HDHP Minimum Annual Deductible (No change from calendar year 2011):
Single – $1,300 (up from $1,250 in 2014)
Family – $2,600 (up from $2,500 in 2014)
HDHP Out-of-Pocket Maximum:
Single – $6,450 (up from $6,350 in 2014)
Family – $12,900 (up from $12,900 in 2014)
HSA/HDHP Market Growth
HSA holders own the assets in the accounts and can build up substantial sums over time. Enrollment in HSA-compatible insurance plans has increased to 10 million earlier this year, from 1 million in March 2005, according to, America’s Health Insurance Plans (AHIP), a trade group.
HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of health plans participating in the HSA/HDHP market.
The number of people with HSA/HDHP coverage rose to more than 11.4 in January 2011, up from 10.0 million in January 2010, 8.0 million in January 2009, and 6.1 million in January 2008.
30 percent of individuals covered by an HSA plan were in the small group market, 50 percent were in the large-group market, and the remaining 20 percent were in the individual market.
14% of all workers in the private sector that have access to a Health Savings Account acc. to Bureau of Labor Statistics.
States with the highest levels of HSA/HDHP enrollment were California, Ohio, Florida, Texas, Illinois and Minnesota.
HSA Advantages:
Opportunity to build savings – Unused money stays in your account from year to year and earns tax-free interest. The HSA also gives you an investment opportunity.
Tax-free contributions and earnings – You don’t pay taxes on contributions or earnings.
Tax Free Money allowed for non traditional Medical coverage– As per IRS Publication 502, unused moneys can be used for dental,vision, lasik eye surgery, acupuncture, yoga, infertility etc. Popular Examples
Portability – The funds belong to you, so you keep the funds if you change jobs or retire.
Our overall experience with HSAs have been positive when employer funding is at minimum 50% using either the HSA or an HRA (Health Reimbursement Account-employer keeps unspent money). Traditional plans trend of higher copays and new in network deductibles has also led to the popularity of an HSA.
Is your HSA compliant? Which pre-tax qualified HSA, FSA, HRA spending card is right is right for you? Please contact our team at Millennium Medical Solutions Corp (855)667-4621 for immediate answers.. Stay tuned for updates as more information gets released. Sign up for latest news updates.
(Note that a health plan will not fail to qualify as a high deductible health plan merely because it provides certain preventive health services without a deductible, as required under Health Care Reform.)
A: You are eligible for our Travel Medical Insurance plan if you reside outside of the U.S. or have a good faith intent to reside outside of the U.S. for six months or more in a calendar year. Please note that Travel Medical Insurance does not meet the definition of “minimum essential coverage” under PPACA. Travel Medical Insurance is not intended to provide U.S. citizens residing in the U.S. with health insurance. While your Travel Medical Insurance plan for worldwide coverage will not be affected by PPACA, you should review the information below to see if you are exempt from the requirements of PPACA or not, and whether you will have to pay a tax penalty or not. Under PPACA, all U.S. citizens, nationals and resident aliens will be required to purchase minimum essential coverage (PPACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. The exemption applies to a U.S. citizen who has a tax home (main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and is a bona “de resident of a foreign country. See details under the IRS foreign earned income exclusion test. If a person was required to purchase minimum essential coverage and did not, she/he would be required to pay a tax penalty for not purchasing PPACA coverage (if she/he “les a U.S. tax return). In many cases, this tax is far less than the premiums that a person would pay for obtaining PPACA coverage.
Travel Medical Insurance is not intended to provide U.S. Citizens residing in the U.S. with health insurance. While your Travel Medical Insurance plan for worldwide coverage will not be affected by PPACA, you should review the information below to see if you are exempt from the requirements of PPACA or not, and whether you will have to pay a tax penalty or not.
Under PPACA, all U.S. citizens, nationals and resident aliens will be required to purchase minimum essential coverage (PPACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S.
The exemption applies to:
A U.S. citizen who has a tax home (your main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and
has been a bona fide resident of a foreign country or countries for an uninterrupted period that includes an entire taxable year; or
» is present in a foreign country or countries during at least 330 full days in a twelve month period. See details under the IRS foreign earned income exclusion test.
