Now that the holidays are over and the New Year has begun, you may find yourself wondering if you missed your chance to acquire health coverage for 2015.  Good news!  There is still plenty of time to apply.  Although December 15th was the application deadline for coverage beginning January 1st, Open Enrollment is still ongoing and will be until mid-February.

If you are applying for a government subsidy through the healthcare Marketplace, you can still get coverage beginning February 1st as long as you complete your application by the 15th of January.  Also, if you are NOT applying for a federal subsidy, you can be in a Blue Cross Blue Shield individual health plan as early as January 15th, provided you complete your application by midnight January 8th.

Don’t forget:  Under the Affordable Care Act, you are required to carry health insurance or incur a tax penalty and the penalty is increasing.  For 2015, the penalty is 2% of your yearly household income or $325 per person and $162.50 for each child.  In order to avoid paying a tax penalty, the federal government has mandated you cannot go more than a three month period without health insurance and that’s where Blue Cross Blue Shield of North Carolina can help.  Not only will a BCBSNC health plan save you from incurring this tax penalty in 2015, it will also give you the peace of mind that comes from knowing you and your family are covered in times of sickness and health.

Whether you are applying for a federal subsidy or not, Blue Cross Blue Shield of NC has a health plan that will fit not only your family’s health care needs, but also your budget.  Don’t miss your opportunity to apply.  The New Year has begun, but there is still time to complete an application for health insurance before Open Enrollment 2015 comes to a close.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

Blue Cross Blue Shield of North Carolina announced that it will begin providing many of its ACA (Affordable Care Act) members the opportunity to receive an in-home visit offering a comprehensive medical exam.  During this at-home visit, members can review medications and discuss health care conditions and concerns with a licensed medical professional.  BCBSNC is offering this program in an effort to better assess the health conditions of its members and to help encourage members to practice preventive health care maintenance.

Because Blue Cross Blue Shield NC recognizes that many of its members are new to the health care system, they are making strides to try and engage new ACA enrollees in a health maintenance program.  These visits not only offer members a chance to discuss their health history with a professional from the comfort of their own home, the home assessment also helps identify any urgent health care problems.  During the visit, members can ask questions and get advice on issues they may need to discuss further with their primary care doctor.  Once the at-home visit has taken place, the health professional will share the results from the assessment with the member’s primary care doctor to ensure that the PCP has knowledge of the member’s overall health status and to help manage any health concerns.

BCBSNC sent letters to many ACA members and has also made phone calls offering these in-home health assessments.  Members may have been contacted for various reasons, including being high-risk, having no prior history with a Primary Care Physician or having a medical condition that would benefit from such an assessment.  These home assessments come at no charge to members and are performed by certified registered nurse practitioners, physicians and physician’s assistants.  Although not required, Blue Cross Blue Shield NC encourages its members to take advantage of the at-home assessment.

Typically, the at-home visit take about an hour and there is no lab work or blood work done during the assessment.  At the conclusion of the visit, the health provider will provide the member with information based on the outcome of the assessment and will discuss the importance of maintaining a relationship with a health care professional.  Members are being encouraged to follow-up with their PCP to discuss the outcomes of the assessment.

BCBSNC is committed to the health and well-being of its members.  Offering in-home health assessments is just one more way Blue Cross Blue Shield of North Carolina is striving to insure the health of North Carolina residents.  For more information on Blue Cross Blue Shield of North Carolina insurance coverage, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.

If you did not get health coverage previously under the Affordable Care Act, you can enroll in a plan for next year starting Nov. 15. And if you are already covered, you can change or renew your plan for next year. If you don’t sign up by Feb. 15, 2015, you will be without coverage until January 2016 unless you have a qualifying life event .

There are at least three key components to choosing an ACA plan that is right for you and your family: Benefits, premiums and the network of doctors and hospitals.

Benefits:

All ACA plans are required to cover “essential health benefits” as described in the law. And all individual plans must cover preventive health benefits entirely.

Beyond these requirements, consumers have choices when it comes to how much they pay out-of-pocket for covered services. Plans are broken into four categories — bronze, silver, gold and platinum. As these names suggest, bronze plans have the highest deductibles and co-payments, platinum the lowest.

When shopping for a plan, look for the “Summary of Benefits and Coverage” which describes what the plan covers. Also be sure to review each plan’s prescription drug formulary to see what drugs are covered. Or call the plans you’re considering and ask about any specific services you think you might use in the coming year.

Premiums

Health plans across the nation have been preparing customers for changes in rates from current plans for the new ACA enrollment period.  Generally speaking, the higher your out-of-pocket costs, the lower your premiums are. This tradeoff between rates and out-of-pocket costs is an important element to consider when shopping for coverage, CLICK HERE FOR YOUR NEW 2015 RATE.

Federal subsidies help consumers pay for coverage through the ACA. If your household income is between 100% and 400% of the federal poverty level, you do not have coverage through an employer, and you meet certain other requirements, you will be eligible for a federal subsidy to purchase a plan through the exchange.

Networks

Another important consideration for consumers is whether their current physicians and hospitals are in-network. Going outside the plan’s network typically results in higher charges — sometimes significantly higher. And some plans don not cover services provided outside their networks.

