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Healthcare Enrollment Seminar
Presented by Debbie Fleck
Do you have Health Care Insurance?
IT’S THE LAW
2015 OPEN ENROLLMENT
November 15, 2014 to February 15, 2015
Failure to comply will result in a tax penalty unless you qualify for an exemption
Every person in United States is required to have health insurance beginning in 2014
You are uninsured for less than 3 mos of year
You have no tax filing requirement
You are incarcerated
You are not lawfully present in the US
You suffered a hardship
You do not have access to affordable coverage
You may qualify for an Exemption
You may be eligible for government subsidies to help you pay for your health insurance
1. Tax Credit
2. Cost Sharing
Two Types of Healthcare Subsidies
Tax Credit Subsidy
Government pays a part of your insurance premium based on your household income
Individuals with incomes under 400% of FPL may qualify for monthly tax credits
TAX CREDIT SUBSIDY
You can request your Tax Credit as an Advance Tax Credit so it can be used right away to lower your monthly premiums
Cost Sharing SubsidyDepending on Income the Government may subsidize a part of your deductible and out of pocket
Individuals with incomes under 250% of FPL may qualify for subsidized deductible and maximum out of pocket
Cost Sharing Subsidy
Household Income & Family Size
Claim Filing Status
US Citizen or Legal Immigrant
Access to “affordable” Employer-based Coverage or other coverage
Key Factors in determining Subsidy Qualification
If married at the end of 2015, you must file a joint income tax return with your Spouse
To Qualify for Subsidies
No one else will be able to claim you as a dependent on their 2015 tax return
You must file a federal income tax return in 2016 for the tax year 2015
If you have access to “affordable” employer-based coverage , you will not qualify for healthcare subsidies
Affordability Test in 2015
If the premium for the lowest cost plan for employee only coverage is less then 9.56% of household income, the coverage is considered affordable
“Mixed status” families can apply for a tax credit or cost sharing subsidies costs for dependent family members who have legal immigration status
If you do not have legal immigration status, you will not qualify for subsidies
1. Am I eligible to purchase group coverage through my employer? Is my family eligible?
2. Do I have to wait until the open enrollment period to enroll? When is the next open enrollment date?
3. How much is the lowest plan option for single coverage?
4. Does the plan meet the “minimum essential” requirements?
Important Questions for your Employer
What are the Income Thresholds to Qualify for Healthcare Tax Credit Subsidy?
TAX CREDIT SUBSIDIES
Household of One - $12K - $47K
Household of Two - $16K - $63K
Household of Three - $20K - $79K
Household of Four - $24K - $95K
Household of Five - $28K - $112K
Household of Six - $32K - $128K
2015 Numbers are rounded to the nearest $1,000 for simplification
What are the Income Thresholds to Qualify for the Cost Sharing Subsidy?
COST SHARING SUBSIDIES
Household of One - $12K - $29K
Household of Two - $16K - $39K
Household of Three - $20K - $49K
Household of Four - $24K - $60K
Household of Five - $28K - $70K
Household of Six - $32K - $80K
2015 Numbers are rounded to the nearest $1,000 for simplification
Wages, Salaries, Tips, etc.
Taxable Interest & Tax-Exempt Interest
Taxable Pension/IRA Distributions
Unemployment Compensation
Alimony Received
Rental Real Estate & Royalties
Ordinary Dividends & Foreign Earned Income
Social Security benefits, including disability
Net Self-Employment Income
WHAT INCOME IS INCLUDED?
Self-employed Business Expenses
IRA Deduction & H S A Contributions
Alimony Paid
Supplemental Security Income (SSI)
Veterans’ Disability & Worker’s Compensation
Tuition/Fees
Moving Expenses
Gifts
Child Support
DO NOT INCLUDE …
Worker Visa
Student Visa
Temporary Protected Status (TPS)
Lawful Temporary Resident
Asylum & Refugee
Registry Applicants
Order of Supervision
Lawful Permanent ResidentGREEN CARD
Eligible Immigration Examples
Green Card (1-551)
Reentry Permit (I-327)
Alien Number (I-94)
Notice of Action (I-797)
Temporary I-551 Stamp (I-94/I-94A)
Employment Authorization Cfard (I-766)
Refugee Travel Document (I-571)
Common Immigration Documentation
Tax Credit Subsidy is subject to Reconciliation up to Cap
Cost Sharing Subsidy is not subject to Reconciliation
The monthly tax credit is based on your “estimated” income for 2015
IRS will compare your 2015 income tax return to the income estimated on the application
If income is lower/higher than amount included on application, the tax credit will be reconciled on your income taxes
TAX CREDIT SUBSIDY RECONCILIATION
Failure to comply will result in a tax penalty unless you qualify for an exemption
Every person in United States is required to have health insurance
Tax Penalty for Non-Compliance
Higher of:
Two (2) % of your yearly household income
$325 per person up to $975 per family $162.50 per child under 18
Name & Date of Birth
Social Security Number
Employer Name & Phone Number
Household Income
Immigration Documents (if not US citizen)
General Information (address, tax filing, etc.)
