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I heard there is a penalty for not buying health insurance. Is that true?

If you failed to get healthcare coverage in the year 2014, you may be responsible for paying a penalty. This is because part of the Affordable Care Act mandates that you have coverage of some type. This does not mean that every person, however, received coverage. Some people might have started the enrollment process but never finished. Others may have felt they were unable to identify the right plan for them. Still others may not have understood the ramifications of going without coverage.

There are a few different terms that capture what this penalty is. It could be referred to as a fine, penalty, individual mandate, or individual responsibility payment. Since open enrollment closed in March, you will only be eligible for a special enrollment period if you meet certain criteria, like having lost your job and the health insurance that goes with it at some point during the year.

The fee changes on a yearly basis, so you should be aware that it will continue to grow as the years go by that you skip getting insurance. In 2014, there are two different ways to calculate the fee. If you or your dependents have gone without obtaining the minimum essential coverage, you will pay whatever of these two amounts is higher: 1% of your yearly household income, or $95 per person for the year (with the penalty being $47.50 for children under the age of 18). Only the amount over the poverty threshold of $10,150 is used to calculate the income percentage payment that you will be responsible for paying.
If you are uninsured for only part of the year, 1/12th of the yearly penalty can be applied to each month. If you are uninsured for less than three months total, you will not have to pay the penalty. You will pay this penalty on your 2014 tax return, which for most people is filed in 2015.

There are some rare exemptions from the fee, but you should seek coverage options during the open enrollment period that happens starting in November. If you go without health insurance coverage, you will be hit with this penalty for all applicable periods without health insurance. The fee is planned for a raise each year that goes by after the official implementation of the Affordable Care Act, so act now to reduce your liability. How

I Signed up For SHOP, but it takes Forever to Process Enrollments and Terminations. How Can I Speed it up?

Once you have set up your health insurance plan, you need to take the responsibility of managing the details of signing up and dropping employees as you go throughout the course of business. You can add new employees onto the medical plan when they are hired or after they have completed a probationary period. Once an employee has elected which plan they want to be on, it stays that way until they change it through open enrollment, until they have a qualifying status change, or until the employee leaves your company.

In order to ensure that you are prepared for the processing of termination papers, keep track of the following details in the event that it happens. To terminate coverage for an employee who is no longer eligible, you can submit this information through the mail, but you can expect for it to take 10 calendar days. If that does not work for your timeframe, submit the information online at This means that the termination is processed within minute so long as it has been input by you, the employee, or a Certified Insurance Agent. Allowing for time to do this online can save you the waiting period and give you instant confirmation that you have done everything properly, which can save you both time and aggravation. You won’t have to follow up and ensure information was received because you will get confirmation right away.

Likewise, you can use the online process when you are adding a new employee. If this falls outside the open enrollment period, you should know that a new employee is eligible for coverage on the first day of the month outside of your company’s waiting period, although that waiting period cannot exceed 60 days. You can simply log on to the Covered CA website and begin the process of enrolling the new employee by adding them to your employee roster, which will then give the employee access to start their own application.

Although you can submit changes to your Covered CA plan for enrollment and termination through the mail, it will be expedited much more quickly if you submit this information online. You’ll get instant confirmation and satisfaction in knowing that you have saved time and taken the most expeditious route for changes.

I have pre-existing conditions like Diabetes and Blood Pressure. Can I buy health insurance now and be fully covered?

Pre-existing condition refers to a health problem that existed before an individual obtains coverage through a health insurance company. Insurance companies have always bene very aware of their bottom line, realizing that those with serious medical conditions could generate extremely high costs that would influence their profits or make it difficult for other individuals to avoid coverage.

In the past, it was extremely difficult for individuals with pre-existing conditions to get the most out of their health insurance coverage. They might have tried to apply for coverage and discovered that the insurance company declined offering a plan at all because of a pre-existing condition or they might learn after a doctor or facility submitted documents for treatment that the company was attempting to deny benefits based on an alleged pre-existing condition.

Those who could get coverage often paid the price in high costs and high deductibles. Someone with diabetes, a health condition,or even asthma could be classified as having a pre-existing condition. Due to the fact that so many people were being denied benefits or coverage as a result of such conditions, the Affordable Care Act sought to prohibit insurance companies from denying coverage as a result of pre-existing conditions.

