The document provides an overview of important information for enrolling in health insurance plans through the Affordable Care Act for 2015, including: - Essential health benefits that must be covered by ACA plans - Premium tax subsidies and cost-sharing reductions that many who apply qualify for - The need to review current plans as plans may change, be discontinued, or have rate increases for 2015

1. 10 Things You Must Know Before Enrolling In Obama-Care for 2015
#10: Affordable Care Act Health Plans must cover essential health benefits, pre- existing medical conditions and preventative care.
Essential benefits are as follows:
Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. #9: Many that apply for health coverage qualify for a premium tax subsidy.
Approximately 84% of those who applied for health coverage on the Federal Marketplace received a federal tax subsidy to pay some or their entire monthly health plan premium. An insurance agent can help you find the best plan with your choice of doctors and hospitals.
A premium is what you pay the insurance company each month for your health insurance plan. Again Uncle Sam is helping singles and families to get coverage by issuing premium tax credits to make the plans affordable. #8: Your family may be eligible for both a premium tax subsidy and cost-sharing reductions for Marketplace plans.
See the chart below for your eligibility for a tax subsidy and cost-sharing reductions for Marketplace plans.

2. #7: If you are currently enrolled in a Marketplace, “Obama-Care” plan your current plan could be changed, discontinued, or have a rate increase!
You will, if currently enrolled in a plan, be receiving a letter from the insurance company telling you of the changes.
If you do nothing you will be “re-enrolled” in your current plan if it still exists.
This could cause you to have a higher rate to pay each month and possibly cause you to lose your current doctors and hospitals.
Each person needs to contact their current insurance agent, one who is certified by the Federal Government to assist you in the Marketplace; to be sure that you are selecting the best plan for you and that you’re Federal Subsidy won’t be lost or change.

3. In each state plans will be changing with your current insurance carrier and also new insurance companies will be entering the market to offer plans to you.
It is the duty of your insurance agent to help you choose the correct plan for yourself or your family.
There are a lot of moving parts to the Affordable Care Act, “Obama-Care” and you don’t want any surprises when you go to the doctor or hospital.
#6: You must have a health insurance plan that meets the standard of “credible coverage” or pay a tax penalty each year to the IRS.
What is credible coverage?
Credible Coverage is any public or private health insurance or health benefit plan, whether insured or self-insured. The following types of health care coverage are Creditable Coverage: To avoid the penalty for being uncovered you must have insurance that qualifies as minimum essential coverage. Health plans that qualify as minimum essential coverage:

4. If you're covered by any of the following types of plans, you're considered covered under the health care law and don't have to pay a penalty.  Any Marketplace plan, or any individual insurance plan you already have  Any employer plan (including COBRA plans, with or without “grandfathered” status.  Retiree health plans  Medicare  Medicaid  The Children's Health Insurance Program (CHIP)  TRICARE (for current service members and military retirees, their families, and survivors)  Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)  Peace Corps Volunteer plans  Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 Other plans may qualify. Ask your health coverage provider. Health plans that don't count as coverage Health plans that don't qualify as minimum essential coverage don't count as coverage under the health care law. If you have only these types of coverage, you may have to pay the fee. Examples include:  Workers' compensation  Coverage only for a specific disease or condition  Plans that offer only discounts on medical services

5. #5: How much is the tax penalty or fine?
The fee for not having health coverage is calculated one of 2 ways. If you or your dependents don’t have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher. The fee in 2015 If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:  2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.  $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975. The fee for not having coverage in 2014 If you didn’t have coverage in 2014, you’ll pay one of these two amounts when you file your 2014 federal tax return:

6.  1% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.  $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285. The fee after 2015 The penalty increases every year. In 2016 it’s 2.5% of income or $695 per person. After that it's adjusted for inflation. How you pay the fee You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage. Most people will file their 2014 returns in early 2015 and their 2015 returns in early 2016. #4: What types of health and dental plans are available in 2015? In 2015 you will find five levels of coverage available on and off the Marketplace.
The health plan category you choose determines how you and your plan share the costs of care. These categories have nothing to do with the quality or amount of care you get. There are 5 categories or “metal levels” of coverage in the Marketplace. Plans in each category pay different amounts of the total costs of an average person’s care. This takes into account the plans’ monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. The actual percentage you’ll pay in total or per service will depend on the services you use during the year.  Bronze: Your health plan pays 60% on average. You pay about 40%.  Silver: Your health plan pays 70% on average. You pay about 30%.  Gold: Your health plan pays 80% on average. You pay about 20%.

