These resources are for anyone shopping (or helping someone shop) for health coverage within the health insurance marketplaces created through the Affordable Care Act (also known as the ACA or Obamacare).
This year, open enrollment begins on Nov. 1, 2020, and ends Dec. 15, 2020.
commonly asked questions regarding the ACA and how it affects you.
This cartoon explains health insurance using fun, easy-to-understand scenarios. It breaks down important insurance concepts, such as premiums, deductibles and provider networks. The video explains how individuals purchase and obtain medical care and prescription drugs when enrolled in various types of health insurance, including HMOs and PPOs.
This is the third YouToons video written and produced by the Kaiser Family Foundation. The video is narrated by former U.S. Senate Majority Leader Bill Frist, a nationally-recognized surgeon and Foundation trustee.
Also available in Spanish: http://youtu.be/mDPhCo11z0E
“Health Insurance Explained – The YouToons Have It Covered” The Henry J. Kaiser Family Foundation, accessed 10/19/2017, www.kff.org/understanding-health-insurance
According to Blue Cross and Blue Shield, the Affordable Care Act (ACA) — formally known as the Patient Protection and Affordable Care Act (PPACA) — puts individuals, families and small business owners in control of their health care.
The ACA is intended to significantly reduce the number of uninsured Americans by providing a continuum of affordable coverage options through new insurance options.
It reduces what families will have to pay for health care by capping out-of-pocket expenses and requiring preventive care to be fully covered without any out-of-pocket expense.
A central goal of PPACA is a U.S. federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, it represents the most significant government expansion and regulatory overhaul of the country’s health care system since the passage of Medicare and Medicaid in 1965.
It provides a number of mechanisms to achieve this goal. These mechanisms include mandates, subsidies, and tax credits to employers and individuals. The ACA also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. Additional reforms aim to improve health care outcomes and streamline the delivery of health care.
Starting in 2014, virtually every American will be required to purchase or have employer-provided medical insurance because of the Patient Protection and Affordable Care Act, or ACA. Those who don’t purchase the insurance will face a tax penalty at the end of the year.
Everyone is responsible for purchasing and maintaining the “minimum essential coverage” for basic health needs.
Minimal Essential Coverage
Minimum essential coverage means securing coverage either through a government-sponsored or employer-sponsored health insurance plan, a private health plan, or any other health benefit plans recognized by the Health and Human Services secretary.
Currently in the U.S. there are millions of Americans who are uninsured and who rely on taxpayer-supported programs when they need health care.
Part of the idea behind minimum essential coverage is this: If everyone is paying for insurance rather than taxpayers paying to support the uninsured, then the overall cost of health care in the U.S. will go down.
Starting in 2014, most people will be required to have health insurance or pay a penalty if they don’t. Coverage may include employer-provided insurance, coverage someone buys on their own or Medicaid.
Several groups are exempt from the requirement to obtain coverage or pay the penalty, including:
- people who would have to pay more than 8 percent of their income for health insurance
- people with incomes below the threshold required for filing taxes (in 2012, $9,750 for a single person and $26,000 for a married couple with 2 children)
- those who qualify for religious exemptions
- undocumented immigrants
- people who are incarcerated
- members of Indian tribes
If you or someone in your family has a pre-existing health condition – such as heart disease, asthma, or even a pregnancy – you will find it much easier to obtain coverage or change plans starting in January 2014.
ACA bars insurers from denying coverage to people with pre-existing conditions, or physical or mental illnesses or conditions that existed before coverage began. Insurers also can no longer refuse to pay for otherwise-covered medical care and services due to a pre-existing condition or charge you more because of a pre-existing condition in the family.
Plans both in and out of the marketplace will come in four levels – bronze, silver, gold and platinum – that will vary in what they cover, what they charge in premiums and what deductibles and other out-of-pocket costs they require. But these plans cannot charge you more based on your medical history. Insurers can only vary their premiums based on your age, the number of people in your family covered by the policy and whether you use tobacco.
As of August 2013, we are not aware of any changes to our existing Medical plan offerings through Blue Cross and Blue Shield of Texas. The federal government has decisions to make and until we have further clarification, CRI will continue to service our existing medical plans. As of Jan. 1, 2014, we have not been able to offer the Association plan to new members. We have alternate plans available.
As the federal government announces decisions, we will post information on this page about how those decisions will affect your coverage through TSCRA and Blue Cross and Blue Shield of Texas.
Bookmark this page and check back periodically for those updates. Watch for ACA updates in The Cattleman News Update, and on The Cattleman NOW (smartphone app).
If you have any additional questions, or just prefer talking with a person, call us at 1-800-252-2849.
The health reform law contains a provision that requires private insurers to continue dependent coverage of children until age 26.
Department of Health and Human Services regulations specify that a young adult can qualify for this coverage even if he or she is no longer living with a parent, is not a dependent on a parent’s tax return, or is no longer a student.
Married and unmarried young adults can qualify for the dependent coverage extension, although that coverage does not extend to a young adult’s spouse or children.