This became effective as of September 2010, starting with children (those under the age of 19). As of that date, children could no longer be denied access to a parent’s plan and companies were disbarred from insuring a child but denying treatments for a pre-existing condition. In 2014, this same rule became applicable for adults.

If you previously were denied coverage at an insurance company or were told you could not have certain treatments because they were linked to a pre-existing condition, this is good news for you. You will now be able to have a choice of health insurance companies on the marketplace that must provide options for you even if you have a pre-existing condition. Those who developed the Affordable Care Act feel that this is one of the greatest accomplishments of the law since it now gives coverage availability to a wide array of Americans who had previously been excluded.

New enrollment for 2015 begins in November of 2014. At this time, you will be able to explore coverage options and discover the best health insurance plan for you.

Is Dental an Essential Health Benefit

The Affordable Care Act is an extremely broad set of rules and regulations that set the tone for the health insurance industry and millions of people across the country. A revolutionary and comprehensive law, it’s not always easy to understand what benefits you are entitled to under the minimum essential health benefits and what you can expect to pay for outside of your traditional coverage. Just a few of the accomplishments of the act include integrating more care delivery, expanding medical coverage for individuals across America, and ushering in major financing changes for the industry.

There are several different factors that influence how dental benefits fit into this picture. Dental coverage is required for children under the Affordable Care Act, but not for adults. There are 10 essential health benefits that all health insurance plans under the Affordable Care Act must have, and pediatric dental benefits is one of these 10 essentials.

For adults, the most important implications for dental benefits are with regard to the expansion of Medicaid. It’s projected that up to 17.7 million adults could get dental benefits through Medcaid. However, this concept relies on the idea that all states provide extensive dental benefits, which is not the case. It’s more likely that about 4.5 million more individuals will get extensive dental coverage through Medicaid under the Affordable Care Act.

Many health insurance plans that are offered on the health insurance exchanges, however, do have dental benefits. As a result of these broad plans that give individuals access to both medical and dental coverage, it’s expected that nearly 800,000 adults will obtain dental benefits by opting for a plan with these included via the health insurance exchange.

It’s critical to read all the fine details about your policy before purchasing it. This will help you understand, for example, whether you will be getting dental benefits or whether you would need to find those outside of your health insurance plan. Your employer may offer a dental plan, for example, or you could purchase one of your own from a range of private dental insurance companies located in your state. Although some insurance companies on the health insurance exchange might offer dental, the vast majority do not. If you need dental benefits as part of your overall coverage, it’s recommended that you budget this into your overall medical expenses for the upcoming year.

My Employer-Based Coverage Is Too Expensive. What Are My Options?

If you have coverage through your employer, you are typically considered covered and won’t be facing the tax penalty for uninsured individuals. There are some cases, however, where the coverage offered through your employer may seem too expensive, leading you to consider your options.

You might be able to switch over to a plan offered through your state’s health insurance exchange, but it’s possible that you will not quality for lower costs as a result of your income. Of course, this depends on the cost and the type of insurance that your employer provides. Since open enrollment for 2013 has already concluded, you can only get health coverage for this year if you qualify for a special enrollment period. Otherwise, you will need to wait until the new open enrollment opens up in November.

There are some factors you need to account for when determining if you want to select a plan from the health insurance exchange.In a job-based health plan, your employer is likely to cover part of your premium cost as a benefit for you working there. If you go for a plan from the health insurance exchange, you will not have any support from an employer for those premiums. You also may not qualify for lower costs on your monthly premiums and costs out of pocket, even if otherwise your income might quality you for it. If your job coverage is considered affordable and meets the minimum value required by the Affordable Care Act, you will not qualify for lower costs. If you have questions about the plan offered at your company meeting minimum value, your employer can inform you.

Job based plans are considered affordable if the share of premiums for the lowest cost coverage is less than 9.5 percent of the family income. The important thing to note is that this is only for the individual cost of care, not for your entire family to be covered. It is likely that you could pay more than 9.5 percent of the income for premiums if you are covering your entire family, but the minimum value standard is only based on the individual cost of a healthcare plan. A plan also meets the minimum value standards if it covers 60 percent of the covered medical costs while the person getting the coverage pays 40 percent of the costs.