Even if a person was required to purchase minimum essential coverage and did not, she/he would only be required to pay a tax penalty for not purchasing PPACA coverage (if she/e/she’s a U.S. tax return). In many cases, this tax is far less than the premiums that a person would pay for obtaining PPACA coverage.
Penalty Tax
Q: What will my tax be if I am required to have PPACA coverage, but do not purchase it?
A: Tax Calculations:
Taxes begin in 2014 and rise in years following. In each year, the tax consists of the higher of a dollar amount or a percentage of household income. For a given household, the tax applies to each individual, up to a maximum of three. Following is the schedule of taxes:
2014: The higher of $95 per person (up to 3 people, or $285) OR 1.0% of taxable income.
2015: The higher of $325 per person (up to 3 people, or $975) OR 2.0% of taxable income.
2016: The higher of $695 per person (up to 3 people, or $2,085) OR 2.5% of taxable income.
After 2016: The same as 2016, but adjusted annually for cost-of-living increases.
Tax Examples
2014 – family of 2; taxable income = $26,000; tax = $260 because $260 ($26,000 x 1%) is higher than $190 ($95 x 2 persons).
2014 – family of 3; taxable income = $26,000; tax = $285 because $285 ($95 x 3 persons) is higher than $260 ($26,000 x 1%).
Non-U.S. citizen With Global Medical Insurance
Q. I am a non-U.S. citizen that will be temporarily traveling to the U.S. Do I need PPACA coverage?
A. Travel Medical Insurance short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. If you are a U.S. citizen, national or legal resident alien in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
However please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
U.S. Citizen – Short-Term Travel Medical Insurance:
Q. I am a U.S. citizen that will be temporarily traveling outside of the U.S. Do I need PPACA coverage for this?
A. IMG’s short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. However, since most PPACA plans do not provide the types of international benefits and assistance that travelers need, you should strongly consider purchasing an international travel medical plan such as IMG’s Patriot Travel Medical Insurance for coverage while you travel outside of the U.S.
If you are a U.S. citizen, national or an “alien lawfully present” in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
However, please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
Q: I am an individual residing outside of my home country and covered under an employer group plan. Does PPACA apply to me?
IMG’s short-term international travel medical products are not a substitute for minimum essential coverage that you may need to have under PPACA. However, since most PPACA plans do not provide the types of international benefits and assistance that travelers need, you should strongly consider purchasing an international travel medical plan such as IMG’s Patriot Travel Medical Insurance for coverage while you travel outside of the U.S.
If you are a U.S. citizen, national or an “alien lawfully present” in the U.S., you will need to maintain minimum essential coverage unless you are exempt. Exemptions include:
Individuals with a coverage gap of less than 3 months.
Individuals who cannot afford coverage (i.e. required contribution exceeds 8% of household income).
Individuals with a religious conscience exemption (applies only to certain faiths).
Members of a health care sharing ministry.
Incarcerated individuals.
Individuals with income below the tax filing threshold; and
Members of Indian tribes.
In general, PPACA does not govern short-term limited duration insurance, like IMG’s short-term travel medical insurance programs.
However, please understand that under PPACA, as of January 1, 2014, extensions of short-term coverage will be limited to less than 12 months to meet the definition of a short-term limited duration plan.
Expatriate Groups (GEO)
Q. I am an individual residing outside of my home country and covered under an employer group plan. Does PPACA apply to me?
On March 8, 2013, the Departments of Labor, Health and Human Services and Treasury issued a Frequently Asked Question (FAQ) announcing that, for expatriate plans, compliance with most PPACA provisions is being delayed until January 1, 2016. The relief from compliance applies for plan years 2014 and 2015 on plans that meet the following definition:
“Insured group health plans with plan years ending on or before December 31, 2015, in which enrollment is limited to individuals residing outside of their home country for at least six months of the plan year and any covered dependents.”
Q: I am a non-U.S. citizen and an international student. Will PPACA’s individual mandate affect my IMG plan?
As non-resident aliens, international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for 2 years (out of the past six).
Since international students are not subject to the mandate, they are not required to purchase a plan that meets PPACA requirements and can purchase an appropriate IMG plan.
