The health insurance industry is changing all of the time. Not only with the government mandates but also with the health insurance companies themselves as the plans that each insurance company offer also change every year. Some companies change deductibles, out of pocket maximums and others may change network options as well as drug formularies. And we know the premiums can change drastically from company to company. That is why last year’s best health plan could be next year’s worst!
We have also seen over the last few years in GA when certain insurance companies such as Humana, Aetna/Coventry and Anthem Blue Cross have completely stopped selling health plans in this area, forcing their policyholders to find other alternatives very quickly as the window for open enrollment for individual health insurance policies on the marketplace is limited from Nov 1st to Dec 15th.
If you have found yourself confused and frustrated by thiswhole process of buying the right health insurance policy for yourself in GA,you are not alone. The days of set it and forget it are pretty much over, at least for now and you will have to look at multiple variables as you prepare to make plan selections for your family in the coming year in Georgia.
The reason is because health plans and available insurance companies can vary significantly from state to state. Not to mention the Medicaid qualification rules can also be different from state to state.
For the year 2020, you will have health plans on and off the health insurance marketplace. Since the individual tax mandate is no more, you will also have more options than in the previous years including catastrophic and short term medical plans, and other health plans that may much cheaper costs with possibly larger networks of doctors and hospitals.
But buyers beware! Not all health plans are the same. Some plans offer limited benefits, do not cover pre-existing health conditions, donot include maternity and some just give you in the network discounts for services and are not actual insurance.
It is very important you take time to understand your benefits before signing up for one because as you may know, once open enrollment is over, you cannot get back on the marketplace plans without a qualifying special enrollment. When in doubt, get expert assistance or second opinions.
Also beware of lead generation websites that look like the health insurance marketplace but are really just designed to get consumers to put their names, emails and phone numbers. Many people we know who have entered their names into these sites have been inundated with phone calls from sales people trying to sell them various health plans. Some of those situations were disastrous because the plans did not cover pre-existing health conditions and the clients found themselves stuck without proper coverage.
As of now, we believe there will be 6 health insurance companies that will be offering coverage in GA in 2020:
Oscar and Caresource are the newest health insurance company to enter the GA individual health insurance market. Based on what we have seen from their webinars and product lineup, we expect them to be a good option for many people but it all boils down to rates, benefits and the network of doctors and hospitals.
Of course there will be many other insurance companies which will be offering short term medical, catastrophic plans, MEC (Minimum Essential Coverage) plan, health share ministries and a multitude of discount health plans.
For 2019, the top short term and catastrophic health plans were with Golden Rule/United Healthcare, National General and IHC and chances are, they will probably be the most competitive in the coming year.
If you have shopped for your own insurance, you already know that each company has multiple plans with multiple optional riders to cover accidents, dental, as well as multitude of additional benefits that come to you with extra costs. You could spend hours trying to figure out all of the nuances.
This is why you should consider working with a qualified health insurance broker who is licensed and appointed with many different insurance companies that can help you find custom solutions for your individual needs.
The best part of working with insurance brokers is that most do not charge any extra for their services because they get paid a commission directly from the insurance companies they represent. Some brokers have charges a fee for assisting consumers during the middle of the year because most insurance companies stopped giving commissions to brokers for special enrollment.
At InsuranceWala, we have never charged a fee for such services because we believe our clients have been pretty loyal to us and it really didn’t take that much time to help people out and hopefully, our clients will renew with us at next open enrollment where we can get paid for servicing them.
When some calls us for a discovery call, some of the first few questions we will generally ask you, in addition to your dates of births,gender, zip code is your annual household income.
This helps us determine if we should focus primarily on marketplace plans or some alternatives.
The second most important factor is the client looking for health plans that cover all pre-existing conditions, full maternity benefits then the marketplace plans are generally the best options for them. Then it’s a matter of drilling down to costs,benefits and the most important thing to most customers, which are the premiums.