My Employer Does Not Offer Coverage- How Can I Buy Health Insurance For My Family?

It’s important to know that in the coming months, certain employers will be required to provide health insurance to their employees. This is applicable beginning in January of 2015 for employers with 50 or more full time equivalent workers. If the business foregoes providing healthcare coverage, the company is subjected to a tax penalty. This is most often discussed using the term employer mandate.

Many other employers who are not affected by a tax penalty might decide that it’s better to avoid providing that coverage altogether because of the high cost of healthcare. They might try alternatives like a defined benefit plan, but this doesn’t really help you if you are looking for health insurance for you and your family. You may need to seek your own plan through a health insurance exchange.

Beginning in January 2014, it was mandatory for most individuals to obtain health insurance coverage or be subjected to a tax penalty. Over time, the penalties become more severe. There are people who are exempted from this penalty, but the majority of the people shopping on the healthcare exchanges are simply interested in finding an affordable and quality option for their families.

If you have not been able to get covered under your employer, it’s time to look at the health insurance exchange. While enrollment periods for 2014 have already passed (unless you meet the qualifications for a special exemption that allows you to enroll outside of this period), you can begin considering options for 2015 in November.

The health insurance exchanges are sponsored by each state with the overarching goal of providing a one-stop shop for all of your healthcare needs. Easily logging on to a website gives you full access to a range of plans that suit your needs. With prohibition of denials for coverage based on pre-existing conditions and required stipulations regarding what kinds of services must be covered in a plan, you’ll have much less to worry about when seeking your coverage through a health insurance exchange.

The exchange breaks it down so that you can see exactly what you’re getting in terms of cost, deductible, and plan benefits. For many people, they find that purchasing coverage outside of the employer gives them the option to select the most appropriate plan for their own needs in a convenient manner.

My pharmacy is not taking my insurance from Covered California- What Can I Do?

Just as many healthcare plans provide options for different medications, health plans also allow for you to get your medicines from pharmacies known as “in network” pharmacies. You’ll want to contact your insurance company or take a look at their website to determine if the pharmacy you work with takes your new plan. If you find out that it’s not covered with the pharmacy you already work with, you may be able to see on the internet what other pharmacies do cover the plan that you have.

As an alternative, you may be able to receive your medications through the mail. Doing your research and finding out what you are eligible for is likely to ease a lot of your fears. If your health insurance company won’t cover your prescription, you may also pursue your right to appeal that decision and have the case reviewed by a neutral third party.

To learn details about what prescriptions are covered and what pharmacies are considered in-network, visit the insurer’s website to determine the list of prescriptions that are included with your plan, verify your coverage and benefits summary, contact the insurer directly, or review the hard copy materials you received.

If you get to your pharmacy and are told that your plan no longer covers it, some insurers may be willing to allow you a one-time refill after you initially enroll in the plan. This is to give you some time to determine the next best step by meeting with your doctor. You can also initiate the insurer’s drug exception process, but you need to discuss this directly with a plan representative as their rules can vary.

For the most part, your doctor will have to confirm to your health plan representatives that the drug is appropriate for your medical condition based on a few factors, such as there being a limit on the number of doses you’re allowed, whether an alternative drug that is covered by your plan is likely to give you side effects that could be harmful or dangerous to you, or whether other drugs that are covered by your health insurance plan are not as likely to be as effective as the drug which you are presently taking.

As you can see, there are multiple options to take if your medication or pharmacy is no longer included in your plan.

I Don’t Understand the Difference between an HMO Plan and a PPO Plan

When you’re selecting new healthcare coverage, it’s very important to be sure that you are looking at all the right details and comprehending the differences between the various services. One of the most common questions surrounding this is with regard to the differences between an HMO and a PPO Plan. Educating yourself about what you get with each type of plan will allow you to make an informed decision.

The first major difference between these two plans is simply to do with price, but that is linked to the features and benefits included in the plans as well. The most common types of plans are HMO plans, which are named for Health Maintenance Organizations. Less common, but more expensive plans are known as PPOs, or preferred provider organizations.

