Mid Georgia Benefits Planning

06/09/2023

Important Information!!!

If you have health insurance through the Marketplace, aka Healthcare(dot)gov or ObamaCare, read this.

Two critical points.

First, Friday Healthplans, one of the Marketplace insurers, is exiting the market. If you enrolled in a Friday plan, your coverage will end 07/31/2023. You are eligible to enroll in new coverage to begin 08/01/2023 but you have to select a new plan between 06/01 and 07/31 to avoid a gap in coverage.

Second point, if you live in a Friday Healthplans service area, you likely qualify for a higher monthly tax credit, premium assistance, on your current plan, regardless of company, based on Friday's market exit. In Middle Georgia, Friday's service areas are the following counties-Bibb, Monroe, Peach, Wilkinson, Baldwin and Hancock. The decrease in your premium may range from $50 to $75 for an individual and likely more for a family.

If you'd like to discuss this with me, call me on my cell at 478-390-6359, my office at 478-743-9191 or send me a message. If I miss your call, leave a message or send a text.

Send a message to learn more

10/17/2022

If you have Medicare Advantage with Aetna, don't throw away that mail you may have received recently. It may be money.

09/26/2022

Do you have Medicare? If so, you likely have Original Medicare and a Prescription Drug Plan or you have Medicare Advantage, a private insurance alternative to Original Medicare.
Either way, you should have received your Annual Notice of Change (ANoC) by now or you will very soon.
Don't throw it away. It needs to be reviewed. This is how the insurance companies tell you what is changing about your plan for next year. Premiums can change, benefits can change, drugs can move from one tier to another. If you wait until January and notice that your premium went up and your drugs cost more, it may be too late to change.
Talk with your agent, or me if you don't have one. Right now, the only thing anyone can discuss is how your current plan benefits will be different in 2013 and only if you've received your change notice but no comparisons can be made to other plans. Beginning October 1, your coverage can be compared to other plan offerings for 2023. Coverage changes can be processed between October 15 and December 7.
If you have questions for me, give me a call at 478-390-6359.

Send a message to learn more

11/04/2021

It's that time again. If you have individual or family health insurance and want to review it and possibly make changes, now's the time. If you don't have health insurance you can add it now. If you want to talk, call me at 478-743-9191 or 478-390-6359. If you want to look online and talk later, click the link.

HealthSherpa is the fastest and easiest way to enroll in ACA / Marketplace health insurance. Click on the link to shop and compare plans, grab a FREE quote, and sign up for coverage.

04/30/2021

On March 11, President Biden signed the American Rescue Act. The new law is extensive but has an immediate impact on health insurance. The health insurance provisions are what I will discuss here.

1 Enhanced Marketplace Premium Tax Credits- Premium Tax Credits are higher for 2021 and 2022. This means if you have a Marketplace health plan your current payment can be reduced. Also, people who previously made too much money to qualify for Premium Tax Credit may now qualify.

2 Unemployment- People receiving unemployment benefits in 2021 will receive Premium Tax Credits as if their income is 135% of the Federal Poverty Level. That’s $17,226 for a single person or $23,274 for a household of two.

3 COBRA Premium Payment- People paying COBRA premium can receive federal payment for those premiums due between April 1, 2021 and September 30, 2021.

Here’s some additional information below but feel free to contact me with questions. Call my office at 478-743-9191, my cell at 478-390-6359 or send a message through Messenger.

Keep in mind that most other Marketplace rules remain in effect. If you are eligible for group health insurance from your employer or a family member’s employer you are still not eligible for Premium Tax Credits from the federal Marketplace.

Enhanced Marketplace Premium Tax Credits- The formula for calculating Premium Tax Credits can seem complicated. I won’t go into great detail here but will explain it further if anyone is interested, just let me know. Here are the basics. Based on your income and how many people are in your tax household, there is a formula to determine how much you can afford to pay for health insurance. That number is compared to the actual premium of a specific health plan available to you, the benchmark plan. The Premium Tax Credit is the difference. For example, a single person making $20,000 can afford to pay about $70 per month under the old formula. If the benchmark plan premium is $500 per month, the federal government will send $430 per month to the insurance company and the individual will send $70 and they have health insurance.

