Can I get Health Insurance with Pre-existing Conditions?

Posted on November 23, 2022November 28, 2022 by admin

Many people wouldn’t be able to afford healthcare if they had to pay for it out of pocket. This is one of the many reasons why health insurance is a wise investment. Our team of insurance experts at Shield Insurance Agency is dedicated to helping Michigan residents understand the benefits of health insurance.

What is Health Insurance?

In short, health insurance helps you pay for your healthcare. Your health insurance will pay for a portion of your healthcare costs or all of the costs after you pay a monthly premium.

Can I get Health Insurance with Pre-existing Conditions?

As a result of the Affordable Care Act, health insurance companies can’t deny a person coverage based on their pre-existing health condition. A pre-existing condition is a health issue that was present before you got healthcare coverage. Health insurance companies aren’t allowed to deny you coverage based on a pre-existing condition.

They’re also not allowed to charge you more as a result of any prior/ pre-existing health issues. Many health insurance companies consider many common chronic ailments as pre-existing conditions. A person with cancer, diabetes, asthma, and more, would be examples of pre-existing conditions. Even pregnancy can be considered a pre-existing condition. Health insurance companies aren’t allowed to discriminate against people who have these pre-existing conditions and more.

Conversely…

If you enrolled in your healthcare plan prior to the Affordable Health Insurance Act, you have a grandfathered plan. This means that your insurance policy can still cancel your policy or raise your rates due to a pre-existing condition. However, our team is committed to answering your healthcare questions and getting the coverage you need.

Contact Us Today

We at Shield Insurance Agency are standing by to serve Michigan residents. If you are enrolled in a plan that started before 2010, you have a “grandfathered plan”. These plans can cancel your coverage or can charge you higher rates due to a pre-existing condition.

Marketplace Circle of Champions: Carlos Garcia Awarded Elite level of 2022

Posted on February 8, 2022September 5, 2023 by Shield Insurance Agency

Shield Insurance Blog | Marketplace Circle of Champions | Contact Carlos!

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
Center for Consumer Information & Insurance Oversight
200 Independence Avenue SW
Washington, DC 20201

Shield Insurance Agent Carlos Martinez Garcia reached the Elite level of the 2022 Marketplace Circle of Champions by helping more than 100 consumers actively apply for and enroll in coverage!

The year-round efforts of agents and brokers play an important role in helping Americans access coverage and we are continually impressed by the dedication and commitment Carlos shows to consumers during the busy Open Enrollment Period.

This is an outstanding achievement! We thank Carlos for the trusted advice, support, and assistance you provide throughout the year to Shield Insurance Agency clients.

Marketplace Circle of Champions: Shield Agent Carlos Garcia Awarded Elite level of the 2022

Don’t Ignore Open Enrollment

Posted on November 16, 2020August 26, 2021 by Shield Insurance Agency

Insurance and you — why open enrollment is not something to ignore. Consider your options carefully and keep your eye on the clock.

If you are one of the 183 million people who receive health insurance through your employer, you might be asking if open enrollment actually applies to you and, if so, if there’s anything you need to do. The answer to both questions is “yes.”

Each year, an open enrollment period takes place that allows employees to enroll in their employer-sponsored health insurance. It gives you the opportunity to either confirm your current health insurance coverage or to consider signing up for a new plan that better suits your needs.

When considering your options during the open enrollment, there are several factors to take into account. Here they are.

Changes to Your Health

First, take a moment to check in with your actual health. You’ll want to plan for any upcoming or ongoing medical needs. For example, if you know you’ll need surgery in the coming months, take the time to check your insurance plan’s network of doctors. This can help you avoid any surprises when it comes to what doctors and services are covered.

Your Budget

Next, take a moment to consider how your health insurance impacts your budget over the course of the year. If you had a high deductible plan with a lower premium, did that work well for you? Or, did you have an expensive medical event that caused you to dip into your savings?

If that’s the case, it’s possible a low deductible plan with a higher monthly premium would better spread out your health care costs over the course of the year.

If you have expensive prescriptions, be sure to review the prescription benefits your company offers. Your employer might work with a prescription discount company that can help reduce your out-of-pocket costs.

More Than Just Health Insurance

Your employer may also offer additional coverage during open enrollment such as life insurance, short-term disability, long-term disability, or even pet insurance. These benefits can be valuable, especially if your employer is willing to contribute to the premium.

To determine whether or not you should participate, consider your circumstances; for example, if you are pregnant and know that you will be away from the office on maternity leave next year, you may benefit greatly from a short-term disability plan. Or, if you recently adopted a puppy, this could be a great time to look into pet insurance.

Timing Matters

Your employer will set the timing for the open enrollment period, determining the start and finish dates.

Generally, employers hold open enrollment during the fall, and your benefits will kick in on January 1 of the following year.

