health insurance

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How Your Health Insurance Changes When You Turn 26

The Affordable Care Act (ACA) made many changes to how health insurance plans cover children and dependents. The law has helped children and young adults access health insurance throughout their formative years. Under the law, children can remain on their parents’ insurance plans until they turn 26 years old. Parents are also able to claim children as health insurance dependents for tax purposes. However, after the age of 26, a child will no longer qualify to stay on his or her parents’ health insurance plan. What To Do As You Approach Age 26 If you’re approaching your 26th birthday, consider the ways you can transition off an old plan and still find new, affordable coverage. Here are some things to think about as you research the ways you can obtain health insurance coverage: You might be able to enroll in your employer’s health insurance plan, if your job offers benefits. Some employers allow their employees to enroll in their benefits plans outside of their standard enrollment periods. Your turning 26 might qualify you for this special allowance. The Affordable Care Act marketplace — a federal and state-run exchange — provides an outlet for Americans to search for health insurance plans. Enrolling in a marketplace plan might qualify young people for cost assistance. These private plans are designed to meet strict coverage and pricing requirements. Private insurance companies offer a variety of coverage options for individuals, separate from marketplace plans.You may not qualify for cost assistance, but you can still find an affordable policy. The ACA requires most Americans to carry health insurance. You might face tax penalties if you don’t. Therefore, you likely cannot go without coverage. Consider the benefits of enrolling in your own plan. Will you be able to afford the cost requirements of your parents’ plan? Does your parents’ plan cover your health needs? Can you still see doctors in your local area who are in your insurance network? Do you have a spouse or child? They can’t have coverage on your parents’ insurance. Therefore, enrolling in your own plan may better benefit your own family. If you work and live independently from your family, this does not disqualify you from staying on your parents’ health insurance plan until you turn 26. However, based on your current health needs, you should consider whether staying on your parents’ plan will benefit you. Got questions about coverage? We’ve got answers! Call SWFL Insurance at 1-800-829-5270 for a free health insurance quote.

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American Rescue Plan Act Expands Subsidies

Summary The American Rescue Plan Act passed both the house and senate and was signed into law by President Biden on March 11, 2021. Many people will focus on the additional stimulus money that will start to be sent in March. However, there are several key changes to share with your customers and members that dramatically improve Marketplace access and affordability. Update: We’ve provided additional facts about this legislation’s impact on subsidies, including a link to the new CMS fact sheet and agent talking points. Details Increased Subsidy Amounts And Expanded Access To Subsidies The American Rescue Plan Act increases the subsidy amounts for all currently subsidy-eligible consumers, and subsidies may now be available for those earning over 400% of the federal poverty level (FPL). You can review the updated FPL job aid here. Update: We’re still working through all the details of this legislation, but here are a few important notes. Starting on April 1 for plans with a May 1 effective date two things will be available at SWFL Insurance: Increased premium tax credits based on the lower income contribution percentage Expanded tax credit access to consumers with household incomes above 400% This means that new consumers and current enrollees who submit an application and select a plan on or after April 1 will receive the increased premium tax credits for 2021 Marketplace coverage. Current enrollees, including those who recently enrolled through the 2021 Special Enrollment Period, must update their applications and enrollments in order to get new eligibility results starting April 1. They’ll need to reselect their current plan in order for the changes to take effect to reduce their premiums for the remainder of the year. Consumers who need coverage starting April 1 should still apply and select a plan by the end of March through the Special Enrollment Period (SEP) so coverage can start April 1. Then to get the added benefits, they should come back after April 1, your application again, and reselect their current plan to have increased tax credits applied to their coverage for May 1 forward. Note: Consumers with ACA plans effective April 1, 2021, or earlier, have the choice of waiting until they file their taxes next year in 2022 to receive the additional premium tax credit amount when they file and reconcile their 2021 taxes. However, we recommend all enrollees, after April 1, update their application and review their plan options during the 2021 Special Enrollment Period through May 15 because they may be able to choose a plan with lower out of pocket costs for the same price or less than what they are currently paying. The updates to the subsidy schedule extend through December 31, 2022. Below are some important changes to note. We will keep you updated as more details of the American Rescue Plan Act are available. Common Scenarios Consumer Scenarios Previous Guidance   American Rescue Plan Changes Subsidy eligible between 100-150% of FPL Individuals who make under 133% of the federal poverty level were expected to pay 2% of their income for the benchmark plan. From 133% to 150% it scales up from 3% to 4% of income. Are now eligible for a $0 monthly payment the first and second lowest Silver plan in their county. Subsidy eligible FPL between 151% and 399% They received premium subsidy based on the cost of the benchmark plan, from 4% to 9.5% Subsidies depend on county, age, and FPL. Everyone will receive a larger subsidy. The size of the increase will also depend on county, age, and FPL. Many Bronze options may now be free to consumers. Over 400% of FPL Individuals in tax households who were over 400% FPL were not eligible for subsidies. Consumers may now have access to subsidies. There is no upper income limit on premium tax credit eligibility, meaning that all middle- and upper-income individuals who purchase their own coverage qualify for a subsidy if their premiums exceed 8.5 percent of their household income. Individual collected or collects at least one unemployment check in 2021 Modified Adjusted Gross Income (MAGI) used to determine subsidy and CSR eligibility was calculated the same way for all tax households. Consumer is treated as the applicable taxpayer and their tax household is capped at 133% of FPL for the purpose of CSR and subsidy calculation for 2021. Unemployed individuals on COBRA Consumers qualify for a SEP for an ACA plan within 60 of losing their group coverage. Consumers qualify for an SEP within 60 days of COBRA expiring. A proposed rule that is pending finalization would create a SEP when an employer ends its contribution to COBRA. It is possible that CMS will amend this to include Federal contributions Consumers receive a 100% subsidy of COBRA health insurance premiums so unemployed workers can remain on their employer healthcare plans through the end of September 2021. What This Means For Members And Consumers  Members Scenarios Situation  Next Steps  Current members who fall into 100-150% FPL and currently have a monthly premium above $0 These members’ subsidy will equal the premium of the second-lowest cost silver plan. Bronze enrollees should buy-up to silver CSR plans. Staying in their current product (HOI vs BCBSFL) will ensure they keep their progress towards their accumulator. Subsidy amounts will update after a person enrolls in a new plan or updates their subsidy application after April 1. The updated subsidy amount will apply to the next month’s bill. CMS should have the subsidies adjusted to reflect the new law by April 1, which means May is the first month where it will be possible to receive an updated subsidy. These members may also be a candidate for an ancillary product, using the reduced monthly premium toward an ancillary premium. Current subsidized members who pay $0. These members will not be affected by the changes, but they may be able to buy up to higher value coverage. If they are 150-200% FPL, they will likely want to buy up to CSR silver. Depending on

