution limits for the calendar year beginning in 2019, according to the IRS.

Individual investors in HSAs tied to high-deductible health plans will be able to contribute up to $3,500 next year, a $50 increase from the 2018 limit. HSAs tied to family HDHPs will see the contribution cap raised $100, to $7,000.

Catch-up contributions for workers over age 55 will remain at $1,000.

The adjustments reflect the application of the Chained Consumer Price Index, or Chained CPI, inflation gauge to HSAs and other tax deductions, which was legislated with the signing of the Tax Cuts and Jobs Act last December.

Previously, the Consumer Price Index, or CPI, was used to set HSA contribution increases.

After implementation of the tax law, the IRS had to make an adjustment to HSA contribution limits for 2018, which were set before the tax bill passed.

Under the original CPI application, the cap on family HSAs was $6,900, but was revised to $6,850 when the Chained CPI was applied. Use of the Chained CPI did not affect caps on individual contributions.

Contributions to HSAs are made on a pre-tax basis, grow tax-free over time, and withdrawals are not taxed when they are used for qualifying health expenses. They must be used with qualifying high-deductible health plans.

For calendar year 2019, high-deductible plans will be defined as those with at least a $1,350 deductible on individual plans and a $2,700 deductible on family plans, both unchanged from 2018.

Qualifying high-deductible plans will have to cap out-of-pocket expenses—deductibles and co-payments, but not premiums—at $6,750 for individuals and $13,500 for family plans, an increase of $100 for individuals and $200 for families from 2018, according to IRS figures.

Which changes to report to the Marketplace!

 

You should report the changes listed below to the Marketplace as soon as possible.

Ready to report changes? Log in to your account.

Changes to report

  • Changes to your expected income for the year
  • Changes in health coverage:

o   Someone in your household getting an offer of job-based insurance, even if they don’t enroll in it

o   Someone in your household getting coverage from a public program like Medicaid, the Children’s Health Insurance Program (CHIP), or Medicare

o   Someone in your household losing coverage, like job-based coverage or Medicaid

  • Changes to your household or individual members:

o   Birth or adoption

o   Placing a child for adoption or foster care

o   Becoming pregnant

o   Marriage or divorce

o   A child on your plan turning 26

o   Death

o   Gaining or losing a dependent some other way

o   Moving to a permanent address in your state.

o   Change in disability status

o   Change of tax filing status

o   Change of citizenship or immigration status

o   Change in status as an American Indian/Alaska Native or tribal member

o   Incarceration or release from incarceration

 

 

For further information call:  Eric Walters

Cell: 602-616-1660

WEB: www.ewconsultant.biz

HSA’s to cover more health benefits

U.S. Rep. Mike Kelly (R-PA) hopes to make health care more affordable for Americans by giving their employers better benefit options to offer them under improved Health Savings Accounts (HSAs).

Rep. Kelly on March 1 introduced the Bipartisan HSA Improvement Act, H.R. 5138, which would improve access to health care through updated HSAs, according to a summary provided by his office. The bill was co-authored by U.S. Rep. Earl Blumenauer (D-OR) and includes cosponsors U.S. Reps. Erik Paulsen (R-MN) and Brian Fitzpatrick (R-PA).

“With so many people increasingly choosing HSA plans, it is important that federal rules allow employers to provide the best benefits possible for their employees,” said Rep. Kelly. “By modernizing HSA policy, this bipartisan bill will promote flexibility, encourage innovation, and expand access to these cost-saving plans for many more Americans.”

An HSA is a type of savings account that allows a person to set aside money on a pre-tax basis to pay for qualified medical expenses. Using untaxed HSA dollars to pay for deductibles, copays and other expenses allows people to lower their health care costs, according to the U.S. Centers for Medicare and Medicaid Services. Currently, more than 20 million Americans are enrolled in HSA-qualified plans, Kelly said, which puts them “in the driver’s seat of their health care, helping them save money and stay healthy.”

Among other provisions in the proposed bill, H.R. 5138 would allow HSA plans to offer HSA dollars that people could use for wellness benefits, including exercise; and to offer pre-deductible coverage for medication and services that help manage chronic conditions, and for health services provided at both onsite employee clinics or retail health clinics, according to the summary.

“By expanding access to affordable care, promoting wellness and strengthening innovation, this legislation will help Americans stay healthy while saving money,” Rep. Blumenauer said.

H.R. 5138 has been referred to the House Ways and Means Committee for its consideration.

2018 Family HSA contribution reduced!

IRS announces 2018 family contribution changes for HSAs

Today, the IRS published Internal Revenue Bulletin (IRB) 2018-10 that contains Revenue Procedure (Rev. Proc.) 2018-19.

Effective for calendar year 2018, the family contribution limit for HSAs has been lowered to $6,850 from the previously set amount of $6,900. This change came as a result of the tax reform law (P.L. 115-97) that changed the annual inflation adjustment factor from the Consumer Price Index (CPI) to a new factor known as ‘chained CPI’. This change was anticipated to slow the rate of changes in all programs under the tax code, including HSAs.

For any further information call:  Eric Walters

Cell: 602-616-1660

WEB: www.ewconsultant.biz

ACA Bog site: www.azhealthinsuranceblog.com

 

Trump admin to change 90 day Short Term Medical rule!

Trump Administration to abandon 90-Day Ruling for Short Term Medical coverage!

Proposed rule to allow short-term, limited-duration insurance for longer periods providing increased choice at a lower cost

In direct response to President Trump’s October 2017 Executive Order, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) issued a proposed rule today that is intended to increase competition, choice, and access to lower-cost healthcareoptions for Americans.

