Sweeping health-care reform legislation means many North Dakotans have more health insurance options. However, choosing just the right a Health Insurance policy can be overwhelming or intimidating. To help, a team of NDSU Extension agents is bringing a new program to North Dakota.
The Smart Choice Health Insurance workshop is a comprehensive, research-based, unbiased program designed to equip people with the tools they need to make the best decision possible for their families.
Through workshops, participants will learn how to analyze what they need and want from health-care providers, compare plans, calculate how health insurance will affect their financial budgets, and apply the information and knowledge gained to make a smart health insurance choice. Consumer workbooks allow participants to enter and use their own information to evaluate their health insurance choices. For more information go to Smart Choice
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The Affordable Care Act states how insurance companies can determine premiums for health insurance policies.
Premiums may be based on:
Age of the insured - although policies for older adults may not be more than 3 times that of a young adult.
Number of people in the family on the insurance policy
Geographic location - North Dakota as 4 rating areas (See map) Premiums are the same for all rating areas in ND.
Tobacco use – premiums for tobacco users may be 1 ½ times the premium for a non-tobacco user.
The level of coverage chosen - The Bronze plan will cover 60% of health care costs with the consumer responsible for paying 40%. The Silver plan 70/30; Gold plan 80/20; Platinum plan 90/10 split.
The following may NOT be used when determining premium:
Gender and Health Status, pre-existing conditions
The affordable Care Act contains two major provisions that regulate health insurance providers increasing premium rates each year, they are:
Rate Review Provision - Insurance companies have to justify rate hikes of over 10% to the state.
Medical Loss Ratio - 80/20 Rule - Insurance companies have to spend at least 80 percent of premium dollars on claimes and activities to improve health care quality. 85% in large group markets.
Our Extension colleagues across the country are already reporting spam, phishing and fraud attempts with the new Health Insurance Marketplace.
Please remember the ONLY way to access the Marketplace is through www.healthcare.gov. Web sites such as Healthcare.com, Obamacare.com, healthinsurancemarketplace.com are not official government sites for enrolling in health insurance through the Affordable Care Act’s Health Insurance Marketplace.
ND Insurance Commissioner Adam Hamm sent out a news release cautioning North Dakotans to be careful and aware during this enrollment period. “Times of change often present opportunity for fraudulent activity,” Hamm said. “Consumers should be suspicious of any unsolicited calls, emails or visits.” And included the following tips.
- North Dakota will have a federally-facilitated Marketplace (formerly called an Exchange) and HealthCare.gov is the only official website for the federal Marketplace.
- Never give your personal health or financial information to someone who calls or comes to your home uninvited, even if they say they are from the government.
- Keep a record of the name of anyone who assists you with purchasing health insurance, including their phone number, email address and the company they work for.
- Insurance must still be sold by licensed insurance agents. While volunteers can help consumers understand choices, they cannot sell, solicit or negotiate insurance. To find out if someone is a licensed insurance agent, visit www.nd.gov/ndins or call the Insurance Department at 1-800-247-0560.
- Consumers still have choices both on and off the federal health insurance Marketplace. Consumers are encouraged to discuss options with their insurance agents and companies.
· For consumer assistance or to report fraud, call the federal hotline at 1-800-318-2596. Small businesses can call the federal hotline at1-800-706-7893
The Affordable Care Act opens more options for farms, ranches and other small businesses to find and enroll in a health insurance policy.
Starting in 2014, everyone (with a few exceptions) will be required to carry health insurance.
Farms, ranches and some small businesses operate within a single family, so they have no employees. These operations may access health insurance through the Health Insurance Marketplace as an individual. Business owners can log on to the website to view, compare and apply for a health insurance policy for themselves and their family. Business owners may choose to stay with the health insurance plan they have now. They also can continue to work with the insurance sales person they have worked with in the past.
If a small business has fewer than 50 employees, the business is encouraged to make health insurance available to employees but are not required to offer health insurance. Small businesses that do not offer health Insurance will not face a penalty. Small businesses that do offer health insurance to employees may be eligible for a tax credit to help with the cost. Talk with your tax advisor to determine if your small business qualifies.
Small businesses with fewer than 50 full-time equivalent employees have the option of shopping for health insurance at the Health Insurance Marketplace through the Small Business Health Options Program (SHOP) https://www.healthcare.gov/small-businesses/.
To view, compare and apply for a health insurance policy go to the SHOP Marketplace.
Start by creating an account online and provide some basic information about your business. In order to be eligible to use SHOP, your business must meet certain eligibility requirements.
Next, you will see all the plans available to your business so you can compare price, coverage and other features side-by-side. You may choose a plan that meets your needs and decide if you will pay all, some or none of the premium for your employees.
Finally, you let your employees know they can sign up for the health insurance plan you have chosen if they want that insurance plan. Your employees also may choose to go on the Health Insurance Marketplace as an individual and apply for health insurance separate from your business.
