Information About the New Health Insurance Exchange Program


Americans can enroll for health insurance through their State or Federal Insurance “Exchange” beginning on Nov. 15, 2014 through Feb. 15, 2015.  However, regular “qualified” individual and group plans will still be available “off-exchange”, and will satisfy the mandate for being insured.   The Affordable Care Act requires that everyone (with a few exceptions) must have qualified health insurance  After Jan. 1, 2014, or pay a fee/tax.  Each year the penalty, which is based on a certain percentage of one’s income, is scheduled to increase.  IRS will oversee the taxation.

Millions of lower-income Americans will benefit from participation with Qualified Health Plans (or QHP’s) offered through the Federal or States Exchanges.  Subsidies and premium tax credits will be available for those whose incomes are low enough to qualify.  Persons whose incomes exceeds the maximum qualifying amount, will still be able to find individual insurance “off-exchange”.  After Dec. 31, 2013, pre-existing health conditions will no longer cause any applicants to be denied health insurance, a major component of Healthcare Reform for Americans!

The health plans from the Exchanges will be Major Medical insurance, with a variety of deductibles and coinsurance percentages from which to choose.  Doctor visit “copays” will be included on many plans, and all plans will have a “maximum out-of-pocket” responsibility limit per year.  With HMO plans, there will be no benefit coverage for services which are performed at “Out-of-Network” facilities or by “Out-of-Network” providers (physicians, etc.).  These Networks will likely be smaller than most traditional PPO networks!  Be sure that you know whether you are choosing an HMO or a PPO health plan.  It will be indicated as either one or the other.  Not all major insurance companies will participate in the Exchange program in every area.  Ask a certified agent which companies will be available where you live.

Review your current insurance policy’s benefits summary and plan details!  It may be advisable that you consider enrolling in a new health insurance plan if your existing one was issued before Sept. 23, 2010.  Plans prior to that date will be “grandfathered in” and will not have to include those “10 essential health benefits” that will be required on plans issued Jan.1, 2014 and later.  For details about these newly mandated essential benefits, go to:   https://www.healthcare.gov/glossary/essential-health-benefits/ .

Also, plans issued after Sept. 23, 2010 allow children up to age 26 to be included on a parent’s plan, and they cannot be denied coverage if they are under age 19, due to pre-existing health conditions.  (However, they can be assessed a higher rate due to increased risk factors.)  All plans issued after this date must provide coverage for one free annual preventive exam per person.

If you do not enroll in a major medical health insurance plan by the end of “open enrollment” (Feb. 15, 2015) you will not be able to get insurance through the Exchanges again until the “annual enrollment”.  You must, however, have health insurance coverage for at least nine months in 2015 to avoid the tax.  If you experience a “qualifying life event” (QLE), that exception will allow you to apply for health insurance within a certain short period of time.  Some QLE’s are: marriage, divorce, birth, adoption, death, loss of health insurance or a move outside of your current plan’s area.

“Certified agents” and “navigators” will be permitted to enroll you in a plan from the Exchanges.  After reviewing your current insurance policy, why not ask a helpful agent at AustinHealthPlans.com to explain your options?  New individual/family “Off-Exchange” major medical plans will still be available for those who do not choose plans through the Insurance Exchange program.  There is no charge for our services and we can often generate quotes within 24  hrs.  Contact us at: (512) 535-3556 or through e-mail at: tom@austinhealthplans.com for further details.

About tcdiehl

I have been an independent insurance agent licensed in Texas since 2003. My focus is providing affordable insurance coverage through multiple reputable insurance providers for individuals, families, and small groups. I can also help with Medicare insurance needs. Allow me to connect you with the appropriate health, life, disability, long term care, and/or dental plan(s) based on your health, personal, and financial needs. Call me at (512) 535-3556, E-mail: tom@austinhealthplans.com.
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