Updated Income Threshold - Tax Credit Eligible on Health Premiums

2015 Federal Poverty Level Chart*

The Department of Health & Human Services (HHS) issues poverty guidelines that are often referred to as the “federal poverty level” (FPL). The Federally-facilitated Marketplace will use the 2015 guidelines when making calculations for the insurance affordability programs starting November 1, 2015.  Fall UNDER the 400% level at your household size and you may be eligible for upfront discounts on your premiums. Contact us www.mosaicemployeebenefits.com for assistance with your application, discount, and plan options. 

Household Size	100%	138%**	150%**	200%**	250%**	300%**	400%**
1	$11,770	$16,243	$17,655	$23,540	$29,425	$35,310	$47,080
2	15,930	21,983	23,895	31,860	39,825	47,790	63,720
3	20,090	27,724	30,135	40,180	50,255	60,270	80,360
4	24,250	33,465	36,375	48,500	60,625	72,750	97,000
5	28,410	39,206	42,615	56,820	71,025	85,230	113,640
6	32,570	44,947	48,855	65,140	81,425	97,710	130,280
7	36,730	50,687	55,095	73,460	91,825	110,190	146,920
8	40,890	56,428	61,335	81,780	102,225	122,670	163,560

Millennial Individual Health Insurance Alternative

If you are healthy and without access to Employer Coverage, weigh your options before purchasing individual health insurance.

Example:

30 years of age
Female
Income $55,000 annually
Non Smoker
Columbus, Ohio Zip Code

Cost of ACA Compliant Gold Health Policy: $322/month or $3,864/annually.  That's a new BMW 3 series.

She could reduce coverage to a Bronze level plan for $222/month,  a true catastrophic policy that covers nothing but risk to bills larger than $6,000.  Preventive care, included.

How to avoid these costs? Penalties, Short Term Insurance, Discounts.

$77.25/month Penalties
$117/month Short Term Insruance
$20/month Telehealth, Dental, Vision, Prescription, Chrio Discounts

Considering the same Female above, for similar  Gold level benefits, her monthly premium is reduced to $214/month. An annual savings of $1,296 by taking the penalty & covering herself with Short Term Insurance & Discounts.

The downside to Short Term Health Insurance - *Pre-existing conditions are NOT covered, Policy maximum $1million.  

-Costs pulled from live carrier quoting tools.
-Penalty estimates pulled from http://taxpolicycenter.org/taxfacts/acacalculator.cfm

obama-"CARE"....Staff Don't CARE!

5 months, 21 logged phone hours, 6 so called "escalations" with HEALTHCARE.GOV.....outcome - Uninsured.

This is not another rant on Obamacare laws.  It is a flawed system needing fixed.  One of the many fixes, Service.  A firsthand story below:

 - Every Individual is guaranteed Health Insurance.....WONDERFUL!
 - Tax Credit assistance in the Public Marketplace for individuals & families who need it....TREMENDOUS!

I rarely mess with the public marketplace.  I if do, I am helping very close friends who may need assistance applying for a subsidy.  Healthcare.gov with its tracking, verification, and service is too messy of a system to deal with and can be very risky at times. If you are perfectly healthy, you are better off with a 12 month Short term policy.

LET THE STORY BEGIN
A friend needed help and I wanted to assist!  She was directed to a policy through the public exchange in December of 2014, by a Navigator; they apparently play "vital role" with Obamacare.  *** (CMS.gov) NAVIGATOR - Navigators are funded through federal grant funds and must complete comprehensive federal Navigator training, criminal background checks, and state training.

NAVIGATORS - THE FIRST OF THE POOR SERVICE
This Navigator, with comprehensive training, directed my friend to a policy with Anthem through the public exchange, stating her preferred Primary Care Physician was In-Network. January comes along, her first appointment scheduled, she pays Out-of-Pocket, Doctor was not in network. Many things wrong with this -  1. ANTHEM is priced out of the individual market in 2015, expensive   2. they have a SKINNY Network (limited doctors & hospitals)   3. There are cheaper carriers with broader networks and similar coverage this Navigator over looked.  Poorly trained, they do not know how to recommend and provide the right health policies to Individuals & Families.  They are only good at navigating through the application.

