What does it cost to use an Agent?
This is the most frequently asked question for people shopping for health insurance, and the answer is: nothing!
So, how do you make money?
If you work with me I am paid by the insurance company but it does not raise your cost a penny. If you apply through my website this happens automatically, but through the exchange there are a few extra steps:
- Once you have created an account click on Select a Broker on the home page.
- Under Search for a Broker enter my last name “May” in the last name field.
- Click Ask for help
- Click Proceed, then OK.
Health Exchange Info
Open enrollment is over for 2015.
To apply outside of open enrollment you need a qualifying (see qualifying events) event unless you or your children are eligible for coverage through Apple health with an income below 139% of the Federal Poverty Level (see below).
- You or your family is eligible for a tax credit to help reduce the cost of a health plan.
- You, your family, or your child(ren) is eligible for free coverage through Apple Health.
Modified Adjusted Gross Income: http://www.healthinsurancenw.com/wp-content/uploads/2015/07/Modified-Adjusted-Gross-Income.pdf
Advanced income tax credits are designed to make health care more affordable. If you qualify for a credit you must apply through the exchange to receive the credit. The credit is advanced monthly and directly reduces the premium you pay for health insurance. You do not have to take any of the credit during the year. When you file your income taxes the amount of credit you are due less any credit advanced during the year will be reconciled. If you don’t take all the credit due, you will received it when you file your taxes. If you underestimate your income or your income takes a big increase during the year and you don’t adjust your credit you may have to pay back some or all of the credit. For self employed business owners I suggest that they take 50-75% of the credit so they don’t get surprised at tax time.
If one or both adults are eligible for employer provided health insurance that is compliant with the ACA (Affordable Health Care Act) and the premium the employee has to pay for employee only coverage is less than 9.5% of the employee’s income then the plan is deemed affordable and the individual or family is not eligible for a tax credit. Depending on income and family size the adults and/or children may be eligible for coverage through Apple Health.
If your income is below 139% of the federal poverty level (see the tax credit calculator) the adults and children will be eligible for Apple health for free. Apple Health provides 100% coverage for medical, dental, and vision for children and 100% medical with limited preventive dental for adults. Apple health has 5 provider networks and many physicians participate and accept one or more of the networks. There are fewer dentists that accept Apple coverage so you need to make sure they accept Apple for children and/or adults.
If family income is between 139% and 200% the children will receive Apple for free. If income is between 200-250% the children will receive Apple for $20 each per month with a maximum charge of $0 per family. If a woman is pregnant you count the unborn child as a family member and she will receive Apple for free if the family income is below 250% until after the child is born. From 250% to 300% the children will receive Apple for $30 each with a maximum of $60 per family. If the family is over 300% and but below 400% the family may be eligible for a tax credit. Age and income affect the eligibility. A 60 year old at 400% will qualify for a tax credit but not a 20 year old.
There is an important income planning opportunity for early retirees. If you keep your income below 400% you can qualify for a substantial tax credit. If your income is over $62,000 and you are healthy you may want to consider an HSA (Health Savings Account) policy. As a couple you can contribute up to $6,650 into a health savings account to reduce your income and if one of you or both of you is over 65 you can add $1,000. The contribution is tax deductible and can be used to reduce your income below the $62,000 threshold. For example a couple both age 55 has an income of $69,649. If they contribute $7,650 into a Health Savings account they will reduce their income to $61,999 and be eligible for a monthly tax credit of $447 or $5,364 for the year. So they are getting paid $5,364 to save $7,650.
When using the calculator enter your location, zip code, and income. Enter your household income including W-2 income, net rental income after expenses, net self employment income after expenses, K-1 income, S corp income, interest, and dividends. Do not include child support or L&I. Deduct any SE tax (line 27 on your 1040), contributions to an IRA, HSA, or if you are self employed, self employed health insurance premiums (line 29). Do not include any income for children under age 19 if they do not have to pay tax on the income.