International Students – Exempt as Non-Resident Aliens
Under the IRS international student exemption, anyone “temporarily in the United States on an “F”, “J”, “M”, or “Q” visa for the primary purpose of studying at an accredited academic institution or vocational school (and certain family members of students), and who substantially complies with the requirements of that visa,” is exempt from being treated as a resident alien, and is therefore exempt from the individual mandate as a non-resident alien.
Even after 5 years in the U.S., an international student may continue to be a non-resident alien for tax purposes under the “Closer Connection” exception if they can prove that they still have a closer connection to their home country than to the U.S.
The Individual Mandate and Alien / Non-Alien Status
The IRS provides a questions and answers page on the individual mandate. Question 11 asks whether all individuals living in the U.S. are subject to the mandate. The answer is that U.S. citizens and permanent legal residents are subject to the mandate, as are “foreign nationals who are in the U.S. long enough during a calendar year to qualify as resident aliens for tax purposes.” Thus, non-resident aliens are not subject to the individual mandate, even if they have to file a tax return.
Under IRS Publication 519, Tax Guide for Aliens (the green card test), green card holders are resident aliens for tax purposes. The substantial presence test uses a formula to count the number of days present in the U.S. over the past 3 years. Generally, you a resident alien after six months of presence in the U.S. – unless you are exempt.
Resources
For Travel Insurance questions and to discuss options please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
NY makes the top 25 list again but not the right one. According to the results of an independent study commissioned by New York Life’s Long-Term Care Operations, the average cost for nursing home care in the U.S. has climbed significantly in the past five years, up 20% to $95,706 per year from $79,935 in 2009. In addition, the need for care is growing, with current estimates that seven in ten Americans over the age of 65 will become cognitively impaired or unable to complete at least two activities of daily living over their lifetimes.
The staggering costs of nursing homes have led to a 50% home care surge not surprisingly.
Study Results:
The top 25 most expensive markets, ranked by the daily cost of a private room in a nursing home in the U.S., are:
Rank in 2014
Market
Nursing Home Private Room Annual Rate
Rank in 2009
1
Bridgeport-Stamford-Norwalk, CT
$159,359
2
2
Anchorage, AK
$156,950
1
3
New York-Northern New Jersey-Long Island, NY-NJ
$155,180
4
4
Poughkeepsie-Newburgh-Middletown, NY
$155,180
5
5
Hartford, CT
$154.118
3
6
Boston-Worcester-Lawrence, MA
$146,372
6
7
Rochester, NY
$141,244
8
8
San Diego, CA
$135,554
15
9
Seattle-Tacoma-Bremerton, WA
$131,750
20
10
San Francisco-Oakland-San Jose, CA
$130,283
12
11
Philadelphia-Wilmington-Atlantic City, PA-NJ-DE
$129,239
9
12
San Jose-Sunnyvale-Santa Clara, CA
$127,130
13
Albany-Schenectady-Troy, NY
$126,932
7
14
Portland, ME
$121,910
11
15
Honolulu, HI
$121,154
14
16
Washington-Baltimore, DC-MD
$120,709
18
17
Sacramento-Yolo, CA
$120,322
22
18
Boise, ID
$118,475
19
Milwaukee-Racine, WI
$118,005
16
20
Manchester-Nashua, NH
$117,264
13
21
Miami-Fort Lauderdale, FL
$116,931
25
22
Buffalo-Niagara Falls, NY
$116,577
10
23
Los Angeles-Riverside-Orange County, CA
$115,165
19
24
Detroit-Ann Arbor-Flint, MI
$114,716
25
Portland-Salem, OR
$111,909
24
Long-term care costs continue to increase with the following national averages:
National Averages
2014
2009
Percent Change
Nursing Home Private Room
Annually
$95,706
$79,935
20%
Assisted Living Room Monthly
$4,139
$3,100***
34%
Hourly Home Healthcare
$21.86
$21
4%
Assistance for Long-Term Care Planning
New York Life recently launched a Cost of Long-Term Care Services by Area tool atwww.newyorklife.com/ltccosts to help consumers begin to better understand the current, average long-term care costs in their region. The tool allows users to select from over 160 metropolitan areas that are searchable by state and view the current nursing home, assisted living facility and hourly home care rates for the area they selected.
For LTC questions and to discuss options please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available.