Individuals that qualify for tax credits get a significant discount in premiums because the government is subsidizing the costs with advanced premium tax credits that are being paid directly to the underlying insurance companies. In addition to the reduced costs, many times there are also cost sharing which gives you much lower deductible, out of pocket maximums and co-pays. In 2019, certain insurance company had plans with zero deductibles, zero co-payment for primary care visits with a max of a$1000 per year for an individual. The 2020 benefits remain to be seen after Nov 1st.
If you would like to get quotes on the marketplace and see if you will be eligible for tax credits and cost reductions, you can get rates by clicking here. This is a special link for our agency.
As we have said before, use this as a research tool if you wish, but please use our expertise to apply and choose the proper health plan. Not only can we make it easier for you, it won’t cost you any extra.
One of the primary reasons many people choose health plans on the exchange plans is that they may be eligible for tax credits and cost reductions depending upon the size of their households and household incomes. If you believe you will qualify for the tax credits, you should probably consider the options on the marketplace first as it will give you some options that will cover all pre-existing health conditions, cover routine physicals at 100% and unlimited lifetime benefits at reduced rates.
Most health plans on the marketplace are probably HMO plans that are specific to your region but in the event of an emergency, would cover you around the country as well as the world. But to be sure, better check with your insurance company.
Generally, there are 3 main criteria to qualify for coverage on the health insurance marketplace. Yes, there are other criteria also including not being incarcerated in prison and many others, but for most of us, these are the main three.
1. You must be a legal resident or citizen. A visitor’s visa does not qualify. To look at all qualifying statuses, go to healthcare.gov
2. Must not be eligible for Medicare or Medicaid.
3. Must not have other group health insurance.
Now keep in mind, just because you can purchase health insurance thru the marketplace, this does not mean you will be eligible for the tax credits nor the cost reductions. You may have to pay the full rates!
Yes, if they are a legal resident with either a valid green card or other qualifying statuses, not only are they eligible to purchase coverage thru the marketplace, but also may be eligible for the tax credits and cost sharing.
Yes, as long as they are legal residents of the U. S. with a valid green card or other acceptable immigration statuses and are not eligible for Medicare or Medicaid,they are eligible to purchase health insurance thru the marketplace. If they also have incomes that are within the income thresholds and they file their own taxes, they may also be eligible for tax credits and cost reductions.
To qualify for tax credits on the health insurance marketplace in GA, there are 3 general rules.
1. You must be a legal resident or U. S.citizen. For most immigrants, a valid green card is enough, but there are many other qualifying criteria. To see the full list of qualifying criteria,click here.
2. Your household income must fall between a certain threshold based on the number of people on your tax return and all sources of income, not just W-2 or salary income. If you own a business, your profits also are included in your income, if you have rental properties, social security income, investment income, all of these are included in the formula.
It is very important to know what your estimated income will be from all sources because many people find themselves having to pay back all of their tax credits when they file their taxes because they did not take into account all of the other sources of income. Here is a link for what income is counted.
3. You must not be eligible for Medicare, Medicaid or group health benefits where the employer is offering your health benefits that are subsidized by the employer and is not costing you more than 9.86% of your household income. This number is for 2019.
If your household income is too high or too low to qualify for the tax credits under Obamacare,you may want to consider other alternative health plans in the area, unless you have serious health issues that may not be covered and may prevent you from getting coverage outside the marketplace.
Some of the alternatives to marketplace plans are short term medical plans, health share ministry plans and various other health plans. Some of the most popular are short term medical plans because they offer lower premiums, wider networks and are pure insurance which is regulated by the insurance industry, unlike health share ministry and other plans.
Yes, the amount of income you need is based on the number of people in your household or your tax return. If you are a single person, the minimum income required for 2020 is around $12,140 and for a couple it is $16,480 per year.
We have seen many people whose incomes that fall below the minimum get no tax credits and sometimes have to without health insurance because they cannot afford the premiums. In some cases, they may be eligible for Medicaid in GA depending up on their medical needs, net worth and citizenship status.
Yes, we know it is complicated. That is why we recommend you talk to a qualified person who can guide you thru this process. If you would like to discuss your options, schedule your discovery call today.