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Medicare Advantage Plans 2021

The Medicare open enrollment period is here, and this year will likely be a record for the number of people signing up for Medicare Advantage plans for 2021. New Advantage plans being offered are providing more and more benefits to Seniors and are very attractive for people who have a lot of healthcare needs. They can cover services for common, necessary medical procedures and diagnosis, and help to provide peace of mind. That is often worth the monthly premium for many seniors who currently struggle to pay their healthcare bills every month. And, there might $0 premium plans available in your area. Any changes made during this time will go into effect on January 1st of the following year. Medicare Advantage Plans in 2021 will provide at least as much coverage as both Part A and B Medicare together (Original Medicare), although some plans offer additional benefits. Many advantage plans in 2021 will have Part D prescription drug coverage built into the plan, as well as dental, vision, and hearing coverage also included. Medicare Advantage Plans 2021 – 3 Big Changes For 2021 Due to Medicare advantage plan benefits improving each year, along with the recent Covid-19 pandemic and an effort to improve overall medical services for Seniors, the Center for Medicare & Medicaid Service (CMS) has initiated some changes to Medicare advantage plans in 2021. The 3 Major Changes to Medicare Advantage for 2021 plans are: A Medicare Part D drug plan Coverage Level Change (including donut hole parameters changing) An expanded Telehealth service offered to patients Changes to End-stage renal disease (ESRD) applicants Medicare Part D Drug Plans For 2021 For years Medicare has had something called the “donut hole”. This is a time when the cost of your medications reach a certain level, and you are in what is called a coverage “gap”. Historically when this happened your drug costs would rise dramatically. The Medicare Part D change in 2021 is raising the amount of money it takes to reach this donut hole, causing some to get in later than usual which is always a good thing. The amount it took to reach this gap in 2020 was $4020, and it’s being raise in 2021 to $4130. Expanded Telehealth Services In 2021 Another great change taking place to Medicare advantage plans in 2021 is the extended telehealth benefits. Members of advantage plans can now receive care in a virtual format in the safety and comfort of their own homes. Internet and conferencing via video makes this all possible, and it became a necessity due to the COVID virus. In all honestly, this was long overdue and is especially important for those who have trouble leaving the home. Any check-ins to your doctor can be performed via: Phone calls Video conferencing Using Text message Using the provider/patient website portal End-Stage Renal Disease Applicants In 2021 In the past, Medicare advantage plans were only available to people who had ESRD if they enrolled in one during their open enrollment period or changed during the Medicare Annual election (AEP) period each October. Due to an act in Congress called the 21st Century Cures act, in January of 2021 beneficiaries who have ESRD may enroll into Medicare Advantage plans and be eligible.

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