Congratulations – you just signed up successfully for Obamacare! You made it right before the March 31st deadline and avoided the individual penalty and getting blocked out for 2014. Don’t relax just yet. If you’re one of the many people who applied on the first open enrollment it’s smart to expect some bumps over the next few weeks. Shifting deadlines and technical glitches have left many insurance companies scrambling to catch up to the flood of requests. To make sure you start things right, here are some easy ways to stay vigilant:
Pay the premium –Until you pay for the plan you do not truly have a plan just yet. Some states and insurance companies have extended the deadline to pay, but its best to do this as soon as possible. For maximum peace of mind, get written confirmation from your new insurance company. If you go to the doctor before you pay your premium, you may end up footing that medical bill if the insurance company doesn’t have a record of your premium payment.
Member ID Cards –in about 1–2 weeks after you receive your first bill you will receive your Member ID card from your carrier after you’ve made your first premium payment. This is the card you’ll share with medical providers and pharmacies when you receive service. Your carrier may allow you to print a temporary ID card if you need care prior to receiving your Member ID card(s). Your insurance card will (hopefully) arrive in your mailbox in early January. You’ll present it wherever you need services: at the pharmacy, doctor’s office or hospital. Since insurance companies had a very short turnaround time to process new members, you may see a delay. Don’t panic! Go to the insurance company’s website to see if you can print a temporary ID card. (This is a lifesaver!) If you turn up empty, call the company’s customer service number to confirm that you are in their system as an enrolled member.
Don’t rush to the doctors – If you have an immediate need for a prescription or an appointment, by all means take care of it asap. But if you can, wait a few weeks before scheduling your doctor’s visit. This will give time for the insurance companies and doctors to update their systems with all the new plans and enrollees. This way, you help ensure that the medical claim for your doctor’s visit will be processed accurately – and that you dodge some of the early-stage craziness.
Double check – that your doctor is in your new plan’s network . Most of the new insurance plans also came with new provider networks. Its smart to double check that your favorite doctor is in the network for the exact plan you just enrolled in. There are specific networks for different insurance products, so make sure you are checking the right one. If your doctor is not in the network, keep in mind that you may have to pay significantly more money to see an out-of-network doctor, so you may consider switching. See States Pushing Back Against Smaller Networks
Keep records – Keep a record of your payments, calls, emails with your insurance company and physicians. Just in case of a technical glitch in the insurance or doctor’s computer systems, you can show evidence of your payment or confirmations from your insurance company.
Obamacare 2014 Deadline Nearing. You are now more knowledgable than most after reading this article. Given all the new changes thanks to the new insurance plans, new enrollees, and changing deadlines, being aware of these simple tips will help you avoid unnecessary headaches. And remember, if you are still shopping for insurance, you only have until March 31st to enroll in a plan.
For enrollment help before the deadline information please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
Qualifying Events for Marketplace Special Enrollment Period
After March 31, 2014, what are considered qualifying events for individuals to buy coverage from the Exchange Marketplace outside of the annual enrollment period?
Please note that the open enrollment for Marketplace coverage ends March 31, 2014. See more at: Obamacare 2014 Deadline Nearing. The next proposed open enrollment period is November 15, 2014 – January 15, 2015. According to the Healthcare.gov site, most special enrollment periods last 60 days from the date of the qualifying life event.
Whats is a Qualifying Event?
A Special Enrollment Period (SEP) is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Eligible individuals have 60 days to enroll after their Qualifying Life Event.
Individual or dependent loses minimum essential coverage due to: job loss; employer no longer offers coverage; divorce; death of a spouse; becoming ineligible for Medicaid or Child Health Plus; expiration of COBRA; or health plan is decertified.
Marriage, birth, adoption, or placement for adoption
Gaining status as a citizen, national, or lawfully present individual
Consumer is newly eligible or ineligible for tax credits and/or cost sharing reductions
Permanent move to an area that has different health plan options
Marketplace staff or contractor enrollment error
Qualified Health Plan violated a provision of its contract
American Indians can enroll or change plans one time per month throughout the year
Other exceptional circumstances, as defined by HHS
Approximately 50% of all enrollments occur outside of Open Enrollment due to Qualifying Life Events. If you are uninsured do not miss your chance to enroll before March 31!