Under the new calculation, that same person with the same income with the same $500 per month plan will qualify for a higher Premium Tax Credit, probably $500 (previously $430) or more or maybe just $490 but either way, their new payment will drop to $0 or $10.

Under the old rules, a household making more than 400% of the Federal Poverty Level made too much money to qualify for Premium Tax Credits. For a married couple, that is $68,960 per year. Under the old formula, this couple could afford to pay about $565 per month. Health insurance for a couple that are 63 and 59 years old could easily be over $2,000 per month. That couple, with an income of $68,950 would qualify for a tax credit of about $1,435 per month and pay $565 or less for health insurance. If their income is $68,960, over 400% of FPL, they would not qualify for any tax credit and would have to pay the entire premium.

This has changed. Now, both couples would qualify for a PTC of over $1,500 per month, under or over the old cut off amount, and now pay less than $500 per month for the same plan.

Unemployment Enhancement- This new rule isn’t quite in place yet but will be implemented sometime this summer, likely June. If you or someone in your tax household received any unemployment benefit in 2021, even if it was only 1 week, you qualify If you are single and make $20,000 or $50,000 or $150,000 your health insurance Premium Tax Credit is now calculated as if you made $17,226 and your responsibility for health insurance premium is now $0. This rule also applies to people who made less than FPL, $12,760, and did not previously qualify for Premium Tax Credit now qualify if they receive any unemployment benefit in 2021.

COBRA Premium Payment- COBRA is a law that allows an employee of certain employers to continue the group health insurance plan they had while working by paying the full premium plus a 2% administration fee. It is typically very expensive. Losing an income due to a layoff then having to pay a health insurance premium that may be greater than your house payment is difficult, to say the least.
The ARA provides that the federal government pay the COBRA premiums for coverage provided between April 1, 2021 and September 30, 2021 for Assistance Eligible Individuals. To be an Assistance Eligible Individual, you must be eligible for COBRA by reduction of hours, change from full time to part time status or an involuntary termination of employment. You are not eligible for COBRA premium assistance if you are eligible for other group health insurance through another job of yours or your spouse’s, Medicare, or certain other employee benefit arrangements.

This payment is made by the federal government to your COBRA administrator, not to you directly.

If you have questions or need assistance, just let me know.

10/09/2020

Medicare Annual Enrollment Period, aka open enrollment, begins October 15 and ends December 7. This is the time of year to review your Medicare plans and make changes.
If you get Medicare through a Medicare Advantage plan or if you get your prescription drugs through a Medicare Prescription Drug Plan you should review your Annual Notice of Change (ANOC) that you should have received recently. Look for more than premium change. Check to see how your current drugs are covered next year. Medicare.gov is the best place to compare all available plans and I'll be glad to help guide you through the process.
There are new programs that help with insulin costs. Select plans offer certain insulins at a $35 copay all year long. If you buy any type of insulin I cannot stress how important it is to review and compare all available plans.
In addition, in the past people with End Stage Renal Disease (ESRD) could not change their Medicare plan. For the most part, what ever they had, they were stuck with it. That restriction does not exist in 2021. Anyone receiving Kidney Dialysis can now shop, compare and change their Medicare plan.
Call me at 478-743-9191 with questions. You can call this number at any time, day or night. If we aren't available a professional answering service will answer your call and get your message to me.

03/27/2020

The Corona Virus Aid, Relief and Economic Security Act (CARES) has passed both the House and the Senate and is expected to be signed into law immediately. This is about $2 Trillion ($2,000,000,000,000) of relief. I have copied and pasted a brief summary below.

Individuals and Businesses: The CARES Act functions largely as an economic stimulus by providing cash payments to individuals below a certain income, providing extra unemployment benefits and allowing self-employed individuals to apply for unemployment. For businesses, aid is provided through emergency grants, forgivable loans and relief for existing loans. These provisions are intended to assist employers to help them stay in business, keep employees on their payroll, and allow them to continue to support employees through employee benefits and health insurance.