If you have had coverage before, or have a current plan, do not automatically assume your doctors will still be in-network for a new or renewed plan. It is best to check each time you go through an open enrollment period. All ACA plans are required to tell consumers which providers are in the plan’s networks. When shopping, look for the link to the provider directory.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

 

With all the changes in health insurance due to the Affordable Care Act, you may be facing Open Enrollment 2015 with a sense of dread, but don’t worry!  Jerry Ballard and Associates is here to help.  We understand how difficult and confusing the process of applying for health insurance can be and it is our pleasure to help you make it through with as little stress as possible.  If you are our customer, and need assistance making changes to your existing BCBSNC health plan or you are trying to obtain new health coverage, we are more than happy to help you choose the perfect plan for you and your family.

Because of the changes brought about by the Affordable Care Act, it is more important than ever for you to have a BCBSNC Authorized Agent to assist you with your application and other insurance needs.  Negotiating the government Marketplace and trying to determine subsidy eligibility can be overwhelming to say the least.   Between effective date deadlines, trying to make payments, and understanding various plans and benefit coverages, it is easy to feel lost.  Having an agent who is knowledgeable, concerned and easy to talk to can make all the difference in the world.  Further, there is almost nothing more frustrating than being placed on hold for extended periods of time or being unable to speak to a live person when you need it most.  At Jerry Ballard and Associates, we guarantee that will not be your experience.

Insurance is what we sell, but customer service is what we do best and we are committed to giving our clients the very best of our knowledge and attention.  We value your time and understand your concerns and we are prepared to meet the challenges of Open Enrollment 2015 with your family’s needs in mind.  November 15th and the start of Open Enrollment is just around the corner and we know you have a choice when it comes to your health insurance agent.  Let us show you what makes not only a Blue Cross Blue Shield of North Carolina health plan the very best you can buy, but also what makes Jerry Ballard and Associates the agency you want in your corner.

Whether you are looking for Blue Advantage, Blue Select, Blue Value, or Dental Blue, Jerry Ballard and Associates is your agency of choice for Open Enrollment 2015.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

 

GO BLUE – AVOID UPCOMING TAX PENALTIES

In 2014, the Affordable Care Act mandates that all taxpayers purchase health insurance or pay a tax penalty when reconciling taxes.  In addition, the penalty will increase every year until 2016.  Below is a list of the graduating tax penalty as outlined in the Affordable Care Act.

• 2014: a minimum of $95 per year or up to 1% of annual individual income (whichever is greater)

• 2015: a minimum of $325 per year or up to 2% of annual individual income (whichever is greater)

•2016: a minimum of $695 per year or up to 2.5% of annual individual income (whichever is greater)

To avoid having to pay these penalties, get your Blue Cross Blue Shield of North Carolina FREE RATE QUOTE today.  BCBSNC offers a variety of health insurance plans and premiums that will work for both you and your budget.  To find the plan that suits you best, click here.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obamacare. Call us for details.

To help make health care more affordable, the federal government offers advance premium tax credits, or subsidies, to low-to middle-income individuals and families. Your subsidy is an advance premium tax credit and is applied directly to your premium. Government subsidies reduce the amount you pay for your insurance plan.

To be eligible for a subsidy, you must meet certain requirements.

• Be between 100% and 400% of the federal poverty level (FPL).
• Not eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program,  Medicare or military coverage, such as Tricare.
• Not have access to minimal essential coverage through an employer. (An exception may be made if your employer’s plan does not cover at least an average of 60% of covered benefits or if the employee’s share of the premium is more than 9.5% of his or her income.  Employers can tell you if their plans meet these criteria.)

Subsidies can be used on any plan you choose except for grandfathered plans and catastrophic plans for those under 30. How much of a subsidy you qualify for is based on income and household size.

Our free BCBSNC Rate Quote offers a calculator to determine if a subsidy may be available to you.

2016 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA
Persons in family/household	100% Poverty guideline	250% Poverty guideline	400% Poverty guideline
1	$11,770	$29,425	$47,080
2	$15,930	$39,825	$63,720
3	$20,090	$50,255	$80,360
4	$24,250	$60,625	$97,000
5	$28,410	$71,025	$113,640
6	$32,570	$81,425	$130,280
7	$36,730	$91,825	$146,920
8	$40,890	$102,225	$163,560
For each additional person, add:	$4,020	$10,050	$16,080

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more information on Blue Cross Blue Shield of North Carolina insurance coverage, the Marketplace and healthcare gov to apply for your subsidy, please visit our website at www.nchealthplans.com or call our toll free number 888*765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.

 

 

 

 

 

 

Everyone knows you have to pay for health insurance, but did you know there is also a cost to being uninsured?  Under the Affordable Care Act there is a price to pay for not carrying health insurance. The penalty incurred for being uninsured is sometimes called the “individual responsibility payment” or the “individual mandate,” and the fine in 2014 is calculated one of two ways.  If you or your dependents do not have health insurance that qualifies as minimum essential coverage you will pay either 1% of your yearly household income or $95 per person, whichever is greater, for the year ($47.50 per child under 18).