What information do I need for each member of my family?
Create a marketplace account at www.healthcare.gov
User Name & Passwords are Case Sensitive
How do I apply?
Marketplac e account created
Your Marketplace account has been created. There is one more step left before you can use your account. Click on this link to verify your email address: https://www.healthcare.gov/marketplace/global/en_US/emailVerification
Open Email & Click on Link - Look for SUCCESS
After Marketplace Account is Created go to Email Account
Verify your Identify
Complete your Marketplace Application
What are the Next Steps?
Select a Plan
You will need to pay your 1st Month’s Premium to Activate your Policy
FINAL STEP
No Cost to You for obtaining professional advice from a Licensed Agent
Agent information must be entered at the beginning of the application
Navigators, Application Assisters, & Customer Service Representatives are not licensed agents and cannot provide professional advice on selecting a plan
Debbie Fleck (License #1044540)Independent Texas Agent since 7/25/1995
Licensed in Texas, Florida, Tennessee, Colorado, & Georgia
RHU Designation
AHIP Medication certification
SgS designation
ACBS designation
PPACA certification
FMM certification
ChHC designation (almost complete – 1 more exam)
REBC designation (almost complete – 2 more courses)
Deborah Fleck
The Diamond Benefit
FFM User ID: FADKAL1044540
NPN #: 1019320
Debbie Fleck can assist with healthcare enrollment - Information must be included at beginning of application
No changes to your plan
until the next open
enrollment period
Pick your Plan Carefully
What is Your Budget?
PLATINUMGoldSilverBronze
Your options Depends on Your Budget
PPO versus HMOOffice Visit CopayPrescription CopayDeductible LevelOut of Pocket LevelQualified H S A Plan
Plan Considerations
PPO More flexibility but higher monthly premium
cost
Access to a much larger network of providers
You do not need to select a PCP
You can choose providers outside the network,
but your benefits will be better in the network
PPO versus HMO
HMO Less flexibility but lower monthly premium cost
Access to a smaller network of providers
You must select a primary care physician (PCP)
who will coordinate your care
You will need a PCP referral to see a specialist
You must obtain services from only HMO
providers
PPO versus HMO
A Deductible is the amount that you pay for your healthcare services before your benefits begin – depending on your plan the deductible may not apply for doctor’s visits and prescriptions The Out of Pocket Maximum is the most you will have to pay of eligible expenses, including your deductible & copays
A Copay is a fixed amount you pay each time you receive services
All Plans Provide Preventative with No Cost Sharing (100%, No Deductible)
All Plans are Unlimited (No $ Limit) which provides protection for large medical bills
Some plans include Office Visit and Prescription Copays without having to meet the Deductible
A Health Savings Account is
a tax qualified account you
setup to work in
conjunction with your
health insurance
Your HSA contributions can be used to pay the health insurance deductible and qualified medical expenses not covered by the health insurance, including dental and vision
You must be covered by a High Deductible Health Plan (HDHP) to qualify for an HSA
Health Savings Account (HSA)
Your HSA contributions are tax-deductible
Interest earned on your account is tax-free
Withdrawals for qualified medical expenses are tax-free
Unused funds and interest are carried over year to year
Benefits of an H S A
Enrollment must be completed by the 15th of the preceeding month during open enrollment to go effective the next 1st of the month
Open EnrollmentNovember 15, 2014 to February 15, 2015
What if I miss Open Enrollment?
If you qualify for a Special Enrollment Period (SEP), you may still be eligible to enroll
An individual or dependent losing health coverage
Loss of employer-sponsored health coverage
Loss of Medicaid or CHIP coverage
Loss of coverage under parent health plan due to turning age 26 & no longer eligible as a dependent child
What Qualifies as an SEP?
Loss of coverage resulting from Death or Divorce
Birth or Adoption of Child
Expiration of COBRA or short term medical plan
Release from incarceration
Other exceptional circumstances
What Qualifies as an SEP?
What does NOT qualify as a SEP?
Policy lapse for non-payment of premium
You are unhappy with current plan
Voluntary termination for any reason
You missed open enrollment
An individual or dependent losing health coverage
Loss of employer-sponsored health coverage
Loss of Medicaid or CHIP coverage
Loss of coverage under parent health plan due to turning age 26 & no longer eligible as a dependent child
What Qualifies as an SEP?
Loss of coverage resulting from Death or Divorce
Birth or Adoption of Child
Expiration of COBRA or short term medical plan
Release from incarceration
Other exceptional circumstances
What Qualifies as an SEP?
What does NOT qualify as a SEP?
Policy lapse for non-payment of premium
You are unhappy with current plan
Voluntary termination for any reason
You missed open enrollment
Resources
www.thediamondbenefitgroup.comwww.join.mewww.healthcare.gov
