The Affordable Care Act has totally changed the world of Individual and Family Health Insurance. Gone are the days of an insurance company not covering pre-existing conditions or charging you more for known health conditions. There are now only restrictions when you can purchase new coverage. You will need to take advantage of the Annual Open Enrollment Period or have a Qualifying Event to open a window on a Special Enrollment Period. Qualifying Events are things like termination of employment, birth, death, divorce or moving to a new area.
The 2015 Annual Open Enrollment period runs from November 15, 2014 through February 15, 2015.
In either case, you can look you can get a free quote with the link below:
Choosing the Plan that is Right for Your Household-
1) Cost- The first consideration is typically cost. Bronze plans will be the least expensive. You will need to factor in your household’s eligibility for receiving a subsidy for the purchase of health insurance. Please see below for basic guidelines in making this determination.
2) Point of Purchase- The second consideration will be your point of purchase- On the Exchange or Off the Exchange. If your household is eligible for a subsidy, you must purchase coverage through Connect for Health Colorado- we will assist you! If your household is not eligible for a subsidy, KMB recommends applying directly to your chosen carrier to avoid some of the issues associated with the exchange/marketplace.
3) Provider Network Size and Flexibility- PPO, EPO, HMO. Many of the new plans have reduced the size and access of their networks. You will want to be aware of any restrictions on a carrier by carrier basis.
4) General Coverage Characteristics- Do you want coverage that includes copays for daily expenses, or are the tax advantages associated with a Health Savings Account (HSA) a better fit? How much out of pocket exposure can you afford- higher out of pockets will typically mean a lower premium.
5) Carrier Stability and Track Record- Please consider the “Name-Brand” carriers first. The Affordable Care Act has allowed several new carriers to enter Colorado to market their products. While we feel these carriers will be great for competition over the long-term, we would recommend you choose a carrier with a track record. We would ask that you consider options from (in alphabetical order, not preference)- Anthem Blue Cross/Blue Shield, Assurant, Cigna, HumanaOne, Kaiser Permanente and Rocky Mountain Health Plans.
Subsidy Eligibility-
Should you feel that your household might qualify for an Advanced Premium Tax Credit you will need to limit your shopping to the “On Exchange” options. The Advanced Premium Tax Credit is also known as “the Subsidy”. To qualify for a subsidy your household income must fall within Federal guidelines. Household income must be between 133% and 400% of Federal Poverty Limits (FPL). Additionally, if your household income is less than 250% of FPL, you may qualify for additional assistance in the form of lower copays, deductibles and out of pocket amounts; you must purchase a Silver plan for this additional assistance. Here is a chart for determining your household eligibility:
2014 Federal Poverty Guidelines
48 Contiguous States and DC
|
Household Size |
100% |
133% |
150% |
200% |
250% |
300% |
400% |
|
1 |
$11,670 |
$15,521 |
$17,505 |
$23,340 |
$29,175 |
$35,010 |
$46,680 |
|
2 |
15,730 |
20,921 |
23,595 |
31,460 |
39,325 |
47,190 |
62,920 |
|
3 |
19,790 |
26,321 |
29,685 |
39,580 |
49,475 |
59,370 |
79,160 |
|
4 |
23,850 |
31,721 |
35,775 |
47,700 |
59,625 |
71,550 |
95,400 |
|
5 |
27,910 |
37,120 |
41,865 |
55,820 |
69,775 |
83,730 |
111,640 |
|
6 |
31,970 |
42,520 |
47,955 |
63,940 |
79,925 |
95,910 |
127,880 |
|
7 |
36,030 |
47,920 |
54,045 |
72,060 |
90,075 |
108,090 |
144,120 |
|
8 |
40,090 |
53,320 |
60,135 |
80,180 |
100,225 |
120,270 |
160,360 |
Please note that if any member of your household is eligible for affordable and qualifying employer-sponsored health insurance your entire household cannot claim the Advanced Premium Tax Credit. If you claim the subsidy, but are not technically eligible to do so, you will have to pay it back as part of your tax return.
If your household will/does not qualify for the subsidy, we would recommend that you go directly to the carrier so you can avoid the Marketplace “Mess”. You can apply directly with your chosen carrier by using the “Apply Now” button on the provided illustrations.
It usually takes two to three weeks for an application to be fully processed by the selected carrier from the date received by the carrier. All policies issued with an effective date on or after January 1, 2014 cannot impose pre-existing condition limitations.