Affordable Care Act (ACA)

Call for Enrollment Assistance

2020 Open Enrollment Period is November 1st - December 15th, 2019

Avoid the glitches of signing up, Agent Express Signup Links: BCBS,  UHC, Cigna; The insurance company you choose will interact with Healthcare.gov (or FFM) to determine your official subsidy (if qualified) and then you can complete your enrollment by the deadline of December 15th, 2019.  (Agent/Broker...NPN#8771610).  To File An Appeal with the Marketplace (pdf)

Health Insurance (Marketplace Plans)

CLICK HERE - Out of Pocket Protection "GAP" Plan   

Dental/Vision Insurance

 CLICK HERE - PPO Dental/Vision Plans 

 AGCY

Understanding Healthcare Reform...Rates, Penalties, Subsidies, Premium Rebates

Guaranteed Issue:  Insurance companies must sell coverage to everyone regardless of pre-existing conditions and can't charge more because of health or gender. 

QUALIFIED HEALTH PLANS (or QHP's) are being offered by BlueCross BlueShield and other carriers.  Private Health Insurance Companies involved in the Affordable Care Act "Obamacare" must abide by the Government Rules in order to participate.  For increased transparency, insurance carriers must allow review of rates as part of the qualification process.  Government experts will monitor and review each carrier's rate hikes. 

Example:  Insurance Companies are not allowed to charge an older adult over 3 X rate of a 21 year old.

The Penalty 

Unknown Status (Individual shared responsibility in 2020 is TBD)

Everyone is required  by law to have health insurance and must be enrolled in a QUALIFIED HEALTH PLAN (QHP) that includes all the minimum Essential Health  Benefits (EHB) in order to avoid the Annual Tax Penalty (based on LINE 37 of IRS Form 1040). 

In 2020, individuals owe 1/12th of the Annual Payment for each month they (or their dependents) did not have coverage and were not exempt.  Individuals without coverage for less than 3 consecutive months during the year may qualify for the Short Coverage Gap Exemption and will not have to make a payment for those months.  The Short Coverage Gap Exemption only applies to the first coverage gap during the year:

The Penalty in 2019 is 2.5% of household income (or $695 per adult and $347.50 per child up to a family maximum of $2085), whichever is GREATER. 

After 2016, the tax penalty will increase annually by the cost-of-living adjustment.

Example of the Penalty in 2019:  Someone earning $50,000/year who chooses not to obtain health insurance with EHB will be penalized $1,250 not $695 (in 2017); the penalty could be affording several months of coverage instead.

Example #2 of the Penalty in 2019:  Someone earning $1,000,000/year who chooses not to obtain health insurance with EHB will be penalized $25,000 not $695 (in 2017).

The Exemptions

If you already have Medicaid, CHIP, Medicare, VA, IHS, TRI-CARE, or Employer Coverage, you're not required to obtain a QHP in order to avoid the annual tax penalty. 

Example: In Houston (Harris County), the Community Harris County Hospital District (HCHD) or "Gold Card" is not a QHP and does not exempt anyone from paying the penalty.  Doctors working in the HCHD are limited on how much they can provide based on funds available in the county and the severity of health problems.  There are no limits with Affordable Healthcare.  QHP's are major medical policies.

With the passage of the Healthcare Reform Act into Law, there are major changes within the health insurance industry.  It's important to make the right plan selections that best fit your situation.  The new changes are in effect and everyone has access to new plans inside the marketplace.