Affordable Care Act (Obama Care) Enrollment Starts TODAY!

The enrollment period for healthcare coverage is set to begin today under the new Affordable Care Act (Obama Care). There is a great deal of confusion about the program itself as well as the enrollment process due to the amount of detailed information currently available. The initial enrollment period for individual and family coverage will run from October 1st, 2013 to March 31st 2014.


Some of the things we currently know:

• In 2014 all eligible Americans will be required to carry health insurance or be subject to a fine.
• Tax incentives will be offered to offset premiums and out of pocket expenses based upon income levels tied to the federal minimum poverty level.  
• No one can be excluded or charged a higher premium for pre-existing health conditions.
• Qualified Health Plans will be available through Marketplaces (previously called exchanges) for individuals and families who do not have access to affordable employer-sponsored plans.
• The marketplaces for each state will provide a place to compare coverage options and to purchase health insurance. The selection of a plan that works best for you may be determined with the assistance of a certified agent or broker.

To Read more about the Affordable Care Act, see below:

• Consumers can use agents and brokers to help guide them through the process of enrolling and selecting their health insurance plan without additional cost.  We are here to help.
• Insurance carriers can not limit or exclude coverage for pre-existing health conditions.  This provision is called guaranteed issue.  Insurers must also offer to renew or continue all in force coverage at the option of the policyholder, which is called guaranteed renewability.
• Insurance carriers are limited to basing premium variations to age, family composition, geographic area and tobacco use.  Tobacco use premium surcharge is limited to 1.5 times the non-tobacco users rate.
• Premium rates can very by age for enrollees between the ages of 21 and 63 on each birthday until age 63.  Older enrollees can not be charged more than 3 times the amount that younger enrollees are charged.
• Health plans must make coverage available to children up to the age of 26.  Young adults can join or remain on parents insurance coverage even if they are married (coverage does not extend to married child’s spouse), not living in Parent’s household, not attending school, not financially dependent or even if they are eligible to enroll in their own employer’s plan.
• All plans must include 10 Essential Health Benefits (EHB): Doctors Visits, Hospitalizations, Mental Health & Substance Abuse, Rehabilitative Services & Devices, Laboratory Services, Emergency Services, Maternity & Newborn Care, Prescription Drugs, Preventive & Wellness Management and Pediatric Services.
• Lifetime and annual coverage limits are eliminated on all plans under the Affordable Care Act.
• Out of pocket expenses (deductibles & coinsurance) are capped for 2014 at $6,350 for an individual and $12,700 for families enrolled in individual market plans.
• The plans available in the Individual Marketplace (Exchanges) will be: Catastrophic – offers least amount of coverage but must comply with above maximum out of pocket limits, Bronze – 60% of cost paid by insurer, Silver – 70% paid by insurer, Gold 80% paid by insurer, Platinum – 90% paid by insurer up to out of pocket limits above.
• When the application process begins on October 1st 2013, an individual must live in the United States, be a resident in the state where enrolling.  Also they must be a United States citizen or national (or a lawfully present non-citizen), not be incarcerated, other than incarceration pending the disposition of charges.
• To apply for coverage you will need to visit your states Marketplace website and complete one application.  By completing a single, web-based application, you will receive health insurance coverage options, eligibility guidelines for premium tax credits and cost sharing reductions.
• When completing the application your information will be verified through various government agencies.  If there are inconsistencies you will need to resolve them in order to continue the process.
• Premium Tax Credits is a new income tax provision that helps individuals and families afford health insurance coverage through the Marketplace.  You may choose to apply all or some of your tax credit towards the premium cost on an advanced basis which will be paid directly to the insurance company.  At the end of each year your account will be reconciled.  You also have the option of taking the tax credit on your tax return.
• Cost sharing is also available to some, which is a tax credit applied deductibles and coinsurance.  Premium tax credits and cost sharing eligibility are based on income requirements.
• In order to qualify for premium tax credit your income must be between 100% and 400% of the federal poverty level.  The federal poverty level for 2013 is $ 11,490 for an individual and $ 23,550 for a family of four.
• To be eligible for cost sharing programs you must have an annual household income at or below 250% of the federal poverty level and also be enrolled in a silver level plan through a Marketplace.
• In order to receive premium tax credits and cost sharing, you must select the Silver (70% co-insured) plan through the Marketplace.
• There will be open enrollment periods annually with special enrollment periods for certain triggering events such as: becoming or gaining a dependent, becoming a citizen, loss of Medicaid eligibility, loss of affordable employer sponsored coverage, permanent move to another state or other exceptional circumstances as identified by the Marketplace.
• You will have 60 days to enroll for new births, adoptions and marriage.  If the Individual Marketplace is notified before the last day of the month that the marriage occurred, coverage will begin the 1st of the following month.
• Under the Affordable Care Act you may have an agent or broker assist you through the process.  There is no additional cost to you by having an agent or broker assist you!

Pinnacle Insurance is here to help you. As your agent, we can assist you in correctly identifying program eligibility, including potential options for financial assistance, as well as completion of the Affordable Care Act application to avoid enrollment delays due to application errors.

Affordable Health Care Reform is here and it will change the manner in which many people make coverage selections and buy health care coverage. Are you ready? We are here to make sure you don't take chances with your health.
Please feel free to call if you have questions or feel we can be of service, call Pinnacle Insurance at 412-816-1000 or visit our website www.pinnacle4ins.com.