LSM INSURANCE ASSOCIATES IS
NOT AFFILIATED WITH LSM & ASSOCIATES
HAVE MEDICARE OR ACA OPEN ENROLLMENT QUESTIONS
BRINGING CLARITY TO CONFUSION
Leslie S. McMillan, Benefits Broker
ADVANTAGES OF BUYING AN AFFORDABLE CARE PLAN
NO PRE- EXISTING CONDITION EXCLUSIONS The biggest benefit of purchasing an Affordable Healthcare (ACA) plan is that YOU can't be turned down if you have a pre-existing condition. This means that as soon as your coverage starts you are eligible for any eligible medical expense and are covered for any medical condition including maternity or cancer.
FEDERAL TAX CREDITS COULD LOWER YOUR MONTHLY PREMIUM Depending on your INDIVIDUAL circumstances, you may qualify for a federal subsidy which will lower the monthly cost you pay. The subsidies are based on the number of people that are on your tax return and your income. Becoming eligible for subsidies is based on the income you report when you initially apply and is on a sliding scale because the subsidies are also determined by how many individuals are counted on your annual tax return. A big challenge is that you must estimate how much you are going to earn in the current year. If you are self-employed, or if you have different jobs during the year, your income may change. This is a concern because when you file your taxes for the current year, the government will look at the income amount you applied with. If it is dramatically different and is higher or lower when you submit your annual taxes, you could have to pay the federal subsidy back to the government!
USE THIS TO DETERMINE IF YOU ARE ELIGIBLE FOR SUBSIDY
If you fall below 100% of the federal poverty level or above 400% of the federal poverty level (FPL), you aren't eligible for subsidies. Determine how many people will be included on your next tax return and see if your income falls within 100% to 400%
CAN I STILL BUY AN ACA PLAN IF I MAKE TOO MUCH/TOO LITTLE?
You can still buy a plan during open enrollment or when you have a qualifying event if you don't qualify for federal subsidies. In these cases, you must pay 100% of the monthly premiums. We can send you quotes so you can determine the plans that work best for you.
DISADVANTAGES OF BUYING ACA -HEALTHCARE.GOV, OBAMACARE PLAN
The rates for these plans are based are solely based on your age. Men and women pay the same rate. This means that the rates are higher than you may have anticipated. In addition, the federal legislation allows insurance carriers to rate individuals that are older at 3x the rate for those in their 20's. Lastly, the plans will charge you 20% more if you are a smoker, which is defined as someone that has smoked cigarettes and/or vapes within the last 12 months.
If you don't join during the open enrollment, you can only join if you have a special qualifying event. A Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance without any waiting periods for pre-existing conditions. A special qualifying event includes the following life events:
Lose EMPLOYER health coverage at work
Move to of the state
Get married, or divorced
Lose your spouse to death
Have a baby