Wednesday, March 9, 2016

Life Series Part I

Life Series Part I: Health Care



Did you wake up one day and realize that you are all of a sudden responsible for you. Your actions? Your life? It's part of the very sad and tragic circle of life. So, what does "adulting" actually mean? Let's take a look: College, Banking, Career (applications, resumes, job hunting), Dr. Appointments, Bills, Insurance (health, car, home, etc), Taxes...the list goes on and on and on.

Starting a series on How To Handle Life seemed appropriate considering the number of people who simply just do not get it. ***I was fortunate and had the luxury of a husband (boyfriend at the time) when these issues came up who handled them...while teaching me along the way. I have encountered so many people however, that either weren't that lucky, did not have the learning opportunities (family or school wise), or simply never cared to figure it out themselves. Thus, the reason for this awesome series!

I will be covering a myriad of topics to help you or someone you know (friend, sibling, child) navigate this treacherous thing we all call adulthood.


Lesson 1: Health Insurance

Everyone at this point has heard of ObamaCare. And whether or not you like it, it's here to stay...well, hahaha for the next year or so at least. So, save yourself the heartache, the penalty fees and healthcare struggle in general and let me explain a little more in depth about what ObamaCare is and how to obtain it. The in's and out's of the new healthcare system are tricky, but here is some very valuable info. Enjoy.


What is ObamaCare?
The official name for “ObamaCare” is the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) for short.
• The ACA was signed into law to reform the health care industry by President Barack Obama on March 23, 2010 and upheld by the Supreme Court on June 28, 2012.
• ObamaCare’s goal is to give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending.• The Affordable Care Act expands the affordability, quality, and availability of private and public health insurance through   consumer protectionsregulationssubsidiestaxes,insurance exchanges, and other reforms.• January 31st, 2016 was your last chance to get 2016 coverage at Healthcare.Gov without qualifying for Special Enrollment

Now that you understand what ObamaCare is, let's discuss a few key topics:

1. Why do you need Health Care/ObamaCare?


The obvious reason, would be to protect you and your loved ones from unseen catastrophic events. But it's not just catastrophic events that can throw your family into a financial crisis. Simple things like strep throat, the flu, a broken arm, having a baby...and let's face it-if you have kids and no insurance, you are setting yourself up for major failure! Anyone who has children knows that the doctor's office becomes your second home. 

2. What are the repercussions for not having Health Care/ObamaCare?

If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. (The fee is sometimes called the "penalty," "fine," or "individual mandate.")

The Fee for not having Health Insurance in 2016...
The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
Percentage of Income:
  • 2.5% of household income
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
Per Person:
  • $695 per adult
  • $347.50 per child under 18
  • Maximum: $2,085
Paying the fee:
  • Using the percentage method, only the part of your household income that’s above the yearly tax filing threshold ($10,150 for individuals, $20,300 for couples filing jointly in 2014, the most recent year available) is counted.
  • Using the per-person method, you pay only for people in your household who don’t have insurance coverage.
  • If you have coverage for part of the year, the fee is 1/12 of the annual amount for each month you (or your tax dependents) don’t have coverage. If you’re uncovered only 1 or 2 months, you don’t have to pay the fee at all. Learn about the “short gap” exemption.
  • You pay the fee when you file your federal tax return for the year you don’t have coverage.
3. What are the costs associated with Health Care/ObamaCare?


First, let's take a look at the different plans associated with ObamaCare:



1. Bronze- Bronze plans tend to have the lowest premiums of all Metal Plans. That is because they only have to provide 60% of cost sharing on average. Bronze plans provide an average cost sharing value (known as Actuarial Value AV) of 60%. This means that a Bronze plan must cover an average of 60% of all that plans enrollees covered out-of-pocket costs. This does not mean that 60% of actual costs will be covered for any one given person. In fact, a small minority of policy holders will account for the majority of costs. So actuarial value should always be looked at as a sign of how good a plan’s cost sharing is, not as a literal amount. Literal cost sharing amounts can be found on a plan’s benefit sheet.



2. Silver- Silver Plans are the marketplace standard plan. The second lowest cost Silver plan in a state is used as the benchmark plan when determining subsidies.

Silver plans provide an average cost sharing value (known as Actuarial Value AV) of 70%. This means that a Silver plan must cover an average of 70% of all that plans enrollees covered out-of-pocket costs (based on a standard population). This does not mean that 70% of actual costs will be covered for any one given person. In fact, a small minority of policy holders will account for the majority of costs. So actuarial value should always be looked at as a sign of how good a plan’s cost sharing is, not as a literal amount.
3. Gold- Gold plans provide an average cost sharing value (known as Actuarial Value AV) of 80%. This means that a Silver plan must cover an average of 80% of all that plans enrollees covered out-of-pocket costs. This does not mean that 80% of actual costs will be covered for any one given person. In fact, a small minority of policy holders will account for the majority of costs. So actuarial value should always be looked at as a sign of how good a plan’s cost sharing is, not as a literal amount. In some states Gold plans must meet additional criteria, making cost sharing offered on these plans even more attractive. Of course with better cost sharing, comes higher premiums.


4. Platinum- Platinum plans are designed to cover 90% of out-of-pocket costs on average. This is known as having an Actuarial Value of 90%. This means for a standard population the plan will on average cover 90% of all out-of-pocket costs for essential health benefits. This is not the exact amount of cost sharing your plan will provide you.

Given the generous cost sharing, platinum plans have the highest premiums on average. Not all insurers offer Platinum plans on the Marketplace. Different states may have different rules for what these plans must offer beyond minimum standards in the ACA.
***For information on costs for you and your family, please visit https://www.healthcare.gov/apply-and-enroll/health-insurance-plans-estimator-overview/ to get a free estimate.

4. Where do I sign up?


There are a number of places that you can sign up for your new ObamaCare/Health Care program depending on the state in which you live. Simply do a good search or visit https://www.healthcare.gov/  an enter your information.



Please remember that there are certain open enrollment periods (OEP). This year is November 1, 2016 through January 31, 2017.



**Obamacare Special Enrollment Period


If you’ve experienced a qualifying life event, you may be able to sign up for Obamacare during a Special Enrollment Period. A qualifying life event triggers a 60-day time frame that allows you to apply for a major medical health insurance plan and ensure that your application is approved.

Qualifying life events include the following life-changing events:
  • Loss of essential health coverage: If you or a dependent lose health coverage that meets government standards.
  • Change of family structure: If you get married, divorced, have or adopt a child, or have a death in the family.
  • Change of citizenship status: If you become a U.S. citizen or national.
  • Government error: If you lose, change, or enroll in coverage because of an error committed by an officer, employee, or agent of the Exchange or the Department of Health and Human Services as determined by the Exchange.
  • Change in subsidy eligibility: If you become eligible or lose eligibility for subsidies (advance payments of the premium tax credit or cost-sharing reductions).
  • Move to a new coverage area: If you permanently move to a new area.

5. Why should I Care?


Two simple facts: You love your family. You love your money. Don't put you or your family in financial jeopardy. Also, do you really want to pay fines for not having insurance?

ObamaCare offers a number of new benefits, rights and protections:


I hope this feature on healthcare has been beneficial to everyone. I know there is a lot of confusion about the healthcare system right now. Please share away with anyone and everyone you know that can benefit from this.

For more information on the information above, please visit http://obamacarefacts.com/obamacare-facts/ or www.healthcare.gov.




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