Every healthcare plan that you select is going to include contracts with clinics, hospitals, doctors, and healthcare providers that are considered part of a “network” In managed care plans through HMOs, it’s very likely that you will need to receive all of your care from providers in the network, otherwise you might find out that you are being charged for visiting a physician outside of your plan, for example. While there are some cases you might choose to do this, not realizing the implications of going outside of network can be extremely expensive when you’re presented with the final bill that insurance will not cover.

In the HMO plan, you will select a primary care physician who will provide all of your basic and general healthcare services. If you need to visit a specialist, you will have to get a referral from this individual.  If you don’t get the referral or see someone outside of the network, you’ll likely be footing the bill for those services.

In a PPO plan, the contracts are with a network of preferred providers. You are not required to select a primary care physician, and you won’t need those referrals to other providers in the network for specialized care. If you get care from a doctor in the preferred network, you are only responsible for your deductible and a copay for your visit. If you opt for doctors outside of the preferred network, you will have to pay a higher amount and you may need to pay the doctor directly and get reimbursed after from your insurance company.

What is a State Health Insurance Exchange?

State health insurance exchanges are part of the Affordable Care Act rollout. States either implemented their own state run health exchange or they have opted to let the federal government create the exchange for them. Some states have also partnered with other states or the federal government to create a hybrid type of exchange. Your health insurance exchange might also be called a health insurance marketplace.

There is a lot of flexibility in the Affordable Care Act that gives individual states options for how to run their exchange. As a result, many states who have taken it upon themselves to craft an exchange have opted to find the best way to present insurance options to residents of the state. In this sense, you can see how the health insurance exchange is like an online market. You can shop for plans, compare plans against one another, and learn more about the implementation of healthcare reform.

The goals of health insurance marketplaces are to provide you with options and empower your decision making. The purpose of having them online is that it makes it easier for you to read through all the coverage options. In the past, insurance has been difficult to purchase because of the variety of fine print and challenges in understanding all the small nuances of a policy. Hoping to eliminate some of those problems, which led people to forego insurance entirely or to select a plan that did not really meet their most critical needs, state insurance exchanges try to present information in a clear and helpful manner.

On your state’s health insurance exchange, you can review all the plans that fit your application. All plans are required to provide some basic services, but you’ll want to ensure that you have found a plan that best suits your needs when it comes to premium costs, co-pays, and deductibles. You might have to do some shopping around to identify the best plan for you and your family, but the health insurance exchange makes that easier. You can clearly see what sets one plan apart from another, giving you the opportunity to narrow down your choices to a handful of plans. If you need more help or information, it’s available, but many people have been able to research and select the best plan for them simply by going online. New enrollment for 2015 opens in November- have you gotten coverage yet?

Whats Cheaper? Buying plans on my own or buying COBRA Insurance.

If you have been laid off or fired from your job, the amount of details you may be considering can be overwhelming. It can be difficult to figure out where to start, but health insurance should certainly be something you consider fixing right away. Typically, you’ll expire out of your employer sponsored coverage at the end of the month or billing period for that coverage.

Your employer is legally obligated to give you the option of continuing on with your existing plan at your own cost for up to 18 months after you leave your job. Shortly after leaving, you should receive sign-up details from your employer to learn more about what you’ll need to do if you plan to keep your existing coverage. On the plus side, COBRA can allow you to continue your coverage as you search for a new job or other options. On the downside, however, your coverage is likely to be extremely expensive.

Many people who are laid off or are fired find that the high cost of COBRA is not something they can afford being newly unemployed. Unless you have banked significant savings and are concerned about emergency care or services for an existing condition, COBRA may not really be an option for you. In addition to fronting the cost for your own care and your family’s care, your employer has the option to add on a 2% administration fee for continuing to manage the plan. Overall, the cost of keeping your coverage through COBRA can be far too much to make it worth it.

Thankfully, you do have another option, and that is getting coverage through the health insurance marketplace. Although enrollment periods for signing up in general are limited each year, being laid off from your job means that you could qualify for a special enrollment period for up to 60 days after your termination from your employer. You’ll need to provide all the information for your coverage, as well as your income level, in order to see what plans are available. Make sure you act sooner rather than later if you are concerned about a lapse in coverage causing serious problems for you or your family.

While it’s hard to return to normal life after being laid off, you need to act quickly to determine how you will be maintaining health insurance coverage.