There are some health care benefits you can count on getting no matter the plan you choose in 2014. The Affordable Care Act requires that all new plans cover essential health benefits for all individual and family plans and small group plans. I've underlined the benefits which are typically not included in pre-2014 plans.

All new 2014 plans offer these required essential health benefits:

• Outpatient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric dental and vision

Preventive services will be paid at 100 percent with no copay when you see an in-network provider. Other benefit costs apply towards deductible and will be paid for after you meet your deductible. Depending on the plan you choose, you may still be responsible for paying a copay and coinsurance.

It is important to note that these benefits come with a higher price of coverage.  In addition, approximately 10% of the new monthly premiums are taxes which will help pay for the start up of the Marketplace enrollment system and tax subsidies for eligible citizens.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.

For those of you who are on a new plan effective 1/1/14 or later, I'm going to briefly share a few key points regarding your current plan benefits. As the government has changed the Affordable Care Act (ACA) laws 35 times, we are finding our more every day which may affect your choices for the future. Initially, not all of the administrative procedures of the 2014 plans were released because they were still writing the legistlation.

If you are on a new PPACA 2014 plan, depending on how much you use your insurance, you may not realize how differently the benefits are administered this year. 

1. The network coverage is very different.  Blue Cross Blue Shield has 5 different networks and the bigger the network, the bigger the monthly premium.  You must stay in-network to receive benefits.  There are no out-of-network benefits on most plans unless the claim is a "true emergency"....now defined as potential loss of life or limb if immediate medical treatment is not sought. 
2. Primary care doctors must make referrals to specialists and coordinate your care.  If you don't have a primary doctor, one will be assigned to you.  If you haven't established a relationship with one, please do so and let your insurance company know.  An annual physical is paid for by insurance carriers to provide early detection of health issues if you see an in-network provider.  Certain other preventative care tests are also covered based on age and frequency.
3. If you received a subsidy and the Marketplace has requested information to support your income, and/or identity, please send it in promptly to avoid losing your subsidy.
4. If your coverage lapses due to non-payment of premium, you cannot receive a new tax subsidy for your next plan until 1/1/15.  This is a new law written last week!  If it is close to the end of the month and you haven't yet paid your premium, please pay online or call the carrier to make a payment over the phone.  Payment receipt and processing must be completed by the carrier prior to the end of the month. 
5. If you dropped your plan which was effective before 2014, you cannot go back to it.  Think twice before making a change and call us for assistance.
6. If a generic is available, you can't get a brand name medicine.  If you jump thru lots of hoops, you may get an exception to this rule with your doctor's help.
7. If a medicine is available over the counter, you can't get a prescription for it anymore, nor can you pay for it with a
8. After March 31st, you cannot change your plan benefits.
9. You must have a qualifying event to change your coverage with a special enrollment period.  This includes: Marriage, divorce, birth, death, adoption, moving to a new area where your plan isn't offered, loss of coverage, etc.  Should you have one of these events, please contact us. 

Open enrollment will begin again November 15, 2014 for a January 1, 2015 effective date. It is expected to run through February 15, 2015.  We have no information yet on the 2015 plans and what the enrollment process will be.  We have not been told yet if you will need to re-enroll.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.

"Most individuals can keep their plans for another 2 years."

After the wrath of anger from consumers who had their individual health insurance plans cancelled 4th quarter of 2013, the Obama Administration chose to avoid this issue during the mid-term elections this upcoming fall. 10 times as many people were scheduled to have their health insurance canceled at the end of 2014. This week it was announced, most individuals could keep their plans for another 2 years. The Administration called pre-Affordable Care Act insurance "no-frills" plans. I have to dispute that idea completely, as many plans had more features and benefits than the new 2014 plans. Regardless, this is good news for those who would not receive a significant subsidy. Most pre-ACA plans have more affordable monthly premiums and include benefits to use the coverage more affordably, too.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller / SHOP Marketplace Enroller from Grand Rapids, Michigan.

By Jemal R. Brinson and Ryan Haggerty | Tribune graphics
Key part of Affordable Care Act will make health coverage more widely available.

A key part of the Affordable Care Act takes effect Tuesday, when millions of Americans are expected to begin signing up for new health insurance plans, many of which will be subsidized by the federal government. The policies will be sold by various companies through government-run websites called exchanges or marketplaces, where people can compare plans before choosing their best option. The exchanges were created to offer affordable coverage to people who don’t have insurance or who pay too much for their coverage, with most low-income families qualifying for Medicaid or federal subsidies that will help them pay for their policies.

Most people who have coverage through their jobs will likely keep their current policies, although some may be eligible for policies offered through the exchanges. Insurers selling plans through the exchanges cannot deny coverage or charge more to people with pre-existing medical conditions, and they must cover treatments for those conditions. Many preventive services also will be covered at no cost. About 7 million people are expected to use the exchanges to shop for new policies, with coverage beginning in 2014, according to the Congressional Budget Office. With a few exceptions, people who do not have insurance will face a tax penalty, starting next year at $95 or 1 percent of household income, whichever is greater. Here’s a look at how Americans will access health coverage once the exchanges open, plus information about how implementation of the health care law varies across the states.

