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By:  Kirk Lyman-Barner

kirk@client-first-insurance.com

Now in its sixth year, Marketplace insurance is again available during Open Enrollment from November 1st to December 15th, 2019. According to a study commissioned by Governor Kemp, currently 1.5 million Georgians are without health coverage. But it doesn’t have to be this way.

In 2014, the Marketplace was launched, offering Affordable Care Act individual and group health plans. Much has changed since then: gone are the tax penalties for not having coverage, but the need for affordable insurance with coverage for preexisting conditions remains resilient. Recent studies have shown that two-thirds of the 1.5 million uninsured are eligible for coverage and over half of them are eligible for financial assistance.

Client First Insurance Solutions (est. 2003) has been writing Marketplace health insurance plans from the beginning of the ACA and has helped more people qualify for financial assistance than any other agency in Southwest Georgia. Owner Kirk Lyman-Barner and two agents, Tamma Phillips and Jignasha Patel, are committed to helping reduce the number of uninsured in Georgia and have the knowledge and experience Georgians need to navigate their way through the Marketplace.

 

Below is a chart that will determine if you are eligible for financial assistance:

Number of persons in household       Minimum Income         Maximum Income

1                                                          $12,490                       $49,960

2                                                          $16,910                       $67,640

3                                                          $21,330                       $85,320

4                                                          $25,750                       $103,000

5                                                          $30,170                       $120,680

more                                                    add $4,420 each

What is concerning is the lack of affordable coverage for individuals and families both above and below the guidelines. Those below were supposed to be enrolled in the Expanded Medicaid  program, which is not offered in Georgia. Georgia legislators are currently working on ways to expand Medicaid for adults who are above the age of 19 and are not disabled. But there is little momentum in Congress at this point to come up with a solution for those who fall above the maximum income guidelines.

For business owners and self-employed, there is often a misconception regarding income guidelines is the confusion surrounding receipts and profit. Eligibility for financial assistance in the Marketplace is based on profit, not receipts. For example, truck drivers and farmers often have high business receipts but after business expenses are deducted, they show a much smaller profit. Profit is the number that should be used when studying plans. It is usually verified by a recent Schedule C tax form or a self-employment ledger.

 

Alternatives to Marketplace Plans

Short Term Plans are often championed by agents as an alternative to the Marketplace plans.  They can give coverage for temporary situations such as a college student who has no income, for people between jobs, or during the waiting periods for employer coverage to begin.   However, be very cautious because these plans will not cover medical claims for pre-existing conditions. Each time a short-term plan is renewed, medical underwriting resets the pre-existing exclusions.

Religious Health Share Plans received special status from the ACA laws allowing them to be considered creditable coverage, although they are not required to meet the minimum standards qualified ACA plans must meet, including coverage for family planning, pre-existing coverage or prescriptions, or claims related to pre-existing related illness. They are also structured around specific religious beliefs and have strict religious requirements that many people are unable to meet.

Frequently Asked Questions

• When is Open Enrollment?

Open Enrollment is November 1 – December 15th. After that 45 day period, you can only enroll in a Marketplace plan if you are eligible for a special enrollment such as marriage or divorce, birth or adoption of a child, change of address, or loss of employer or Medicaid coverage.

• Is there a fee for working with an insurance agent?

There is no fee for working with an insurance agent. Agents are paid commissions by the insurance carriers if they pass training certification, are appointed, and carry errors and omissions insurance. Working with a local expert is often easier and faster than using the Marketplace websites or calling the Marketplace call center. The call center representatives are not agents and they can not discuss the complexities of the various plans available to you.

• I have a plan for 2019, will I be automatically re-enrolled?

Each year, the Federally-facilitated Marketplace (FFM) must re-determine the eligibility of consumers enrolled in coverage through the FFM. The FFM uses auto re-enrollment to ensure that current enrollees who do not make an active plan selection by the end of Open Enrollment can have coverage at the start of the year. Active re-enrollment, where an applicant updates his or her application and plan selection, is always preferred, and agents and brokers are encouraged to work with their clients to ensure their current plan selection and income and other eligibility information is accurate for each plan year.

 

• Why is the Marketplace asking me to send in documents?

Enrollment in a Marketplace plan involves verification of your personal information such as employment, income, citizenship, participation in Medicare or Medicaid, incarceration history and your tax filing history. If the Marketplace computers find a data mismatch or detect a change in income from previous taxes, your account may be flagged to justify the change.  Client First Insurance Solutions has contracted with a software company to assist in eligibility requirements and uploading your documents. We can guide you through the requirements and manage the delivery of any documents to your Marketplace account for review and confirmation.

 

• If I’m married, do I have to file a joint tax return?

Yes. By submitting an application to the Marketplace, you are agreeing to file married jointly if that is your status.

• I would rather have my children on my family Marketplace plan instead of Medicaid or the CHIP program. Can I do this?

Yes, but only if your children are turned down by Medicaid. If the Marketplace determines that your family may fall into the income range that would make your children eligible for Medicaid, the software will send an application to Medicaid for you. If you receive a letter denying their Medicaid application, we can assist you in enrolling your children on your Marketplace health plan.

• My employer insurance is too expensive, can I enroll in a Marketplace plan?

Maybe. There is an expense and qualification test to see if you are eligible. We can help you understand the rules and determine if you are eligible for a Marketplace plan.

• How do I find out if my doctor or hospital is in network for a particular Marketplace health insurance plan?

Each insurance carrier is required to keep an up to date website to help consumers know if their doctor or provider is in or out of network. Your agent can help you with that research.

 

You can contact Client First Insurance Solutions at 229-942-9025 or email at kirk@clientf-first-insurance.com.