Healthcare: The CARES Act also includes $100 billion for hospitals and $150 billion for state and local governments to combat the COVID-19 pandemic. The bill expands coverage beyond what was in last week's Families First bill by requiring health insurers to pay for coronavirus testing beyond those that are FDA-approved, including lab and state-developed tests as well as other tests approved by HHS.

Accessibility for telehealth is also expanded. High-deductible health plans with HSAs may now allow pre-deductible coverage for telehealth and other remote services, as well as allowing the use of HSAs for the purchase of over-the-counter medications without a prescription.

Very limited action was also taken to address surprise medical bills. Under the CARES Act, all health insurance plans would reimburse a COVID-19 test provider at the in-network rate put in place prior to the pandemic. If the provider is out of network, the health plan is to fully reimburse the provider based on the provider's own "cash price," which must be made publically available while the public health emergency is still declared. Providers that do not post their test price publically could be fined up to $300 a day.

This action taken by Congress follows the passage of the Families First Coronavirus Response Act and several pieces of emergency guidance released by the Trump Administration. We are expecting more action from Congress and the Administration to address other aspects of the coronavirus pandemic. Be sure to regularly check your email, NAHU's social media channels and website for any updates. Should either the CDC or WHO guidance change, NAHU will act accordingly and immediately update you.

12/16/2019

Open Enrollment Extended

2020 Marketplace health insurance enrollment will be extended until 12/17.

If you've not chosen a plan or need to make a change you still can. If you have questions I can help. Call me at 478-743-9191 or 478-390-6359.

Check your options here. https://www.healthsherpa.com/?_agent_id=milton-martin-bnodeq

12/15/2019

Important Update for residents of Crawford County, Georgia

If you are a resident of Crawford County and bought health insurance through the Marketplace for 2019 it would have been an Anthem Blue Cross plan. If you have not gone to the Marketplace and updated your account for 2020 and are only relying on the letter you received from Anthem Blue Cross you may be in for a surprise when you receive your January bill.

The Anthem Blue Cross everyone is used to is not the Anthem Blue Cross that is available on the Marketplace. It is the same company but the Pathway network is not very widely accepted. This means it is harder to find a medical provider who accepts the coverage.
Anthem Blue Cross almost pulled out of the individual Marketplace a few years ago but would have left around 80 Georgia counties without an option for health insurance. Thankfully, Anthem reconsidered and stayed but exited many counties that had other options. Crawford was one of those counties that had no other option so Anthem stayed.
If you live in Crawford County and have an Anthem Blue Cross marketplace plan and receive a tax credit to help pay the premium you need to be aware that the estimate letter they sent you back in October is not an accurate reflection of what you will be paying in 2020 if you keep that coverage. The new total premium is correct but the tax credit is based on 2019 and will be much lower is 2020 because of 2 additional companies being available in Crawford with significantly lower premiums. If you are in Crawford County and have not gone to the Marketplace and updated your account you will likely be devastated when you realize how much you are going to have to pay to keep Anthem in 2020.
For example, you may have a $2,000 premium with an $1,800 tax credit leaving your part at $200. The reality is that your tax credit in 2020 would drop to $1,200 leaving you owing $800 to keep Anthem. This is why the Marketplace has been asking you to update your account.
If you need professional help, I'll be working all weekend. I can help you to understand what you are up against and can help you with the update through the 15th.
My agency is Mid Georgia Benefits Planning and you can call me at 478-743-9191 or 478-390-6359.

You can use this site to review options throughout what is left of December 15,

https://www.healthsherpa.com/?_agent_id=milton-martin-bnodeq

12/15/2019

Today is the last day to enroll in health insurance through the Marketplace until next year, unless you qualify for a Special Enrollment Period.

Go to my quote site if you haven't enrolled yet. It only takes a few minutes.

If you need help with plan selection, call me at 478-390-6359 or 478-743-9191 or message me here.

https://www.healthsherpa.com/?_agent_id=milton-martin-bnodeq

11/06/2019

The more confused you are the more beneficial talking to an expert will be. If you are trying to figure out Medicare or health insurance and need help, call me at 478-743-9191.

10/11/2019

If you like dogs like I do then you will appreciate this video that is about a minute.