Please note, however, that the penalty increases every year.  In 2015 it is 2% of income or $325 per person and in 2016 and later years it is 2.5% of income or $695 per person.  Also, it is important to remember that even if you pay the penalty, you still do not have health coverage and are responsible for 100% of your medical care.

The important thing to understand is that not only is health insurance a prudent decision for your life, it is also a wise choice for your wallet.  Blue Cross Blue Shield of North Carolina (BCBSNC) offers an array of affordable health plans  that not only save you from unwanted out of pocket medical expenses, it can also save you the cost of being uninsured.  For a complete definition of what qualifies as minimum essential coverage and a comprehensive look at how the tax penalty for being uninsured is calculated review the Affordable Care Act guidelines with IRS.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obamacare. Call us for details.

Posted April 14, 2014 – Blue Cross Blue Shield- Health Care Reform Blog

By: James LaCorte

Where does my health insurance premium really go? Health insurance customers often ask a simple question about the premium they pay every month:

Where does my premium dollar go? They’re usually not asking for a quick tutorial on how insurance works: Most people understand that everyone pays into a pool, and only those who need medical care take money out in the form of health care claims. What many of these folks really are asking is how much of that money actually pays for health care and how much goes toward running an insurance company — or toward profits.  Fair question.  Blue Cross and Blue Shield of North Carolina (BCBSNC) paid $5 billion in claims in 2013. Recently we announced that we spent almost 86 cents of every premium dollar paying for our customers’ health care – doctor visits, surgery, tests, medicine, eyeglasses, etc.

Our non-medical spending largely goes toward customer service and technology. We are also a full-taxed company. In 2013, we paid out more than $100 million in local, state and federal taxes.

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Affordable Care Act Open Enrollment ends March 31. 2014.  You need to purchase your new health insurance policy before the Open Enrollment period ends, if you plan to purchase through the exchange, or face a penalty. GET YOUR FREE RATE QUOTE AND APPLY TODAY for Blue Cross Blue Shield of North Carolina.

You will not have the opportunity to enroll again until  the next Open Enrollment starting November 2014 for coverage that starts January 1st, 2015. That means you cannot wait for a medical need to enroll.

Blue Advantage plans are available in all metallic levels: bronze, silver, gold and platinum. The levels differ by how much of your medical costs a plan will pay on average. They are based on approximate values for standard medical expenses.  If you qualify for a subsidy through the Marketplace, it could significantly decrease the amount of your monthly premium for your Blue Cross coverage.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

The Affordable Care Act does a lot to boost access to preventive services and encourage consumers to use them. Health care reform also requires that many preventive services be provided at no cost to the consumer, such as colonoscopies and contraceptive and many more services.  Click on the link to view all services that is outlined by BCBSNC.

Regular preventive care can help you stay in better overall health.  Make sure you understand how your preventive care benefits work, and be sure to take advantage of them.

Preventive care services are generally covered at 100 percent of the allowed amount when they meet the following conditions:  The service is delivered by an in-network provider;  The service is performed in an in-network, office-based setting or   stand-alone clinic and filed as an office visit;  The service is received only once per benefit period, and the service does not include any additional procedures.  Get your Free Rate Quote today.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.

The Affordable Care Act (ACA) requires individual and group health plans to report publicly their medical loss ratios (MLR), which represent the percentage of each premium dollar that is spent on health care services and quality improvement. ACA also requires such plans beginning on January 1, 2011, to provide an annual rebate to enrollees if the MLR is below the minimum requirement for the applicable market. The minimum requirement is 80% for individual and small group markets and 85% for the large group market.

Though the ACA directs a national standard for all insurance carriers’ MLR, some states may require more stringent ratios. The ACA’s MLR requirements will serve as a floor, below which insurance carriers may not fall without being penalized as noted above. However, US Department of Health and Human Services (HHS) has the discretion to grant a state-specific waiver of the MLR requirement, and several states have requested and received waivers. North Carolina received an MLR waiver from HHS, effectively reducing the minimum MLR for individuals in 2011 to 75%. In 2012, that requirement will be raised to the statutory minimum of 80%. Otherwise, MLR requirements are 80% for small groups, and 85% for large groups.
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The term “actuarial value” has not been frequently used, even in the insurance business…yet! Even those in the business may have a hard time understanding it and even harder time explaining it. But the Affordable Care Act (ACA) uses actuarial value to describe many of the requirements and restrictions for compliant plans, so it becomes increasingly important to understand and explain what this term means and how it applies in a post-ACA world.
Actuarial value is often seen as the “true” value of a plan. It is the percentage of covered costs that the plan expects to pay for an enrollee in the plan. As an example, a person with a plan that had an actuarial value of 70% would be responsible for on average 30% of the cost of the covered benefits under the plan. Depending on the behavior of the enrollees in the plan, the actual value of the plan may vary slightly. Until the passage of ACA, “actuarial value” was not a household term. Long-time insurance employees likely have a loose grasp on the concept, but in the post-reform world, it will be a commonly used tool to estimate the true value of a plan.
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