The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law.

Short-term, limited-duration insurance, which is not required to comply with federal requirements for individual health insurance coverage, is designed to provide temporary coverage for individuals transitioning between healthcare policies, such as an individual in between jobs, or a student taking a semester off from school.

This announcement builds on the President’s October 2017 Executive Order 13813, “Promoting Healthcare Choice and Competition Across the United States,” which directs the Departments to consider proposing regulations or revising guidance to expand the availability of short-term, limited-duration insurance and allow it to cover longer periods.

The Departments published a final rule in 2016, which restricted short-term, limited-duration insurance to less than three months. Key stakeholders, including state regulators, have expressed concerns that the current limit could cause harm to some consumers, limit consumer options, and have little positive impact on the risk pools in the long run.

Today’s proposed rule would address these concerns by reverting to the previous definition of short-term, limited-duration insurance which permits coverage for nearly a full 12 months.

The link to the proposed rule can be found here: https://www.federalregister.gov/documents/2018/02/21/2018-03208/short-term-limited-duration-insurance,

Comments on the proposed rule are being accepted now.

Contact:  Eric Walters

WEB: www.ewconsultant.biz

CELL: 602-616-1660

Email: ewinsurance@gmail.com

 

 

 

 

New Tax Bill & Individual Mandate

December 20, 2017

Tax Reform Bill Includes Repeal of Individual Mandate Beginning in 2019

On Dec. 20, Congress passed the Tax Cuts and Jobs Act, which makes significant changes to individual and corporate provisions of the U.S. tax code, including a reduction in the corporate tax rate to 21%, down from 35%, beginning in 2018.

The bill includes permanent effective repeal of the Affordable Care Act (ACA) individual mandate, requiring individuals to purchase and maintain health coverage, by zeroing out the penalty beginning in 2019.

For 2018, most individuals are still required to maintain coverage or pay a penalty when they file their 2018 federal income tax return.

The bill was negotiated by a conference committee comprised of representatives from both the Senate and House after each chamber passed their own versions of tax reform. The final bill was passed 51-48 by the Senate and 224-201 by the House before being sent to the President. President Trump is expected to sign the bill into law soon.

The bill also changes how certain tax thresholds will be indexed for inflation. Affected provisions, including the ACA “Cadillac” Tax (scheduled to take effect in 2020), will now be indexed to the Chained Consumer Price Index (CPI) instead of the regular CPI (the previous metric). That change makes it likely that more employer-sponsored plans would trigger the Cadillac tax sooner.

Phoenix Tops US in population growth!

Phoenix Tops US in Population Growth

 Article originally posted on Phoenix Business Journal on May 25, 2017

Phoenix is tops in the U.S. for population growth, according to new data from the U.S. Census Bureau.

Phoenix added 32,113 persons to its population between July 2015 and July 2016. That’s more than any other city in the U.S.

Los Angeles added 27,173, San Antonio 24,473 and New York 21,171 persons during the same time frame, according to the Census data. The population data is for cities and not metro areas.

That is good news for the real estate industry, home and apartment builders and business recruiters. It also shows the Phoenix market is getting back to pre-recession norms after the last real estate and economic crash.

Population growth stalled during and right after the recession.

The Phoenix metro area and Arizona as a whole have long depended on population growth to fuel construction, retail and restaurants and business services. A larger population also means Phoenix is in line for more federal funding for transportation, infrastructure and security dollars for programs based on population.

The city of Phoenix is expanding its Metro light rail system and also wants to bring more residents to its downtown core. A growing population can help convince developers and builders to do that.

The city of Phoenix’s population now totals more than 1.6 million persons. That ranks fifth among U.S. cities and ahead of Philadelphia (1.57 million).

New York is the largest U.S. city at 8.5 million followed by Los Angeles at 3.98 million and Chicago with 2.7 million.

The Phoenix metro area has 4.66 million persons. That ranks 12th nationally.

Maricopa County also topped the list of U.S. counties for population growth during the same time frame.

Lee McPheters, an economist with Arizona State University’s W.P. Carey School of Business, is projecting 2 percent population growth for the Phoenix metro this year. That comes after 2.1 percent growth in 2016 and 2 percent in 2015. A growing population certainly shows economic attractiveness and strength and appeals to employers looking for workers, home and apartment builders as well as real estate investors.

The Valley’s large labor pool is attractive to back-office and call centers and distribution hubs.

JPMorgan Chase & Co. (NYSE: JPM), Amazon.com Inc. (Nasdaq: AMZN), Bank of America (NYSE: BAC) and Wal-Mart Stores (NYSE: WMT) all have large operational footprints in the Phoenix market.

The West Valley city of Buckeye also ranks as one of the fastest growing U.S. cities posting 4.8 percent growth between July 2015 and July 2016. Buckeye has 64,629 residents, according to the Census Bureau.

That growth ranks Buckeye seventh nationally. Conroe, Texas near Houston had the highest growth at 7.8 percent. Frisco, Texas near Dallas was second with 6.2 percent population growth.

Overall most of the population growth in the U.S. is in the South and West.

“Overall, cities in the South continue to grow at a faster rate than any other U.S region,” said Amel Toukabri, a demographer with the Census Bureau. “Since the 2010 Census, the population in large southern cities grew by an average of 9.4 percent. In comparison, cities in the West grew 7.3 percent, while cities in the Northeast and Midwest had much lower growth rates at 1.8 percent and 3 percent respectively.”

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