Mid Georgia Benefits Planning

Important Information!!!

If you have health insurance through the Marketplace, aka Healthcare(dot)gov or ObamaCare, read this.

Two critical points.

First, Friday Healthplans, one of the Marketplace insurers, is exiting the market. If you enrolled in a Friday plan, your coverage will end 07/31/2023. You are eligible to enroll in new coverage to begin 08/01/2023 but you have to select a new plan between 06/01 and 07/31 to avoid a gap in coverage.

Second point, if you live in a Friday Healthplans service area, you likely qualify for a higher monthly tax credit, premium assistance, on your current plan, regardless of company, based on Friday's market exit. In Middle Georgia, Friday's service areas are the following counties-Bibb, Monroe, Peach, Wilkinson, Baldwin and Hancock. The decrease in your premium may range from $50 to $75 for an individual and likely more for a family.

If you'd like to discuss this with me, call me on my cell at 478-390-6359, my office at 478-743-9191 or send me a message. If I miss your call, leave a message or send a text.

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If you have Medicare Advantage with Aetna, don't throw away that mail you may have received recently. It may be money.

Do you have Medicare? If so, you likely have Original Medicare and a Prescription Drug Plan or you have Medicare Advantage, a private insurance alternative to Original Medicare.
Either way, you should have received your Annual Notice of Change (ANoC) by now or you will very soon.
Don't throw it away. It needs to be reviewed. This is how the insurance companies tell you what is changing about your plan for next year. Premiums can change, benefits can change, drugs can move from one tier to another. If you wait until January and notice that your premium went up and your drugs cost more, it may be too late to change.
Talk with your agent, or me if you don't have one. Right now, the only thing anyone can discuss is how your current plan benefits will be different in 2013 and only if you've received your change notice but no comparisons can be made to other plans. Beginning October 1, your coverage can be compared to other plan offerings for 2023. Coverage changes can be processed between October 15 and December 7.
If you have questions for me, give me a call at 478-390-6359.

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It's that time again. If you have individual or family health insurance and want to review it and possibly make changes, now's the time. If you don't have health insurance you can add it now. If you want to talk, call me at 478-743-9191 or 478-390-6359. If you want to look online and talk later, click the link.

https://www.healthsherpa.com/?_agent_id=milton-martin-bnodeq

HealthSherpa | Fast, Easy Obamacare Enrollment HealthSherpa is the fastest and easiest way to enroll in ACA / Marketplace health insurance. Click on the link to shop and compare plans, grab a FREE quote, and sign up for coverage.

On March 11, President Biden signed the American Rescue Act. The new law is extensive but has an immediate impact on health insurance. The health insurance provisions are what I will discuss here.

1 Enhanced Marketplace Premium Tax Credits- Premium Tax Credits are higher for 2021 and 2022. This means if you have a Marketplace health plan your current payment can be reduced. Also, people who previously made too much money to qualify for Premium Tax Credit may now qualify.

2 Unemployment- People receiving unemployment benefits in 2021 will receive Premium Tax Credits as if their income is 135% of the Federal Poverty Level. That’s $17,226 for a single person or $23,274 for a household of two.

3 COBRA Premium Payment- People paying COBRA premium can receive federal payment for those premiums due between April 1, 2021 and September 30, 2021.

Here’s some additional information below but feel free to contact me with questions. Call my office at 478-743-9191, my cell at 478-390-6359 or send a message through Messenger.

Keep in mind that most other Marketplace rules remain in effect. If you are eligible for group health insurance from your employer or a family member’s employer you are still not eligible for Premium Tax Credits from the federal Marketplace.

Enhanced Marketplace Premium Tax Credits- The formula for calculating Premium Tax Credits can seem complicated. I won’t go into great detail here but will explain it further if anyone is interested, just let me know. Here are the basics. Based on your income and how many people are in your tax household, there is a formula to determine how much you can afford to pay for health insurance. That number is compared to the actual premium of a specific health plan available to you, the benchmark plan. The Premium Tax Credit is the difference. For example, a single person making $20,000 can afford to pay about $70 per month under the old formula. If the benchmark plan premium is $500 per month, the federal government will send $430 per month to the insurance company and the individual will send $70 and they have health insurance.

Under the new calculation, that same person with the same income with the same $500 per month plan will qualify for a higher Premium Tax Credit, probably $500 (previously $430) or more or maybe just $490 but either way, their new payment will drop to $0 or $10.

Under the old rules, a household making more than 400% of the Federal Poverty Level made too much money to qualify for Premium Tax Credits. For a married couple, that is $68,960 per year. Under the old formula, this couple could afford to pay about $565 per month. Health insurance for a couple that are 63 and 59 years old could easily be over $2,000 per month. That couple, with an income of $68,950 would qualify for a tax credit of about $1,435 per month and pay $565 or less for health insurance. If their income is $68,960, over 400% of FPL, they would not qualify for any tax credit and would have to pay the entire premium.

This has changed. Now, both couples would qualify for a PTC of over $1,500 per month, under or over the old cut off amount, and now pay less than $500 per month for the same plan.

Unemployment Enhancement- This new rule isn’t quite in place yet but will be implemented sometime this summer, likely June. If you or someone in your tax household received any unemployment benefit in 2021, even if it was only 1 week, you qualify If you are single and make $20,000 or $50,000 or $150,000 your health insurance Premium Tax Credit is now calculated as if you made $17,226 and your responsibility for health insurance premium is now $0. This rule also applies to people who made less than FPL, $12,760, and did not previously qualify for Premium Tax Credit now qualify if they receive any unemployment benefit in 2021.

COBRA Premium Payment- COBRA is a law that allows an employee of certain employers to continue the group health insurance plan they had while working by paying the full premium plus a 2% administration fee. It is typically very expensive. Losing an income due to a layoff then having to pay a health insurance premium that may be greater than your house payment is difficult, to say the least.
The ARA provides that the federal government pay the COBRA premiums for coverage provided between April 1, 2021 and September 30, 2021 for Assistance Eligible Individuals. To be an Assistance Eligible Individual, you must be eligible for COBRA by reduction of hours, change from full time to part time status or an involuntary termination of employment. You are not eligible for COBRA premium assistance if you are eligible for other group health insurance through another job of yours or your spouse’s, Medicare, or certain other employee benefit arrangements.

This payment is made by the federal government to your COBRA administrator, not to you directly.

If you have questions or need assistance, just let me know.