7.  Platinum: Your health plan pays 90% on average. You pay about 10%.  Catastrophic: Catastrophic coverage plans pay less than 60% of the total average cost of care on average. They’re available only to people who are under 30 years old or have a hardship exemption. What to consider when choosing a plan category Think about your health care needs when choosing a category of Marketplace plan.  If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.  If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Silver, Bronze, or Catastrophic plan. These plans cost you less per month, but pay less of your costs when you need care.  If you qualify to save on out-of-pocket costs: Silver plans may offer the best value. You may qualify for lower out-of-pocket costs based on your household size and income. If you do, you can get these out-of-pocket savings only if you enroll a Silver plan. If you make this choice you'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium.  If you’re under 30 or have a hardship exemption and want low monthly premiums: You may want to choose a catastrophic plan designed to protect you from worst-case scenarios, like serious accidents or diseases. Of course, it’s impossible to predict all your health care needs for the year ahead. Pick a plan that fits your budget and meets your and your family’s expected needs.

8. #3: What is the Health Insurance Marketplace? Here’s a quick rundown on the most important things to know about the Health Insurance Marketplace, sometimes known as the health insurance “exchange.” Important. Before November 15, 2014, you can enroll in a Marketplace health plan only if you qualify for a Special Enrollment Period. Any plan you enroll in before November 15, 2014 ends December 31, 2014. You can apply for Medicaid and CHIP any time. Find out if you qualify for a Special Enrollment Period or view plans and prices for coverage ending December 31, 2014. Use the Marketplace to get covered The Health Insurance Marketplace helps uninsured people enroll in health coverage. Fill out a Marketplace application and we’ll tell you if you qualify for:  Private health insurance with savings based on your income. Plans cover essential health benefits, pre-existing conditions, and preventive care. Most people who apply through the Marketplace qualify for premium tax credits and savings on out-of-pocket costs based on household size and income.  Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost coverage to millions of families with

9. limited income. Many states are expanding Medicaid to cover more people. Find out what Medicaid expansion means for you. Fees, exemptions, and qualifying coverage  Most people must have health coverage or pay a fee. If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) — whichever is higher.  You’re considered covered under the health care law if you have any job- based plan, any plan you bought yourself, Medicare, Medicaid, CHIP, and many other kinds of coverage. See a full list of plans and programs that meet the health law’s coverage requirement.  Some people qualify for an exemption from the fee based on income or other situations. 3 more things to know  If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you’ll qualify for premium tax credits and other savings based on your income only if the job-based insurance isn't considered affordable or doesn’t meet minimum value requirements.  If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan.  You can buy a plan outside the Marketplace and still meet the health care law’s coverage requirements. But if you buy outside the Marketplace, you won’t be eligible for premium tax credits or other savings based on your income.

10. #2: The deductibles for some of these health care plans seem to be a large amount $6.300 for a single person and $12,600 for a family. Is there a way to reduce that out-of-pocket expense?
Yes there is some relief for individuals and families in the Marketplace. First if you qualify for Cost Sharing Reductions in the Silver plans then you will see your out-of-pocket costs reduced. A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category (See Health Plan Categories). If you're a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits
Another way you can reduce your out-of-pocket costs is to purchase a Qualified Health Plan Supplement Plan. With that type of plan the insurance company will pay you a set benefit amount for such items as doctor’s visits, hospital stays and such items as x-rays and imaging.
Ask your agent about Supplement Plans including Accident and Cancer Care and Hospital Indemnity plans which pay you for each day you are confined in a hospital.

11. #1: What do I do next?
It’s all a little confusing for the average American to grasp the 2,000 pages of the Affordable Care Act and the more than 10.000 pages of regulations that affect how you buy healthcare now and into the future.
With the IRS and other agencies of the Federal Government watching how your purchase and use your healthcare it’s important that you make the right choices each and every time for yourself and your family.
That is why you should turn to an insurance agent who has training in the health care market and who has to certify each year to assist you in finding the best coverage for your family.
There are a lot of agents out there but only a few have taken the time to certify on the government website and have taken the tests and have the necessary skills to help you.
To apply online click here: https://health.acaexpress.com?npn=239960 or better yet just give my office a call at: 816-224-9466.
You’ll be glad you called.
Best regards,
Duaine Owings-President
Plan To Win Insurance Agency
Blue Springs, Mo
www.GetAHealthPlan.com