Then enter family size, and adult ages, then hit submit. Look at the percentage of the Federal Poverty Level (FPL) first. If it is below 300% then the children will be eligible for Apple and if you are eligible for a tax credit you will see the approximate monthly credit amount. The calculator usually underestimates the amount of the credit.
If your family is over 300% then go back and enter the number of children in your family and this will increase your tax credit since the children are not eligible for Apple.
Adult children age 19 or over not on your tax return should not be included in the household and must apply separately based on their age and income if they need coverage.
Children age 19 and over who are eligible for Apple must be included but you list them as not applying and then they need to have their own separate application. On the child’s app in this case you do have to list applying for “myself” but you need to add the rest of household members and their income. This is complicated I realize and the customer service reps at the Health Plan Finder or I can help you with this process.
You need to have proof of legal status if you do not have a Social Security number i.e. passport, green card, citizenship papers, etc.
Once you select a plan (I can help with this) you will need to pay a premium. If you pay by the 23rd coverage will start the first of the following month. If you are eligible, the next screen will ask how much of the tax credit you want to use from 0 to 100%.
Preventive Services Coverage: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html
General Health Insurance Info
Medicare Part A Hospitalization is free and there is no reason not to enroll in this coverage.
Medicare Part B Medical is $104.90 unless you are subject to an income surcharge. (Single income over $85,000, couple $170,000). Enrolling in Part B is not mandatory but recommended. A few people only enroll in Part A and B with no supplement or Medicare Advantage coverage. If you do not enroll in Part B when you are eligible and enroll later you are subject to a 10% per year permanent surcharge. The one exception is if you are covered by an employer group plan that is Medicare creditable. If this is the case you can enroll when you leave the employer coverage without penalty.
Medicare Part D Prescription Drug coverage is provided by private insurance companies and prices start at $17/mo. You can shop, compare and enroll with a Part D plan at www.medicare.gov.
1. Medigap or Medicare Supplement plans
These plans are offered by private insurance companies and are standardized nationwide. You must be enrolled on Medicare Part A and B and most companies only offer these plans to enrollees age 65 or older. You can see any provider who accepts Medicare and these plans pay after Medicare. My most popular plan is Plan F from Regence Blue Shield. It is $182/mo and includes Silver Sneakers.
Silver Sneakers is a nationwide organization which covers membership and many popular gyms locally most YMCA’s, Curves, Any Time Fitness, 24 hour Fitness, and LA Fitness.
After Medicare pays Plan F pays all Medicare covered services at 100%. There is no deductible or co pays except foreign travel has a $250 co pay and then you pay 20%. This is a very good option for people with ongoing chronic medical conditions or for those that don’t want to worry about co pays and out of pocket maximums. Most people add a Part D plan to this option unless covered elsewhere like the VA.
Medicare Advantage plans
These plans are also offered by private insurance companies and they replace Medicare coverage. You must be enrolled on Medicare Part A and B. These plans are available for individuals enrolled on Medicare A and B prior to age 65 as long as they do not have end stage renal failure, or ALS.
Prices range from $0 to over $200/mo.
Most of these plans include Part D coverage and many include some vision coverage and annual physical exams. People with prescription coverage through the VA may enroll in a plan without Part D coverage. These plans may have a small or no deductible but there will be co pays for office visits, hospital and skilled nursing home stays, and prescriptions.
A typical $0 premium plan may have an annual out of pocket maximum of $6,000 while a plan with a $200/mo premium may have an annual out of pocket maximum of $2,000.
The most popular Medicare Advantage plans are PPO (preferred provider organizations or HMO (Health Maintenance Organizations). PPO plans allow you to go out of network to providers of your choice for a higher premium and higher co pays. HMO plans only cover their list of providers except in the case of an emergency. All plans cover you worldwide for emergencies. Medicare Advantage plans include Silver Sneakers.