Thursday, November 20, 2014

Health Insurance Enrollment FAQs

Understanding the Affordable Care Act 

Insure the Lake can help you with your Lake of the Ozarks health insurance needs.  Open enrollment for 2015 will be from November 15, 2014 to February 15, 2015.  For 2015, coverage can start as early as January 1, 2015.  Insurance in the Marketplace are offered by private companies and they all cover the same core set of benefits, known as essential health benefits.  No plan can turn you away or charge you more because you have an illness or medical condition, and plans can't charge women more than men.

Q: What does Marketplace health insurance cover? 

A: All private Lake of the Ozarks health insurance plans offered in the Marketplace offer the same set of essential health benefits.  These benefits include at least the following items and services:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital) 
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born) 
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventative and wellness services and chronic disease management
  • Pediatric services

Q: Am I eligible for coverage in the Marketplace? 

A: Most people are eligible for health coverage through the Marketplace. To be eligible through the Marketplace, you: 
  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present) 
  • Can't be currently incarcerated

Q: What if I have a pre-existing health condition? 

A: Being sick doesn't keep you from getting coverage.  A Lake of the Ozarks insurance company can't turn you down or charge you more because of your condition.

Q: Will I qualify for lower costs on monthly premiums? 

A: When you get health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums. This will depend on your household size and income. When you fill out a Marketplace application, you’ll report your household size and income. If your income falls between the amounts shown below, you’ll qualify for a premium tax credit that you can apply directly to your monthly premiums. This means you’ll pay less money to your health insurance company each month.  Keep in mind that if you or your spouse have other coverage available, you may not be eligible for a subsidy.

If your income falls within the following ranges, you’ll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit. (The amounts below are based on 2014 numbers and are likely to be slightly higher in 2015.)

  • $11,670 to $46,680 for individuals
  • $15,730 to $62,920 for a family of two 
  • $19,790 to $79,160 for a family of three
  • $23,850 to $95,400 for a family of four
  • $27,910 to $111,640 for a family of five
  • $31,970 to $127,880 for a family of six
  • $36,030 to $144,120 for a family of seven
  • $40,090 to $160,360 for a family of eight

Q: What is modified adjusted gross income? 

A: When you fill out the Marketplace application, a number called “modified adjusted gross income” (MAGI) will be used.  MAGI is generally your household’s adjusted gross income plus any tax-exempt Social Security (except for SSI, which is not counted), interest and foreign income you have. It’s used to determine your eligibility for lower costs on Marketplace coverage, and for Medicaid and CHIP.

Q: What if someone doesn't have health coverage? 

A: Beginning in 2014, if you don’t have health coverage, you may have to pay a fee. You may also have to pay for all of your health care. The fee is sometimes called the "penalty," "fine," "individual responsibility payment" or "individual mandate."

Q: How do I apply for health coverage? 

A: Use to apply for health coverage, compare plans and enroll online or over the phone.  You can also enroll directly through an insurance company by using an agent. If your income is too high to qualify for lower costs on coverage, you can buy health coverage outside the Marketplace, directly through an insurance company.

Delivering all of your Lake of the Ozarks Health Coverage needs - Insure the Lake!
We can help you with all of your Lake of the Ozarks insurance needs. You can have peace of mind.   Contact us for a FREE quote request.

Steve Naught, CIC

3736 Osage Beach Parkway
Osage Beach, MO 65065
Next to Golden Coral

T: 573-348-2794
F: 573-348-0191