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F.A.Q.

Frequently Asked Questions

General Health Insurance Questions

When is the open enrollment period?

For Individual Health Insurance: November 1 – December 15

For Medicare Supplement: October 15 – December 7

If you do not buy Health Insurance at this time, you cannot purchase Health Insurance later in the year (until the following open enrollment) unless you have a qualifying event. You also cannot switch plans mid-year without a qualifying event.

What are Qualifying Events?

  • Married or divorced
  • Have a child, adopt a child, or place a child for adoption
  • Have a change in income (this is based on applying for a subsidy during open enrollment and then having a change in income throughout the year, unless you qualify financially for Medicaid)
  • Get health coverage through a job or a program like Health First Colorado (Medicaid)
  • Move
  • Have a change in disability status
  • Have a change in status as an American Indian or Alaska Native or change your tribal status
  • Have a correction to your name, date of birth or Social Security number
  • Experience any other changes that may affect your income and household size
  • Gain or lose a dependent
  • Have a change in tax filing status
  • Have a change in citizenship or immigration status
  • Are incarcerated or released from incarceration

For a full list of qualifying events, click here.

Rules: You MUST notify your agent and complete your change within 60 days of the event! If it isn’t completed in that time, you lose the opportunity to switch.

If I don’t have a qualifying event, and I missed the enrollment period, can I still sign up for health insurance coverage off Marketplace?

Depending on income, you may be able to qualify for Medicaid or CHP+ outside of open enrollment and then if your income changes for the better, you then may be able to qualify for a tax credit instead as a change in the status of a subsidy is a qualifying event.

Remember, if you are not applying for assistance now, you cannot apply later based on a financial change.

If you could possibly be eligible for financial aid throughout the year, A+ Smart Health Insurance Agency strongly recommends that you apply with connectforhealthco.com during open enrollment.

We also are able to help small business owners purchase a business group of two or more employees to gain coverage outside of open enrollment. Beyond those possibilities, we suggest you contact our office to determine if we can ferret out a true qualifying event, it is our pleasure to help you!

What is the difference between EPO, PPO and HMO plans?

Plan Requires Primary
Care Physician
Requires
referrals
Requires
pre-authorization
Pays for
out-of-network
care
Do you have
to file claim
paperwork?
EPO No No Yes, for non-emergency events.
Emergency visits are covered
worldwide without authorization.
No No
PPO No No Yes, for non-emergency events.
Emergency visits are covered
worldwide without authorization.
Yes Only for
out-of-network
claims
HMO Yes Yes Not usually required. No No

What is a Health Savings Account (HSA)?

Health Savings accounts are bank accounts that are stipulated for use with a Health Savings compliant Health Plan. Your agent will walk you through a Health Insurance Plan that is HSA compliant but it is up to you to open the bank account with the bank of your choice for the tax savings. For more information, please contact your tax preparer or the IRS.

What are HSA contribution limits?

2017 HSA Contribution Limits:
Single 3400
Family 6750
If Over age 55: add 1000 to either amount.

2018 HSA Contribution Limits:
Single 3450
Family 6900
If Over age 55, add 1000 to either amount.

Federal Healthcare Reform and Marketplace Questions

How much of a penalty can I have for not having a qualified health plan?

· If you did not have health coverage in 2016 and don’t qualify for a health coverage exemption, you may have to pay a penalty when you file your federal tax return.

· The penalty for 2016 is 2.5% of your household income or $695 per adult ($347.50 per child), whichever is higher.

· Your penalty is based on your income and how many months you didn’t have coverage. Generally, the higher your income and the more months you didn’t have health insurance, the higher the fee.

Is my health insurance rated on my preexisting health condition?

Rating factors that determine individual health insurance premium are no longer based on a person’s health conditions.

In Colorado, your individual health premium will be based on age, geography (the zip code of your home address), and tobacco use.

Once enrolled, the company cannot change the price of your individual premium until the following calendar year and you, the client, are not able to change plans until January, unless you have a qualifying event.

Who is is eligible for a subsidy?

If your gross household income(before taxes are taken out) is at or below what is listed in the table below or if you are pregnant or disabled, you may qualify for free low cost state medical programs known as Medicaid and Child Health Plan Plus (CHP+) or Advance Premium Tax Credits and Cost Share reductions that can reduce out of pocket costs and Health Insurance Premiums.