The Department of Health and Human Services (HHS) recently released final regulations regarding the transitional reinsurance program that the Affordable Care Act (ACA) requires each state to establish beginning in January 2014. The transitional reinsurance program is intended to help stabilize premiums in the individual market during the first three years that the state-based exchanges are in effect (2014 – 2016).
The ACA requires all health insurance issuers and third-party administrators (TPAs) (on behalf of self-insured group health plans) to contribute to the reinsurance program.
The total fees to be collected nationwide will equal $12 billion in 2014, $8 billion in 2015, and $5 billion in 2016. The fee will no longer be collected beginning in 2017. The amount that each insurance carrier or TPA must pay will be determined based on all covered enrollees of that organization.
It is important to note that HHS must still develop the exact methodology that will be used to determine the amount of the fee as it applies to any particular state, carrier, or TPA. However, since the total to be collected is fixed by the law, it is possible to estimate the impact the fee may have on a global basis.
(Source: Parker/Smith/Feek/Insurance & Risk Management Brokerage Firm | www.psfinc.com)
The allocated annual fee on Health Insurer Fee and the Reinsurance Fee has been finalized for Blue Cross and Blue Shield of Texas fully-insured groups (51+ employees) at 3.5 percent of premiums in 2014. Medical premiums will be adjusted to include these fees beginning with the bill for January 2014 coverage. (Source News from the Blues/Insurance Carrier | www.bcbstx.com)
Requiring all companies, both large and small, to carry insurance for employees is thought to level out the playing field. The employer mandate gives employers that pay at least 50 percent of their employee’s contributions the ability to write off their insurance payouts by 35 percent. In 2014, that same write off increases to 50 percent. With the money saved, many employers say they can attract better employees, which builds their business and adds back to the economy.
These penalties will begin in 2015, a year later than originally called for in the law. Smaller employers — those with 50 or fewer full-time workers — are not required to offer coverage, but may get tax credits if they do.
Some features of your employer coverage may already have changed as a result of the ACA law. For example, if you are a parent, your children may now stay on your policy until they reach age 26.
Your plan also now likely covers preventive services like immunizations and screenings at no cost to you. Some employer plans in place in 2010 are exempted from this requirement.
Beginning in January 2014, your plan cannot set an annual dollar limit on your benefits that could leave you without coverage if you get seriously ill. Your plan can no longer limit anyone’s coverage for pre-existing conditions nor can your plan no longer limit the total dollar amount of benefits you may receive over your lifetime. Employer plans are required to limit the amount of cost sharing (such as deductibles and co-pays) that you are required to pay for covered services to $6,350 per person per year. This provision will take full effect in 2015.
- Small employers with no more than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees with a tax credit.
- For tax years 2010 through 2013, a tax credit up to 35 percent of the employer’s contribution toward the employee’s health insurance premium if the employer contributes at least 50% of the total premium cost. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25 percent of the employer’s contribution toward the employee’s health insurance premium.
Fees of $2,000 per full-time employee, excluding the first 30 employees, for employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with more than 50 employees that does offer coverage but haa at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees.
The Affordable Care Act (ACA), also known as the health care reform law, affects health care benefits and costs for businesses and employees. Among the provision of the ACA are federally required fees and taxes. These provisions take effect January 1, 2014 and are accounted for in all renewals, as some coverage months, even when renewing in 2013, fall past the January 1, 2014 effective date.
Please be aware that the required taxes and fees are apply to all insurers who offer health insurance benefits, regardless of the health plan carrier. The ACA fees are assessed on insured and self-funded health plans, on a national per capita or per covered life basis. The fees will help fund temporary reinsurance programs (established under ACA) that would operate in each state from 2014 through 2016.
(Source: news from the www.bcbstx.com)
Special enrollment is open to those who experience any of the life events below that occur outside of the U.S. Health Care Open Enrollment window, which is Nov. 1, 2018 to Dec. 15, 2018.
- I gained a dependent due to marriage
- I gained a dependent due to birth, adoption, or placement for adoption
- I am no longer eligible as a dependent under my prior health insurance due to reaching the maximum age, legal separation, divorce or death of policyholder
- I am no longer eligible for my prior health insurance plan due to termination of employment, reduction in number of hours of employment, loss of employer contribution toward my premiums, or I have exhausted my COBRA benefits
- I gained access to new health plan options because of a permanent move
- I am newly ineligible for payments of the advance premium tax credit
- I am no longer residing or living in my prior health insurance plan’s HMO service area
- An error occurred in my previous health plan enrollment
- I have adequately demonstrated that my previous health plan or issuer substantially violated a material provision of its contract with me
- I and/or my dependent(s) lost minimum essential coverage, due to reasons other than non-payment of premium or rescission.
- Other qualifying event(as required or permitted by applicable laws.
Current year coverage
Open Enrollment for the current year ended January 31st. You can still get health insurance 2 ways:
- If you qualify for a Special Enrollment Period due to a life event like losing other coverage, getting married, or having a baby.
- If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can apply any time.
Insurance plans for next year
The Open Enrollment Period runs from November 1 to December 15 each year.
Plans sold during Open Enrollment start January 1 of the following year.
Cattle Raisers Insurance has devised a navigation aid to help you in your decision making process, click here to learn more.