WHERE THE MESS BEGINS, PHONE STAFF -  POOR SERVICE CONTINUED
I clean up the mess of the Navigator in late January.  Calling Healthcare.gov, I was instructed to submit a new application issuing the new policy my friend needed to include her doctor in-network. Still in the open enrollment period, by switching, we saved her an additional $140/month included her doctor in network, and she acquired stronger benefits.

After we completed her new application, we were instructed to cancel the old application over the phone with Healthcare.gov.  We reported the proper numbers, confirmed cancellation over the phone, all was good!??????......The rep was not able to give us a tracking ID# for the phone call, .GOV apparently doesn't do this, it is based on trust I guess.....! The Healthcare.gov rep, little did we know after we got off the phone, proceeded to cancel an application, but canceled the wrong (new) application.  This process takes Healthcare.gov 30+days to communicate to the insurance carrier. My friend  received her invoice and ID card, 30 days later receives cancellation on the same policy. Anthem had also sent an invoice we thought in error, so we called them direct to tell them them policy had been replaced.

WHERE HEALTHCARE.GOV IS USELESS, ESCALATION MANAGERS? - AWFUL SERVICE LEVEL 3
5 months, 21 logged phone hours, 6 so called "escalations" later with HEALTHCARE.GOV.  Rushing to get hold of Healthcare.gov, we had an emergency.  A preventive cancer drug is needed every 30 days and my friend stood there uninsured.  After a 45 minute hold we speak to a rep and are told to "escalate the issue with a manager." BUT AN ESCALATION COULD TAKE UP TO 60 DAYS! If its between life and death, they tell you to call 911 and continue care without insurance.

These policies run through healthcare.gov and .gov in turn communicates to the carriers.  Most carriers will tell you there is nothing they can do on a subsidized policy without it coming direct from .gov staff.  My friend, who needs urgent medication to prevent a relapse with cancer, might not be able to get it for 60 days because .gov staff will twiddle their thumbs taking their time to fix a mistake made they made?? FYI, this is apparently the highest level of escalation you can get through the system.

5 months, 21 logged phone hours, 6 so called "escalations" & the carrier finally felt so bad they kicked in their services and began to argue with .gov.  Throughout this time the client paid hefty out of pocket costs to maintain her prescription.

As we approach the halfway mark of 2015, a policy has apparently been issued for a 7.1.2015 effective date.

If obama-CARE CARES, create a process that CARES. 
If a mistake is made own up to it and have a system in place to take care of this matter SAME DAY. This is the insurance world, mistakes are very common, they are going to happen.

1. Have individuals hold 3 way calls with the carrier they choose and healthcare.gov.  Utilize this as tracking so each party remains on the same page

2. Hire account managers for large participating cities so services requests requiring multiple calls are communicated through 1 person.

3. I had service reps tell me there was no tracking of calls, tracking of calls but no confirmation number could be passed, and also received activity ID #'s on certain calls.  Your staff is not educated, know the rules and fix it.

