Health Care Reform

There is much confusion in the health insurance market today due to the Affordable Care Act law and possible future changes. The health laws affect your health insurance choice because they now govern what plans are available, what the plans are required to cover, the cost of those plans and when you are allowed to purchase health coverage. If you continue to read below you will find brief answers to help you understand how this all works now.

Our agent, Terri Potter, has 17 years of experience in the individual and family insurance market, and is an expert on Health Care Reform. Having an agent to help you acquire one of the new ACA Health Care Reform plans, on or off Healthcare.gov, will make your life much easier.

We represent most reputable major insurance carriers, so we will help you find the best plan to meet your needs.

We offer expert advice in plan selection and also to advise you on the best use of any subsidy credit that you qualify for to help pay for your premiums. Having an agent will also allow you to continue to receive help with your plan going forward with any issues you might run into like billing or claims issues and getting your insurance cards.

You can call our office with your questions (instead of calling the 800 number at your insurance carrier directly) and talk to our customer service representative. Run Quotes (make Run Quotes an active link) for plans both on and off the Marketplace Exchange.

You do not have to buy a new plan through Healthcare.gov for it to be a qualified Affordable Care Act plan.

The only reason you would want to buy a plan on the FFM Exchange is because you are eligible for and claiming a tax credit subsidy to help pay for your insurance. If you do not qualify for or want to claim a subsidy, then purchasing a plan off the exchange will be much easier. The same plans can be bought both on and off the government exchange. There is much less red tape to go through, and the cost is the same, if you allow me to help you purchase your plan through the insurance carrier instead of going through the government site.

You will also have many more choices of insurance carriers and plans to choose from off the FFM Exchange since only a few carriers participate in the Exchange in Georgia. Most people are not aware that the same plans that are available on the exchange are also sold off the exchange for typically the same price. You can buy any of these new plans through us.

Most people do not realize that an agent can assist you when buying a plan though healthcare.gov. If you purchase a plan through healthcare.gov you would be buying a plan on the Federally Facilitated Marketplace (FFM), also referred to as the Exchange. A person who qualifies for a Tax Credit Subsidy (financial assistance), to help pay for the health insurance, has no choice but to apply through the FFM Exchange.

An agent allows you to have expert advice to help you pick the best plan for your needs, and also to advise you on the best use of any subsidy credit you might qualify for.

Your agent will also be allowed to help with your plan going forward with any issues you might run into such as billing issues and getting your insurance cards. Our agent, Terri Potter, has 15 years of experience in the individual and family insurance market and is an expert on Health Care Reform. Having an agent to help you acquire one of the new ACA Health Care Reform plans will make your life much easier.

Open Enrollment is a set time period when people can apply for a health insurance plan without having to have had a qualifying life event take place. The Open Enrollment time period for the coming 2018 plan year is November 1, 2017 – January 31, 2018, with the earliest effective plan start date of January 1st, 2018.

Many people do not realize that due to the new Affordable Care Act Health laws (referred to by so many as “Obamacare”), it is no longer possible to apply for a health plan any time of the year you wish. However, there are special reasons why you might qualify to apply for a new plan outside of the Open Enrollment window and these reasons are called Qualifying Life Events and are listed below.

Qualifying Life Events (QLE) that make you eligible for a Special Enrollment Period (SEP) for Georgia:

Birth or Adoption
Marriage
Loss of Employer sponsored health insurance, as a result of:
- Termination of employment
- Reduced work hours to the point of no longer qualifying for company health plan
- Employer no longer offers coverage
Loss of coverage for a dependent that reaches dependent limiting age (26)
Exhaustion of COBRA
Loss of eligibility for Medicaid or CHIP
Divorce or Legal separation
Death of the policy holder
Gaining status as a citizen, national or lawfully present individual
Released from incarceration
Loss of coverage due to a permanent move outside of the plan’s service area
Change in income that results in individual determined newly eligible or newly ineligible for tax credits or cost-share reductions.
Member’s current plan is due for a renewal outside of Open Enrollment.

The following benefits must be covered by all health insurance policies:

Ambulatory Outpatient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services