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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.

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.

I was laid off from my job and I lost my benefits. What are my options?

Finding out that you no longer have health insurance as a result of being laid off can be a confusing and frustrating experience. If you have relied on health insurance coverage through your employer in the past, you will lost it at some point after being fired, getting laid off, or voluntarily leaving your position. When this coverage ends tends to depend on your job, as some employers will keep your coverage through the end of the month or a different period if stipulated in your employment contract. The Affordable Care Act does not change your health insurance if you are laid off from your job, so you can expect to lose that coverage if this happens to you. If that’s the case, you have several options about how to proceed.

First of all, you may be able to continue coverage through COBRA, but some individuals find this very expensive. Your employer should provide you with the details about what it would cost to continue this coverage. Even though the price can be high, it may be worth it for you to retain this coverage for a period of time until you figure out your next move. Unless you were fired for gross misconduct, you are eligible to continue your plan through your employer for up to 18 months.

Your other options is to attempt to obtain coverage through the insurance marketplace. Open enrollment for the 2015 year begins on November 15, 2014 and will run through January 15, 2015. If you happen to lose your job outside of these specific dates, you may qualify for a special enrollment period. If this is the case, you have 60 days within which to apply for health insurance coverage from the date you lose your job.

When you apply for coverage through the health insurance marketplace, you will need to supply income details to determine if you are eligible for assistance and tax-sharing programs. Since the exchanges for health exchange are online, you should be able to learn everything you need to about the cost of care. The upside of being laid off in a non-enrollment period is that you may be able to get more personalized service in getting your plan activated if you require help.

Getting laid off is certainly difficult, but you do have options for continuing your coverage or purchasing your own coverage.

How long does it take to get the health insurance? When can we start?

At the close of March 2014, the open enrollment period ended for obtaining health insurance. This doesn’t mean, however, that you have no options to get covered. If you qualify for Medicaid or have someone who needs coverage under the Children’s Health Insurance Program, you may sign up for these services at any time year-round. If you meet the minimum qualifications, you’re eligible to sign up right away to being receiving those benefits.

Outside of the typical enrollment period, you may qualify for special enrollment if you meet any of the following criteria regarding qualifying life events:

  • Divorce or marriage
  • Adopting a child
  • Having a baby
  • Placing a child for foster care or adoption
  • Moving to a new residence
  • Exiting incarceration
  • Obtaining citizenship
  • Losing healthcare coverage at the end of a 2014 individual policy plan, expired COBRA benefits, aging out of a parent’s plan, loss of job-based coverage, or losing eligibility for CHIP or Medicaid.

It’s important to know that voluntary opting out of existing coverage may not necessarily qualify you for a special enrollment period. If you are eligible to apply under a special enrollment period, you might be able to get reduced out of pocket costs or premium tax credits that keep your overall costs down.

If you apply for a Special Enrollment Period and get denied or if you believe, based on reading the above statements, that you are not eligible for a Special Enrollment period, you do have options. You can appeal an existing denial. Furthermore, if you are not eligible or continue to be denied, the Open Enrollment period for 2015 will start on November 15, 2014.

Looking into coverage options for your 2015 plan is a good exercise to begin as soon as possible so that you are aware of what is the best plan for you. Putting in some research on your end will clue you in to the various prices for programs in your state and your official coverage plan will begin on January 1, 2015. Once your coverage becomes active, you are eligible to reap the full benefits of whatever you have selected. This includes going to the doctor, filling a prescription, obtaining preventive care services, or visiting the emergency room. If you already have coverage, you’ll also be able to review your current plan and determine whether you want to change or not.

Can a pregnant person get health insurance under the new law?

One of the most common questions surrounding health insurance under the Affordable Care Act is whether there are certain circumstances or conditions that might prohibit a person from being able to get the health insurance he or she needs. There are numerous ways that women benefit from new coverage requirements under the new law, and maternity care is one of those benefits.