4. PEOPLE CANT WAIT AROUND WITHOUT INSURANCE FOR 60+DAYS

#CAREobamaCARE

Special Enrollment Period For Tax Season

CMS Announces Special Enrollment Period for Tax Season Eligible consumers have from March 15 through April 30 to enroll in coverage The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM. For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30.  If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes. Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:  Currently are not enrolled in coverage through the FFM for 2015, Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes. The special enrollment period announced today will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015.  If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.  This year’s tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns.  Individuals who could not afford coverage or met other conditions may be eligible to receive an exemption for 2014. To help consumers who did not have insurance last year determine if they qualify for an exemption, CMS also launched a health coverage tax exemption tool today on HealthCare.gov and CuidadodeSalud.gov. "We recognize that this is the first tax filing season where consumers may have to pay a fee or claim an exemption for not having health insurance coverage," said CMS Administrator Marilyn Tavenner.  “Our priority is to make sure consumers understand the new requirement to enroll in health coverage and to provide those who were not aware or did not understand the requirement with an opportunity to enroll in affordable coverage this year.” Most taxpayers, about three quarters, will only need to check a box when they file their taxes to indicate that they had health coverage in 2014 through their employer, Medicare, Medicaid, veterans care or other qualified health coverage that qualifies as “minimum essential coverage.”  The remaining taxpayers - about one-quarter - will take different steps. It is expected that 10 to 20 percent of taxpayers who were uninsured for all or part of 2014 will qualify for an exemption from the requirement to have coverage. A much smaller fraction of taxpayers, an estimated 2 to 4 percent, will pay a fee because they made a choice to not obtain coverage and are not eligible for an exemption. Americans who do not qualify for an exemption and went without health coverage in 2014 will have to pay a fee – $95 per adult or 1 percent of their income, whichever is greater – when they file their taxes this year.  The fee increases to $325 per adult or 2% of income for 2015.  Individuals taking advantage of this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015.  This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.  The Administration is committed to providing the information and tools tax filers need to understand the new requirements. Part of this outreach effort involves coordinating efforts with nonprofit organizations and tax preparers who provide resources to consumers and offer on the ground support. If consumers have questions about their taxes, need to download forms, or want to learn more about the fee for not having insurance, they can find information and resources at www.HealthCare.gov/Taxes or www.IRS.gov. Consumers can also call the Marketplace Call Center at 1-800-318-2596.  Consumers who need assistance filing their taxes can visit IRS.gov/VITA or IRS.gov/freefile Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free. For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace Additionally, here are helpful links on Tax Roll-out: Blog.CMS.gov blog http://blog.cms.gov/2015/02/20/what-consumers-need-to-know-about-corrected-form-1095-as/ HealthCare.gov blog English: Is your Form 1095-A correct? https://www.healthcare.gov/blog/is-your-form-1095a-correct/ Spanish version: ¿Está correcto su Formulario 1095-A? https://www.cuidadodesalud.gov/es/blog/is-your-form-1095a-correct/ Press Release: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-02-20.html Exemption Tool: https://www.healthcare.gov/exemptions-tool/#/

Centers for Medicare & Medicaid Services (CMS) has sent this update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.

Anthem Cyber Security Breach - Former and Current personal policy holder information exposed

February 4, 2015 To our valued customers: Safeguarding your employee's personal, financial and medical information is one of our top priorities, and because of that, we have state-of-the-art information security systems to protect your data. However, despite our efforts, Anthem was the target of a very sophisticated external cyber attack. These attackers gained unauthorized access to Anthem's IT system and have obtained personal information from our current and former members such as their names, birthdays, member ID/Social Security numbers, street addresses, email addresses and employment information, including income data. Based on what we know now, there is no evidence that banking, credit card, medical information (such as claims, test results, or diagnostic codes) were targeted or compromised. Once the attack was discovered, Anthem immediately made every effort to close the security vulnerability, contacted the FBI and began fully cooperating with their investigation. Anthem has also retained Mandiant, one of the world's leading cybersecurity firms, to evaluate our systems and identify solutions based on the evolving landscape. Anthem's own associates' personal information - including our own - was accessed during this security breach. We join you in your concern and frustration, and we assure you that we are working around the clock to do everything we can to further secure your employees' data. Anthem will individually notify current and former members whose information has been accessed. We will provide credit monitoring and identity protection services free of charge so that those who have been affected can have peace of mind. We have created a dedicated website (www.AnthemFacts.com ) where members can access information such as frequently asked questions and answers. We have also established a dedicated toll-free number that both current and former members can call if they have questions related to this incident. That number is: 1-877-263-7995. As we learn more, we will continually update this website and share that information with you. And, we developed a memo template and FAQ to help you answer questions you may receive from your employees. We want to personally apologize to you and your employees for what has happened, as we know you expect us to protect your information. We will do everything in our power to make our systems and security processes better and more secure, and hope that we can earn back your trust.   Sincerely, Ken Goulet President, Commercial and Specialty Business Erin Hoeflinger Ohio Plan President   anthem.com | Privacy Statement | One-Click Unsubscribe |  Manage Subscriptions | Update Profile VIEW WITH IMAGES | ADD US TO YOUR SAFE SENDERS LIST OR ADDRESS BOOK. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. This email was sent to: brittany@maketherightmove.biz This email was sent by: Anthem Employer News, 120 Monument Circle Indianapolis, IN 46204 USA CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.

What did you get with your Health Insurance Policy during 2015 Open Enrollment?

(2/15/15 open enrollment ends)

There's still time to switch if you made a mistake!  Many individuals and families without guidance are running into problems, mostly with networks, the first month owning the policy.

*Multiple Family Members on one policy, be sure to look at your deductible options AGGREGATE vs. EMBEDDED.  Depending on your healthcare needs one is better than the other. 

