Change is in the Air…

This year, with the annual health coverage election periods rapidly approaching, people have more questions than usual regarding both Medicare and the Affordable Care Act/Obamacare. Obviously in this highly dynamic environment, anything we say today can change tomorrow, but let’s try to answer some of your questions as best as we can.

I don’t have insurance this year; will I have to pay the penalty?

This is a complicated issue. The president can declare that the penalty for not having health insurance won’t be imposed this year. Since the IRS works for the executive branch, they would then be obligated not to charge people with the penalty; however, the courts may require the penalty to be paid, in essence, overruling the President. The best advice is to assume that you will have to pay the penalty, and if you aren’t required to pay the penalty you’ll feel glad and have a little bonus. If you must pay the penalty and you assumed you wouldn’t have to, you’ll feel upset and angry. Go with the adage…don’t worry; be happy!


Who will provide ACA health insurance this year?

It appears that Ambetter, Molina, Florida Blue’s (MyBlue, Florida Blue Select and Blue Options) will be the carriers you will find on the Affordable Care Act marketplace.  In addition, AvMED (Empower, Engage, or Agility) will be providing plans off the marketplace. Humana has decided NOT to participate in the individual marketplace.


Will there be subsidies this year?

At the moment the answer appears to be yes, subsidies may be available, but that could change either because of the Trump administration or because of the U.S. Federal Courts. To protect the subsidies will take an act of Congress, a ruling from the Federal Courts, a presidential decision or a combination of the above.


What will it cost for individual health insurance this year?

If you don’t get a subsidy, you are likely to see a price increase, which will be based on the fact that you’ve aged and that rates will likely be revised upward. If you get a subsidy, and subsidies remain, then your costs will be determined in large part on the plan you choose, your income, your smoking status and where you live. The baseline for Subsidies is the Federal Poverty Level, which increased by 1.2 percent in 2017. If a single person earns less than $12,060 he/she will not qualify for any subsidy assistance from the Federal Government.


What is often most overlooked in making decisions about Medicare Insurance options?

Most people sign up for Medicare when they are first eligible, and often they choose a plan based primarily on factors like low cost or perhaps a supplemental benefit like Silver Sneakers. What they often don’t take into account enough are True Out of Pocket costs and how the choice they make now may indeed limit their ability to make a better choice for themselves as they age. There is no doubt that the selection of nursing homes and rehabilitation facilities are vastly superior for people with Medicare and a Supplement than they are for people with Medicare Advantage Plans. Also the ability to use almost any hospital, facility or doctor under Medicare is almost always superior than the restrictiveness of any specific network. For many people the luxury of having a Medicare Supplement Plan is just too costly, but for those who can afford it and who can still pass the medical underwriting to gain such a plan, they would be wise to strongly consider that as a viable option during this enrollment period.


Should I review my Medicare Options annually?

The answer is a resounding yes. If you have a Medicare Advantage plan, your plan may have changed, new plans may be offered or your medical needs may have changed. It is worthwhile to review your options, either through your own research or with a professional you trust. It is rarely worthwhile to check with your neighbor unless you know they have exactly the same medial conditions as you have and you are confident that they made a detailed evaluation to come to the conclusion they did.


William Kohn is the Agency Manager of Florida Health Agency (Establish 2008) located in Pompano Beach. You can reach him at 754-205-2005. Medicare and Health Insurance is the primary focus of their practice.

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