SOURCES: Tribune Newspapers reporting, Kaiser Family Foundation, whitehouse.gov, healthcare.gov, University of Illinois at Chicago School of Public Health, Census Bureau, Department of Health and Human Services

Have questions? I can help you navigate through the confusing marketplace. Contact me!
Federally Facilitated Marketplace Enroller #JKINZIE49316@616
National Producer Number #8049289

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

No Coverage Options - DOWNLOAD HERE
Group Coverage Options - DOWNLOAD HERE  

It is recommended that you distribute the attached notice above to your employees prior to October 1st. (Future new hires should receive it within 15 days of hire date.) There are no fines for not distributing it prior to October 1st, per the DOL notice dated 09/11/13.
 
This notice is to inform your employees of the opening of the Federally Facilitated Marketplace and their options to purchase insurance through the Marketplace (formerly called Exchange) which is scheduled to open 10/1/13.  We believe the opening may be delayed due to security issues.  As of this date, we still do not have plan designs and rates available for quoting the carriers on the Marketplace, so several areas are running behind schedule.
 
We are registered enrollers for the Marketplace and can assist your employees if they contact us at 888-883-5290 and/or use our FFM Enroller # JKINZIE49316@616  and NPN # 8049289 on their application.  The majority of employees will not be eligible for a subsidy, due to the premium assistance they receive from you, their employer.  However, spouses and dependents may be eligible for a subsidy, depending on several factors.  Part time workers are encouraged to contact us for assistance in purchasing insurance on or off the Marketplace, depending on their situation.  Penalties for not having coverage are 1% of adjusted gross income on 2014 taxes, and increase in subsequent years.

We wish to be the point of contact for your employees in order to ensure they have the proper information regarding your plan and contribution.  If incorrect information is reported to the Marketplace, your business may be subject to a fine for an employee who received a subsidy.  It is easier to prevent a problem than fix it when it comes to fines.  The fines are also not tax deductible.  This is complicated and ever changing.  
 
Please contact us with any questions or concerns you may have.  We are here to help you manage your employee benefits.

Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.

CLICK to DOWNLOAD this handy little guide to answer basic questions about PPACA Healthcare Reform from United Healthcare.
Please contact me for any questions not covered in the booklet.

If you have questions about the Affordable Care Act, here's a short video overview on how it works. It is the law and it is being implemented. You will be affected, no matter who you are. This is the largest social change in our country since Medicare started in 1965. Take a few minutes to watch this from Kaiser Family Foundation, then let me know if you have any questions.

Health Care Reform Takes Effect In 2014
What Does This Mean For You NOW?

When the Affordable Care Act was introduced, it seemed like a good idea. Healthcare costs were escalating faster than inflation. People with pre-existing conditions found it difficult to get coverage. Preventative care wasn't used for early detection the way it was intended due to cost. 30 million people were uninsured and sometimes weren't able to cover the cost of their medical care. Something had to change. My opinion is and was that the changes required to fix the system didn't need a complete overhaul, but that's what we're getting.

We have been led into the Patient Protection and Affordable Care Act of 2010 with the sweetness of free preventative care, children under age 26 allowed staying on their parent's plan, and no child under age 19 being declined for coverage. Next year, we won't have any medical underwriting so all policies will be guaranteed issue. Rate disparities between age bands will be reduced to a ratio of 5:1 to 3:1 which will result in significant rate increases for people in their 20's (not on their parent's plan).

For policies beginning in 2014, PPACA compliant health insurance plans will be very expensive. New health insurance premiums will be very extensive and policies will cover much more than the average policy covers today. While you may be content with your coverage, more benefits always equal more premiums. A bigger increase will be applied to individual policies since group policies already cover more of the essential health benefits. (See details below on essential benefits.)

Republican House Energy and Commerce Committee members, the Senate Finance Committee and the Senate HELP Committee issued a report looking at several previously released studies to make the point those premiums for Individuals and Small Groups are likely to spike in 2014 due to healthcare reform provisions. The reports I have received show a nationwide average increase for individuals purchasing new coverage next year to cost 50-116% more than this year. New group coverage is expected to cost 32% more than this year due to ramifications. We have creative solutions to reduce the increases implemented on current coverage. New product designs and supplements are being rolled out monthly. Yet rules for implementation are still forthcoming.

The exchanges being put into place for purchasing insurance are expected to charge 30-50% more than purchasing insurance from an agent will cost. This is due to extra fees and taxes collected to help pay for the subsidy low income may receive when purchasing coverage thru the exchange. By the way, the proposed application for the subsidy is currently 45 pages long! The Internal Revenue Service is responsible for much of the financial eligibility after the application has been reviewed by Homeland Security. When we discuss your policy, I will advise you if you will be better served by the exchange than what I can assist you with. It's very complicated and I can't give too much general advice. Exchanges will open October 1st for January 1, 2014 effective dates.

Many uninsured people are waiting to see what happens and what will be available to them. This may leave them with less affordable options. Please encourage your friends and family to talk to me about the affordable options NOW and can put in place today. If you have questions you'd like addressed, please email or call me. Contact Jeanine!

Get Quotes Now
Assurant
Golden Rule/United Health One
Hii

More Information
For more details, please visit www.uhc.com/united_for_reform_resource_center.htm, www.healthcare.gov, and www.kaiserhealthnews.org for more details.

Click on the image to DOWNLOAD this infographic to see additional options for gaining coverage beginning 2014.

Source: Keiser Family Foundation www.kff.org