*Check your networks. They may be limited

State of Ohio Individual Policy Review - 

Molina - STAY AWAY

CareSource - RUN!

Aetna - Competitive premiums, strong benefits, but be weary of the limited network.  If you're okay with Mt. Carmel, you might be okay with an Aetna Policy. State Network. 

Assurant - Premiums are expensive (1st or 2nd on the list) but mostly due to their offering of a National Network.  This is tough to find these days and may be best fit for your child attending an out of state university. 

Anthem - Similar to Aetna, their Pathway network is limited ("skinny").  The major difference, their premiums are expensive for the benefits offered.  I would shy away from Anthem for 2015. State Network

Humana - Not very big in Columbus, you wont find many doctors who accept them.  National network available, also resulting in higher premiums.  Once they become more popular in the big Ohio cities I would consider them.  For 2015, not your best option.

InHealth Mutual - One of my Favorite Insurance carriers. They are in it for the right reasons.  A Non Profit Co-op, they put profits into beefing up benefits and reducing premiums.  They offer a broad network, pick your choice of hospital if you need specialized care or surgery.  Competitive premiums with great plan options.  Very easy to work with. EMBEDDED Family Deductible on PPO's. State Network

Medical Mutual - They dropped their Gold and Platinum Plans for 2015 making the Silver Classic their strongest plan which includes limited Doctor copay visits to 3 per member.  Their network is strong, but their family deductibles are all AGGREGATE.  Competitively priced and great track history with their service. State Network

United Healthcare - Their navigate plus network works like your traditional HMO plan.  Select a Doctor and get referrals for specialists. Might not be your preference.  In addition they are extremely high with their premiums.  Their hearts stand in the Employee Benefits world targeting small businesses with 2-99 employees.  Until they shift their focus, I would pass on UHC.

Questions regarding your current plan / need help understanding your policy? Call us 614.431.4302 or email info@mosaicemployeebenefits.com  

Check out InHealth Mutual's premiums and benefits here!  Quote, App, Enroll, Save

How to Avoid the PPACA Health Insurance Penalty

Forego covering yourself with Health Insurance in 2014 or acquire a short term non-compliant policy?  The IRS come tax season 2015 will impose a penalty and charge you extra.  

If you didn’t have coverage in 2014, you’ll pay the higher of these two amounts when you file your 2014 federal tax return:

• 1% of your annual household income.  The maximum penalty is the national average premium for a bronze plan.
• $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

1. Family members of a worker who qualifies for affordable individual coverage, but not for affordable family coverage.

The IRS put this in because of a quirk in PPACA and the PPACA implementation regulations.

Regulators say an employer can fulfill its obligations under PPACA to offer affordable coverage with a minimum value by providing coverage set up in such a way that a full-time worker's share of the self-only coverage premiums costs less than 9.5 percent of the worker's W-2 wages from that employer.

The employer does not have to offer the worker access to affordable family coverage -- and the family members of that worker do not qualify for PPACA public exchange premium subsidy tax credits.

But the family members will not have to pay the penalty to be imposed on people who fail to have MEC -- and, apparently, they won't have to go through an exchange certification process.

2. A client earns too little income to have to file a federal income tax return.

Some workers don't earn enough to have to file individual income tax returns. As long as those workers are heads of household, not dependents, they will be able to avoid the no-MEC penalty without going to the trouble of filing tax returns simply to report that they have little or no income.

3. The client ended up getting MEC but bought it a little late.

The IRS has created several sets of deluxe hardship exemption justifications for people who had public exchange problems in early 2014 -- or look as if they might have had exchange problems -- and eventually got MEC.

4. The client has been eligible for health care services from an Indian health care provider.

Clients who want to avoid the no-MEC penalty may develop an intense new interest in their Native American genealogical heritage.

5. The client has a low income and lives in a state that did not expand access to Medicaid coverage.

Many states used PPACA Medicaid expansion money to make Medicaid available to all people with income below 138 of the federal poverty level, but many did not. Low-income adults in the non-expansion states can get out of the no-MEC penalty without bothering to apply for exchange certification. 

Information and source from BenefitsPro:

http://www.benefitspro.com/2014/11/26/5-great-individual-ppaca-mandate-exemption-excuses?eNL=547e1be9150ba0b2554a3fad&utm_source=BenefitsBrokerPro&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs&_LID=116707417&page=6