In the individual insurance market prior to the Affordable Care Act, maternity care was routinely excluded for one reason or another. Before the Affordable Care Act went into place, just over 10 % of plans provided access to these services. Even where it was offered, it was frequently considered inadequate as a result of extremely high deductibles (many of which may have cost as much as the total amount of a birth, for example) or waiting pools. Following the full implementation of the Affordable Care Act, however, more than 8.5 million women will have gained access to maternity care through small group and individual plans.

Remember that under this same law, no individual can be denied coverage as a result of a pre-existing condition, either. One such example of a “condition” that result in denial of coverage in the past related to pregnancy was a history of Caesarean sections. Under the new regulations and rules, many more women will gain access to not just maternity care but preventive services. Women will have the peace of mind that regardless of any past conditions or concerns, they are eligible for healthcare coverage through the marketplace.

Another barrier that has been broken through the enactment of the Affordable Care Act is that women will gain more control over their healthcare. Being able to choose a primary care physician and any pediatrician for children is a major benefit, but referrals to see an obstetrician/gynecologist are no longer mandated, either.

Not only are women who are pregnant eligible to receive coverage under the new law, but new regulations have made it much easier to get critical care needed for themselves and for their children. Gaining access to affordable and quality healthcare will likely have far-reaching implications for women and their families across the country. Shopping in the healthcare market provides an array of cost-effective plans with critical coverage for women who are already pregnant or for women who plan to become pregnant in the future.

What’s the difference between HMO and PPO Plans?

Shopping around for health insurance is always a bit intimidating for first time buyers. There is so much important information to know and so many different kinds of plans with different benefits, when looking at all of the information floating around cyber space, it can become a bit overwhelming.

If you are self-employed or working your first full-time job with benefits, open enrollment for your company’s insurance plan can feel super stressful. After all, you don’t have time to wade through a sea of websites to figure out which plan is best for you and your budget. Besides that, there are all these funny little acronyms for things and if you only knew what they meant you’d feel a little more comfortable when it came to picking your plan.

The majority of insurance plans fall into two categories: an HMO or a PPO. These plans are similar in many respects, but they also have a number of important differences, and depending on your situation, one might not be as good for your needs as the other.


HMO stands for “health maintenance organization.” This type of plan connects you to doctors, specialists, and facilities that are part of a “provider network.” One of the features of an HMO is paying a co-pay, which is usually a small fee, to visit your physician or for a trip to the hospital.

Another perk of HMO plans is that they typically have a lower monthly premium than other types of plans. While these are really good benefits of this insurance program, there are some drawbacks.

HMO insurance policies are not very flexible. If the doctor that you visit is not a part of the provider network, you will need to change physicians or pay out of pocket to see your current doctor.

If you should need non-emergency care that is provided for you by a doctor or specialist not in the network, the insurance will likely not cover the cost of the treatment.

In general, HMOs are a great plan for those who are looking for quality care with the lowest possible cost. Be sure to research each program you are being presented and check with your doctor to make sure they are part of the network before signing up.


A PPO is a “preferred provider organization” plan. These plans, like HMOs, put you in a contract with health care professionals that are in a provider network, except PPO plans will cover some of the cost for care that is provided by doctors outside of your network.

Another similarity between HMOs and PPOs is the low monthly premium. The difference being that with a PPO, out-of-network care will be a bit more expensive. HMOs require you to have the permission of your physician to see a specialist, but this is not required with PPO insurance.

Just like HMOs, there are some disadvantages to a PPO plan. The biggest one being the increased cost in the form of a deductible for out-of-network care. This is still a minimal hang up, as the HMO does not cover any of the cost for this type of care.

Also, if your physician charges rates that are a bit higher than what the insurance plan deems to be reasonable, you may be left with additional out-of-pocket costs.

Both of these insurance plans offer great services and premium costs, so it is up to you to decide which one is best for your situation. If your doctor does not take the HMO plan, it might be wise to go with the PPO.