Number of People on Tax Return

Parents/

Caretaker

relatives 68% poverty level

Adults 19-25 133% poverty level

Children 0-18 142%

poverty level

Pregnant Women 195%

poverty level

Possible Subsidy, maximum monthly
figures (2017-2018)

Possible Subsidy,

Annual Income Limitations

1

684

1,337

1,428

1,960

4,020

48,240

2

921

1,800

1,922

2,639

5,413

64,960

3

1,158

2,264

2,417

3,319

6,807

81,680

4

1,394

2,727

2,911

3,998

8,200

98,400

5

1,631

3,190

3,406

4,677

9,593

115,120

6

1,868

3,654

3,901

5,356

10,987

131,840

7

2,105

4,117

4,395

6,036

12,380

148,560

8

2,342

4,580

4,890

6,715

13,773

165,280

9

2,579

5,043

5,385

7,394

10

2,816

5,507

5,879

8,073

Pregnant women count as two people for the Department of Medicaid programs that involve Medicaid and CHP+, however for a tax credit you will gain the additional person on the day of their birth. Please discuss your individual household with your broker for MORE details!!!

This form updated 6/6/2017 and may not be perfectly accurate due to occasional changes in the Federal Poverty Level guideline or possibly new changes from the State of Colorado.

It is estimated that individuals at 100% to 400% of the Federal Poverty level will be eligible for a subsidy of some sort. Eligibility for your potential subsidy can be determined by letting us help you review the Federal Financial Assistance Guidelines to determine the possibility of a subsidy and then submitting your application for verification with the department of Medicaid. Normally a person/ family is turned down for Medicaid and approved for a subsidy in a single letter.

Should I apply for a subsidy?

Common Outcomes Examples for people who may or may not qualify for a subsidy.

Example 1
Income Stated for 2015, $30,000.
Based on zip code and DOB Subsidy determined $200 per month benefit.
Income Determined at Tax Time = $30,000
Client keeps Subsidy

Example 2
Income Stated for 2015, $30,000.
Based on zip code and DOB Subsidy determined $200 per month benefit.
Income Determined at Tax Time = $50,000
Client must repay Subsidy
How to avoid this: Please contact agent if income is in excess of statement to Department of Medicaid.

Example 3
Income Stated for 2015, $50,000
Based on income stated, no subsidy provided.
Income determined at tax time = $30,000.
Client received no subsidy but was technically eligible.
How to avoid this: If there is any possibility of income dipping below subsidy guidelines, apply with ConnectForHealthCO to be able to gain Premium Tax Credit at a later time.

If I qualify for Medicaid, do I also qualify for a subsidy?

No.

My employer is offering money through a cafeteria plan, can I use it towards premiums for a subsidized plan on Connectforhealthco.com?

No.

What if I estimate low for a subsidy and earn more than anticipated?

You may need to pay back part or all of the subsidy amount.

How long does it take to apply for a subsidy?

We have seen the process as fast as minutes and as slow as months so it is best to get it started early if you would like to apply for a subsidy.

Which policies are compliant with the Affordable Care Act?

  • Individual Health Insurance, Medicaid, CHP+ (Must be purchased at open enrollment or with a qualifying event.)
  • Small Group Health Insurance
  • Large Group Health Insurance
  • Partially Self-Funded Group Health Insurance

Which policies are not compliant with the Affordable Care Act if purchased by themselves and could lead to a penalty?

  • Critical Illness
  • Accident
  • Cancer
  • Dental
  • Hospital Indemnity
  • Limited Benefit Policies
  • Short Term Health Insurance

How much will I pay in penalties if I am not insured?

2014 Taxes 2015 Taxes 2016 Taxes
$95 Penalty per Uninsured Adult
or 1% of yearly income
Whichever is greater
50% penalty per child
Up to federal maximum.
$325 Penalty per Uninsured Adult
or 2% of yearly income
Whichever is greater
50% penalty per child
Up to federal maximum.
$695 Penalty per Uninsured Adult
or 2.5% of yearly income
Whichever is greater
50% penalty per child
Up to federal maximum.

What kinds of tax credits are there?

There are two kinds of tax credits:

APTC: Advance Premium Tax Credit, this is the “Money” part of the tax credit, paid directly to the carrier on your behalf if you qualify.

CSR: Cost Share Reduction, this is the “lower deductible, better benefits for free” part of the tax credit, adjusted directly with the carrier if you qualify.

Can Small Group Health Insurance Plans get a tax credit?

Small Group Health Insurance Plans are only able to get a tax credit when they purchase a plan through the marketplace. We recommend determining your eligibility by checking with a certified broker before starting the process.

Do children have a mandate to have pediatric dental coverage?

Yes.