Health Insurance FAQs

What is the Health Insurance Marketplace?

All plans purposed through the Marketplace ensures that you have minimum coverage available, this means that you can not be penalized for not having insurance at the end of the year. There you can also find out if you qualify for Medicaid, or Medicare through your state.

What kind of Health Insurance do I need?

There are several types of Major Medical Insurance Plans and all of them cover you in different ways. For instance a plan that is right for an elderly couple would not be right for a young single person. To find a plan that is right for you, call a Stolly agent and let us help you find a plan at the right cost for you.

As an individual tax payer, am I still required to pay a penalty on my income tax if I don’t have health insurance?

For 2019, individuals will no longer be penalized for failing to obtain acceptable health insurance. This was a result of the Tax Cuts and Jobs Act, tax reform bill which was signed into law on December 22, 2017. For 2019 the individual penalty has been reduced to zero. To read more please click here.   https://content.zywave.com/content/82bb5061-e70b-4994-a21d-f46e7f18bba4

Can Small Business Owners still purchase affordable Health Insurance for their employees?

Even though health insurance is expensive, there are plans for small employers which can offer valuable benefits AND be affordable. Our agents specializing in Employee Benefits can help explain and walk you through the Health Insurance maze. We can make it easy for you!

When is Open Enrollment for the Affordable Care Act?

Open Enrollment for individual healthcare coverage, under the Affordable Care Act, starts November 1, 2019. Call our office to go over the changes in the plans, rates, physician networks and pharmacy formularies. We are certified to assist you in enrolling, re-enrolling or making a change to your 2020 insurance plan.

What do I need to do, during Open Enrollment, if I already have coverage?

If you have individual healthcare coverage under the Affordable Care Act, your coverage will be renewing January 1, 2020. With this renewal you will see changes in rates, plans, physician networks and even prescription formularies. Please call our office for a review of your healthcare coverage and we can assist you with enrolling, re-enrolling or making a change to your 2020 insurance plan. Open enrollment runs November 1^, 2019 to December 15, 2019.

What happens if I miss the Open Enrollment Period?

When this opportunity is over you will not be able to make any changes for 2020 unless you qualify for a Special Enrollment period. Here is the important deadline to consider when you enroll, re-enroll or make changes to your 2020 insurance plan: November 1, 2019 to December 15, 2019- coverage begins January 1, 2020.

Are there any options available other than the Affordable Care Act for individual coverage?

There are short term options, which are not guarantee issue, do not cover pre-existing conditions and have limits on the term of the policy. Please contact our office to see if you would be eligible for these plans.

Is there anything I need to do during the Medicare Annual Enrollment Period if I have a Medicare Supplement plan?

If you want to keep your current Medicare Supplement plan, then there is nothing you need to do during the Annual Enrollment Period. That is a time when people with a Medicare Advantage Plan or a Part D plan can make changes for the following year.

When is the best time to enroll in a Medicare Supplement plan?

The best time to purchase a Medicare Supplement plan is within 6 months of your Medicare Part B effective date, which is also called the Medigap open enrollment period. Your application can not be denied if you apply during this six month window, even if you have existing health problems.

What is a Medicare Supplement plan?

A Medicare Supplement Plan is a type of health insurance policy offered through private insurance companies that works with Medicare to help pay some out of pocket costs you may incur for Medicare covered services, including:

• • Deductibles
  • Copayments
  • Coinsurance

What group health plans are subject to COBRA?

The law generally applies to all group health plans maintained by private-sector employers with 20 or more employees, or by state or local governments. The law does not apply to plans sponsored by the Federal Government or by churches and certain church-related organizations.

What are the H.S.A. contribution limits?

You can contribute up to $3,500 for single coverage/$7,000  for family coverage for 2019. If you’re 55 or older you can contribute an additional $1,000. The 2020 H.S.A. limits will increase $50 for single coverage and $100 for family coverage.

 What is long-term care?

Long-term care involves a variety of services designed to meet a person’s health or personal care needs during a short or long period of time. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own.

What are the various plans available to help pay for long-term care services?

There are three different types of long-term care coverage available in the marketplace today.

• Traditional long-term care insurance that covers only the risk of a long-term care claim.
• Life insurance with long-term care which can be used for long-term care but also has a death benefit if a claim for long-term care never occurs.
• Annuity plan with long-term care which is a tax-deferred annuity that will pay out two or three times the annuity value if a long-term care claim occurs.

 What are the pros and cons to each type of coverage?

Traditional long-term care

• Pros: Affordability, flexibility in coverages, inflation protection, eligible for Medicaid Partnership.
• Cons: If you never go on claim you don’t get anything back, more strict underwriting, premiums can increase over time if the insurer has bad claims experience, reimbursement style benefit so you have to submit receipts and be reimbursed by the insurance company.

Life insurance with long-term care

• Pros: Premiums are guaranteed to stay level, single premium or 5 or 10 pay premium options, underwriting is often less strict, return of premium or death benefit if you never go on claim, indemnity style benefit available so you could pay family members to administer your care, no need to turn in receipts.
• Cons: Inflation protection is sometimes not available, it can be less affordable, plans are not eligible for Medicaid Partnership.

Annuity with long-term care

• Pros: Taxed deferred growth on the premium, often less strict underwriting, two or three times the premium available for long-term care tax-free, can be funded with other non-qualified annuities and taxable gains are tax-free if used for long-term care.
• Cons: Inflation protection is often not available or price prohibitive, requires a large sum of money upfront for funding, reimbursement style benefit so you have to submit receipts and be reimbursed by the insurance company, plans are not eligible for Medicaid Partnership.