Access to health insurance is guaranteed for small businesses through the Affordable Care Act. Starting in 2014, businesses with two to 50 employees cannot be denied health insurance coverage because of the health status of its employees or their family members. Also, in 2014, rates cannot be based on the health status or gender of your employees. Renewal is guaranteed, so your group insurance cannot be cancelled because someone in your group becomes sick. Insurers must accept everyone in your group, including family members.
Small businesses can call 1-800-706-7893 for Marketplace assistance.
There are a few very important dates built into the Affordable Care Act for consumers to be aware of as they plan their health insurance purchases.
The Health Insurance Marketplaces will open online on Oct. 1. Consumers and small businesses will be able to go online to register, view, compare and purchase health insurance policies.
Open enrollment in the Marketplace is Oct. 1, 2013, through March 31, 2014. After the open enrollment period, consumers only may purchase insurance through the Marketplace if they meet certain qualifying events such as a job loss, birth or divorce. The 2014 open enrollment period will be Oct. 15 through Dec. 7.
IMPORTANT! Insurance coverage for policies purchased through the Marketplace between Oct. 1, 2013, and Dec. 15, 2013, will not begin until Jan. 1, 2014. Those purchasing insurance Dec. 15 through Dec. 31, 2013, will have insurance coverage starting Feb. 1, 2014.
After Jan. 1, 2014, those purchasing insurance through the Marketplace between the 1st and the 15th of the month will have insurance coverage starting the first of the following month (For example, enroll Jan. 3 and coverage begins Feb. 1). Those purchasing insurance between the 16th and 30th/31st of the month will have coverage beginning on the 1st of the second following month (For example, enroll Jan. 16 and coverage begins March 1).
To meet the individual mandate and avoid the penalty for 2014, consumers must have purchased their insurance by March 31, 2014, unless the consumer is exempt.
Our Extension colleagues across the nation have been busy ramping up and responding to the new Affordable Health Care Act. Extension has a strong role to play on the education side of this change. Here is a list of some of the great resources developed by Extension.
eXtension.org – three communities of practice are playing a role in eXtension’s response to health care reform: AskHealthLit, Creating Healthy Communities and Financial Security for All.
This link, http://www.extension.org/pages/68424/affordable-care-act#.UkXCc6go5mM, will take you to a list of Affordable Health Care Act resources compiled for consumers, educators, small businesses, farmers and ag producers, plus health insurance FAQs.
AskHealthLit –Created a bank of FAQs relating to health insurance and will answer health insurance-related questions and its impact on personal finances. It also helps people make informed health insurance choices and plan for health care costs.
Check out our video! YouTube video
Like us! facebook.com/askhealthlit
Follow us! https://twitter.com/askhealthlit
Join us! bit.ly/joinaskhealthlit
As the opening of the Health Insurance Marketplace approaches, here are a few reliable resources for finding more information or answers to questions.
HealthCare.gov at https://www.healthcare.gov/ – This is the federal government’s public website for health care reform. Consumers will find access to the Health Insurance Marketplaces and answers to questions concerning changes coming through the Affordable Care Act. This is the website that North Dakotans will use to access the Health Insurance Marketplace.
Marketplace.cms.gov at http://marketplace.cms.gov/ - This is a federal government website for professionals to learn about health care reform and get the latest resources and information to assist consumers. This website provides resources in multiple formats along with training and partnership opportunities. It also has an extensive FAQ bank.
The Kaiser Family Foundation at http://kff.org/health-reform/ has done an amazing amount of research into the Affordable Care Act and how it will impact America. This is a great resource for real-time information as our country makes this massive turn in health care.
AARP at http://www.aarp.org/health/affordable-care-act/ - AARP has taken the lead on providing reliable information on health care reform. The website has a helpful list of fact sheets on a variety of topics concerning the new law. Many of the resources are in multiple languages.
There are a few additional taxes built into the Affordable Care Act besides the tax penalty imposed through the mandate requiring most people to acquire health insurance.
Here is a list of these taxes with a short explanation:
- There will be a 0.9 percent surtax on Medicare taxes paid by those making $200,000 or more ($250,000 joint).
- A 3.8 percent surtax on investment income will be paid by those with an adjusted gross income (AGI) of more than $200,000 ($250,000 for joint-filers). Investment income includes dividends, interest, rent, capital gains, annuities, house sales, partnerships, etc.
- Itemized medical deductions will need to total more than 10 percent of AGI to be included as a deduction on income taxes, which is up from 7.5 percent.
- Flexible spending account contributions now will be capped at $2,500 per year.
- A 10 percent tax on indoor tanning services started in 2010.
- The penalty on nonmedical withdrawals from healthcare saving accounts will now be 20 percent instead of 10 percent.
More information can be found at http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home.