When do I need to complete my application to avoid a federal tax penalty?
You need to complete your application by 11:59pm on Monday, March 31, 2014 to avoid a federal tax penalty. However, if you give us your word that you tried to apply for health insurance and were not able to enroll through no fault of your own, you will have until 11:59pm on Tuesday, April 15, 2014 to complete your enrollment.
I forgot about the enrollment deadline. Can I still buy health insurance through the Marketplace this year?
No. Unless you are Medicaid eligible or you are buying insurance for a child, you must have a major life-changing event called a qualifying life event to be eligible to buy insurance through the Marketplace this year after the deadline. If you don’t have a qualifying life event, you must wait for the next open enrollment period that begins on November 15, 2014 for coverage that starts on January 1, 2015.
When is my next chance to buy insurance through the Marketplace if I am not eligible for Medicaid?
The next open enrollment period for individuals and families begins on November 15, 2014 for coverage that starts on January 1, 2015.
Are there any exceptions to the open enrollment period?
Enrollment in Medicaid, Child Health Plus and the Small Business Marketplace continues all year.
Have a Qualifying Event?
Enroll Now using our online shopping tool
where you can compare plans and prices and enroll
Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance. Qualifying Events for Exchange Marketplace. 76 percent of the uninsured are unaware of the looming March 31 sign-up deadline. Contact us at (855)667-4621.
According to a recent Kaiser Poll the majority of uninsured do not know they have until March 31st to buy health insurance or pay a penalty. The new Kaiser poll found 76 percent of the uninsured are unaware of the looming sign-up deadline. Only 24 percent could name the date correctly. It is worth pointing out that the Individual Mandate has NOT been delayed. The initial 6 month open enrollment is about to end by March 31, 2014.
This is troubling as the first open enrollment’s generous 6 month opportunity tightens up to only 3 month for 2015. The public has always had a weak grasp of ObamaCare’s provisions, but the administration’s tendency to shift deadlines has added to confusion about when patients must act to gain coverage. The poll found that 56 percent now view the law unfavorably while 22 percent view it favorably.
Approximately 50% of the population prefer a plan that allow stem to see more doctors even if it costs more. The network strength is not as wide as on the better risk group marketplace. Yet the majority of the uninsured preferred lowers costs even if this means a smaller network. See States Pushing Back Against Smaller Networks.
For enrollment help before the deadline information please contact our team at Millennium Medical Solutions Corp (855)667-4621. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
No discrimination in favor of highly compensated individuals – awaiting further guidance and definitions
Health plan claim and appeals protections
Patient protections, including the selection of primary care provider, coverage of emergency services, and access to pediatric, obstetrical and gynecological care providers
Importantly, the excise tax will not be assessed if an employer can demonstrate that it did not know, and exercising reasonable diligence would not have known, of a violation. Further, the excise tax will not be assessed if the failure is due to reasonable cause and not willful neglect and it is corrected within the 30-day period beginning on the first date an employer knows, or exercising reasonable diligence would have known, that the failure existed. This limited correction window makes identifying and promptly correcting any potential errors of utmost importance.
For more information on compliance please contact our team at Millennium Medical Solutions Corp (855)667-4621.
A humorous take on Affordable Care Act by the site thelibertyactivist.com asks – What would it be like if buying coffee was handled just like Obamacare.
Obamacare Midsize Employer Mandate Delayed Till 2016.
For small businesses employing 50-99 the Treasury Dept is not requiring compliance of the Employer Mandate until 2016. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
The large group employer mandate had been originally delayed until 2015 in July 2013 see- Obamacare Employer Mandate Delayed, More Guidance. Employers with the equivalent of 50 full-time workers or more had to originally offer coverage or pay a penalty starting at $2,000 per worker beginning in 2014.
Employers with 100 or more full-time employers will have to comply with the Internal Revenue Code Section 4980H “play or pay” provision Jan. 1, 2015. Companies with 100 workers or more could avoid penalties in 2015 if they showed they were offering coverage to at least 70 percent of their full-time workers, the Treasury said.
Under the new rules, companies would be allowed during the phasing-in year to offer coverage specifically to a subset of employees, such as those working 35 hours or more a week, the Treasury said.
