Over the last several weeks I’ve spent many hours getting re-certified for the 2014 Medicare annual enrollment period.
I also spent many hours becoming certified as a “navigator” so I can assist individuals and families in accessing and working with the new Affordable Care Act's (ACA) federally-facilitated health insurance exchange for Michigan, which opened last week. In addition I’ve been fielding phone calls regarding both issues, Medicare and the Affordable Care Act, because people are concerned, confused and for the most part misinformed.
Let’s see if I can’t help out and put all this new knowledge to good use.
For those states whose legislators refused to establish their own state-run exchange, which Michigan was one of those, a federally-facilitated exchange was put in place. On average there are eight insurers competing within those states exchanges. Michigan,on the other hand, has 13 insurers offering 142 plans. Because some plans will be limited by geography (not all carriers have networks in all counties) most of you will be able to choose from 43 health plans. Here in the greater Grand Traverse region, of the 13 insurers, really only a couple of the carriers have the network and programs that make sense for us.
The plans are broken down into five levels of coverage – catastrophic (available to those under age 30); bronze; silver; gold and platinum. Because of the individual mandate, a young healthy 28-year-old individual might choose the catastrophic coverage with higher deductibles and co-pays just to comply at as low a cost as possible, while a young family might choose a silver plan which covers 70 percent of medical costs, limiting their out-of-pocket exposure. The report indicated Michigan’s silver plan would run around $271 a month, which when compared to the national average of $310 is significantly lower. Now before you freak-out and say you can’t afford the $271 a month, remember the ACA has built into it significant opportunities for individuals and families to receive tax credits to help pay for the coverage. Help paying premiums is available for anyone earning up to four times the federal poverty level. The base level for 2014 is $11,490 for an individual and a family of four is $23,550. So if you earn up to four times those numbers you will be able to get help.
These aren’t your “wait until I file my tax return next year” tax credits. These are immediate in-your-pocket credits that are paid directly to the insurer to pay your premium. So let’s say you qualify for a 70 percent reduction of the $271 silver plan monthly premium your exposure is reduced to $81.30. Your tax credit is determined by filling out an application on the exchange and after it is reviewed you will receive a breakdown of your credits and then you can review all plans in your area and choose the one best suited for you needs and wallet.
It’s important to know that although preexisting conditions can no longer be a determining factor in getting coverage, age and tobacco use still are. If you want your coverage to start on Jan. 1, 2014 you must enroll in a plan by December 15, 2013. After that your start date will be determined by the date you enroll, but no matter what, you need to enroll by March 15, 2014 or you will be assessed a penalty for not having insurance as dictacted by the ACA.
The exchange is open. Michigander’s can compare plans private insurers have at www.healthcare.gov or call 800-318-2596. You can also enroll in a policy on the same site. Or you can work with a licensed agent who has been certified through CMS to help you work through the process. Either way you need to do something between October 1, 2013 and March 31, 2014.
The choice is yours.
Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a pre and post retirement income specialist and certified health insurance advisor in Traverse City. If you have any questions or comments about this article or any other senior issue he can be reached at 231-922-1010 or email@example.com.