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.

 March 31st is the final day for open enrollment!

Ok, you have shopped around the Marketplace and looked over the BLUE CROSS BLUE SHIELD OF NORTH CAROLINA plans. Or maybe you have been waiting for the smoke to clear before logging on to healthcare.gov to shop for your health insurance coverage. But, now the clock is ticking, and important ACA deadlines are looming. You need to purchase your new health insurance policy before the Open Enrollment period ends on March 31, 2014, if you plan to purchase through the exchange, or face a penalty. GET YOUR FREE RATE QUOTE AND APPLY TODAY.

During the Open Enrollment period, you can buy qualified private health insurance through the government Marketplace. After the Open Enrollment period, you can only sign up for Medicaid and the Children’s Health Insurance Program (CHIPS) through healthcare.gov. Unless, you qualify under Special Enrollment Period that require a change in your health insurance.  Some of these include getting married, moving, getting a new job that pays more, or losing your health insurance.

SO without qualifying for a Special Enrollment, the planned ACA deadlines for 2015 enrollment are much shorter than this year’s: November 15, 2014 through January 15, 2015. Buying health insurance after that date will be restricted to special circumstances unless you get coverage through your employer.

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.

Cost-Sharing Reductions are only available to those who qualify. Again, they do not apply to Grandfathered Plans. If you qualify, you will want to take advantage of both Cost-Sharing Reductions and Advanced Premium Tax Credits. You can use them both to maximize your savings.Cost-Sharing Reductions are only available to individuals who are ineligible for public coverage and are unable to get qualified health insurance through an employer.

COST-SHARING REDUCTIONS:

2014 plans will be grouped into four metallic levels: Bronze, Silver, Gold and Platinum. In order to take advantage of Cost-Sharing Reductions, you must choose a Silver plan. They help lower out-of-pocket expenses, such as deductibles, co-pays and coinsurance.

Cost-Sharing Reductions are only available for households with incomes thatare between 100% and 250% of the Federal Poverty Level (FPL).

For example, let’s say you go to the doctor and are charged $100. Normally with a Silver plan you might have a co-pay of $25, but because
you qualify for Cost-Sharing Reductions and you chose a Silver plan, you may have a co-pay as low as $5.

Cost-Sharing Reductions can also lower deductibles. For example, a $3,500 deductible may be lowered to $500.

With Cost-Sharing Reductions, you essentially pay for a Silver plan but receive the richer coverage of higher metallic level plans, thereby reducing your out-of-pocket expenses. If you qualify for Cost-Sharing Reductions, you should take advantage of this cost savings benefit.

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). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Information from a BCBSNC publication on 8/12/13.

There are two types of federal subsidies to help reduce health care costs in 2014.They are Advanced Premium Tax Credits and Cost-Sharing Reductions.

+ Advanced Premium Tax Credits lower your monthly premium.

+ Cost-Sharing Reductions help lower out-of-pocket expenses including deductibles, co-pays and coinsurance at the place of service, like doctor and hospital visits. Subsidies are only available on new 2014 plans for those who qualify. Subsidies cannot be applied to Grandfathered Plans, but it may be worth it to switch.

+ Advanced Premium Tax Credits are only available to individuals who are ineligible for public coverage and are unable to get qualified health insurance through an employer.

+ Advanced Premium Tax Credits are determined by income and family size in relation to established Federal Poverty Levels (FPL). Many Americans will qualify for Advanced Premium Tax Credits, including the middle class. Those that qualify must have a household income between 100% and 400% of FPL for their family size.

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There are three ways to go about purchasing insurance for yourself and for your small business: by going through the health care exchange,
contacting an insurer or speaking with a broker.

Health Insurance Exchanges:

You’ve probably heard about exchanges.  The exchange is an online marketplace where various private insurance companies such as Blue Cross Blue Shield will offer their plans.  To simplify the options that will be available on the exchange, and to give a basis for comparison, all plans will be classified according to four levels: bronze, silver, gold or platinum. Bronze plans will provide the least generous coverage, and platinum plans will provide the most generous coverage.

The exchange will enable people to:

• Review plans, compare prices and enroll all at once
• Find out if they are eligible for subsidies It’s important to know that the exchange is the only place to apply for subsidies. It will provide step-by-step instructions to guide you through the process.

Open enrollment on the exchange – the time period in which you will be able to enroll for your 2014 health insurance plan – begins Oct. 1, 2013.  As mentioned earlier, you can also purchase insurance by contacting health insurance companies directly. Or, by speaking with an insurance broker.  No doubt, there is a lot to take in, but we’re dedicated to helping you find an insurance plan that meets your needs and to keeping premiums as affordable as possible.

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). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

As you begin to prepare for 2014, you will need to be familiar with the following terminology…

Affordable Care Act (ACA)– The law intended to address issues with our health care system by increasing access to health insurance, introducing reform and improving quality  also referred to as the Patient Protection and Affordable Care Act (PPACA).

Health Insurance Marketplace– An online insurance marketplace where individuals can compare, shop for and buy qualified health insurance plans.  Also known as an “Exchange”.

Federal Poverty Level (FPL)– A measure of income level (by family size) that determines eligibility for premium tax credits.  For example, a family of four that makes less than $94,200 a year may be eligible for help.

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). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

The information in this article was taken from “Health Care Reform is Coming” from BCBSNC on April 2013.