Treasury also set new rules for how the requirement would apply to workers such as volunteers and seasonal employees, saying that employers wouldn’t be penalized for failing to offer those people coverage, regardless of the number of hours they were working. Teachers, however, wouldn’t be considered part-time workers even if they were away over the summer, and adjunct faculty would have a special arrangement for how their classroom hours should be counted.
The penalty the employer pays would be based on the number of full-time workers that the employer employs. For purposes of calculating the penalty, the employer would not have to include part-time and seasonal workers in the calculations. Under PPACA, only workers who are not offered group health coverage are eligible to apply for exchange coverage.
The coverage must encompass a core set of benefits and be affordable – which the law defines as premiums costing no more than 9.5 percent of an employee’s income – and the employer must pay for the equivalent of 60 percent of the cost of coverage for workers but not their dependents.
As reported in Washington Post: “Administration officials said that organizations with a large number of volunteer employees – such as firefighters and first responders – would not have to provide coverage, along with those hiring seasonal employers who work six months or less in a given year. Teachers will not be considered part-time just because they do not work for three months during the summer, officials added, while the status of adjunct faculty will be calculated on a formula where they would receive credit for 2¼ hours of service per week for each hour they spent teaching or in the classroom.”
Many Employers are asking for flexibilities of defining FT as higher than 30 hours. The law has already had unintended consequences with shift in employment hours especially in industries such as dining, entertainment, services and construction.
Other transitional relief contained in the regulations include:
For employers with between 50 and 99 employees, the employer mandate is delayed until 2016. Note that an employer must provide a certification to take advantage of this relief.
Employees in positions for which the customary annual employment is six months or less generally will be considered seasonal employees and not full-time employees.
When employers are first subject to the employer mandate, they can determine whether they had at least 100 full-time employees in the previous year by referencing a period of six consecutive months, rather than an entire year.
For purposes of determining coverage in 2015 only, employers may use a measurement period (the period used to determine whether a variable-hour employee is a full-time employee) of six months, with respect to a stability period (the period following the measurement period, during which the variable-hour employee must be offered coverage) of up to 12 months.
Employers with non-calendar year plans must comply with the employer mandate at the start of their 2015 plan year, rather than on January 1, 2015.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
With less than 45 days before the first Affordable Care Act Open Enrollment set to end its important to understand the role of both Brokers and Navigators. The Patient Protection and Affordable Care Act (PPACA) requires States to establish a “Navigator” Program to help educate consumers about Health Exchange marketplace. With the new health insurance exchanges a broker can act either as a traditional broker or a navigator (but not both). The info-graph below illustrates how navigators will differ from brokers.
Specifically, agents and brokers play a vital role in the developing health insurance exchanges nation wide. As the individuals with the education and expertise to advise and help select health insurance products for families and businesses large and small, health insurance agents, brokers and consultants occupy a unique place in the health care coverage system.
We educate consumers on their health care coverage choices, help them select the most appropriate plans for their specific needs, and serve as their advocate if problems should arise. Subject to strict state licensing laws and education requirements, agents, brokers and consultants are critical to not only the health insurance enrollment process, but also in serving the healthinsurance coverage needs of individuals and employers after the point of sale.
Benefit specialists design benefit plans, explain coordination issues of public and private benefits to individuals and employees, and solve complex claims and billing issues. We help design and implement cutting-edge health promotion and wellness programs and help our clients comply with state and federal laws like newly enacted PPACA, HIPAA, COBRA and ERISA.
Professional agents, brokers and consultants continue to assist individuals and small businesses with their coverage needs long after the point of sale. Whereas a travel agent is finished with a client after the travel is completed, benefit specialists continues to serve as compliance experts, health and wellness promoters and the prominent contact for complex claims and billing issues. Health insurance coverage is a longstanding commitment for American consumers and often requires guidance from benefit specialists when dealing with a complex healthcare system.
For more information regarding both Exchanges – Individual Exchanges or SHOP please contact our team at Millennium Medical Solutions Corp (855)667-4621. We work in coordination with Navigators to assist with medicaid, CHIP Child Health Plus, Family Health Plus and Medicare Dual Eligibles. We have Spanish, Russian, and Hebrew speakers available. Quotes can also be viewed on our site.