You should expect to receive several email notices from Human Resources – make sure to pay attention so you don’t miss any important signup details.

If you don’t believe your employer has sent anything out, make sure to ask directly. It’s important to sign up for the coverage you want by the close of open enrollment, otherwise, you may have to wait until next year to do so.

If you have a qualifying life event that occurs during the course of the year, your employer will offer you another window of time where you can adjust your benefits. Qualifying events include birth, divorce, or a spouse’s job loss. If you need to change your benefits during the year, feel free to ask questions and find out if your life event qualifies you to make a change.

During open enrollment, your employer is offering you the chance to make potentially critical adjustments to your health insurance — make sure you take advantage! Consider your options carefully and keep your eye on the clock.

Healthcare Premiums Drop

Posted on November 13, 2020December 22, 2022 by Shield Insurance Agency

Healthcare Premiums Drop Slightly As 2021 Open Enrollment Period Draws Near

Even with the election and oral argument in California v. Texas looming, the 2021 open enrollment period will soon be upon us and it’s all about healthcare premiums. In all states except California (where the open enrollment period began on October 15), the 2021 open enrollment season begins on November 1, 2020, with a deadline of December 15 in the 36 states that use HealthCare.gov. States with their own marketplaces—including New Jersey and Pennsylvania, which newly opened their own marketplaces—have set their deadlines later in December 2020 or January 2021.

Ahead of open enrollment, the Centers for Medicare and Medicaid (CMS) released new data on HealthCare.gov marketplace premiums and insurer participation for 2021. CMS’s analysis includes an issue brief on premiums, landscape plan data, and a map on insurer participation. (Public use files do not appear to be posted yet but will be available here when they are.) CMS also released the scheduled maintenance windows for HealthCare.gov for the 2021 open enrollment period.

Healthcare Premiums Drop 2%

Overall, healthcare premiums are expected to drop by 2 percent for a 27-year old for a silver benchmark marketplace plan sold through HealthCare.gov. This builds on a 4 percent decline for 2020 and a 2 percent decline for 2019. The unsubsidized average benchmark plan premium for a 27-year old will be $369/month for 2021 (compared to $388/month for 2020). In four states, silver benchmark premiums will decline by double-digits: Iowa (29 percent), Maine (14 percent), New Hampshire (18 percent), and Wyoming (10 percent). Only North Dakota will see an average benchmark plan premium increase of 10 percent or more (29 percent).

Lower Healthcare Premiums Ahead

Lower premiums are expected even with the pandemic. First, Congress repealed the health insurance tax beginning with 2021, which should result in premium savings that are passed along to consumers. Second, insurers continue to owe record-high medical loss ratio rebates in the individual market. This suggests that insurers are overpricing their products and those premium reductions are warranted. Third, more states have adopted state-based reinsurance programs: currently, 14 states have received a waiver to operate a reinsurance program. Fourth, the pandemic has led to higher profits for many insurers, further incentivizing premium reductions. These factors made it unsurprising that many insurers would reduce their premiums for 2021.

Insurer participation continues to increase.

Six more insurers will offer marketplace coverage through HealthCare.gov, increasing the total number of participating insurers to 181 for 2021. (Even so, this metric continues to lag earlier years in ACA implementation, remaining well below the high of 237 participating insurers for 2016.) Of the 36 states that use HealthCare.gov, 16 states will have more insurers compared to 2020 and 27 states will have counties with more insurers relative to 2020. Only Arkansas, New Mexico, and Wyoming will have an additional insurer offer statewide coverage. Four states have counties with fewer insurers in 2021 relative to 2020 while Delaware is now the only state with just one insurer (down from two states for 2020). Only four percent of enrollees will have access to only one insurer compared to 12 percent of enrollees for 2018 and 20 percent of enrollees for 2019.

Average premium reductions and higher insurer participation are encouraging. The uninsured rate was on the rise long before the pandemic, and robust individual market coverage options will be especially important in 2021 with millions of people losing their job or health insurance. Fortunately, many low-income consumers will continue to have options in 2021. CMS estimates that 30 percent of subsidy-eligible enrollees can find a marketplace plan for $10/month or less, and 71 percent can find a plan for $75/month or less. Of those not eligible for subsidies, 27 percent can find a plan for $300/month or less.

Deductibles Continue to Rise

At the same time, deductibles continue to rise. For bronze plans, the median individual deductible increased from $6,755 for 2020 to $6,992 for 2021. For silver plans, deductibles rose from $4,630 to $4,879. And gold plan deductibles rose from $1,432 to $1,533. Consistent with prior years, nearly all enrollees will have access to a health savings account-eligible marketplace plan in 2021.

Finally, potential maintenance for HealthCare.gov has been scheduled for early morning on November 1 (to make final preparations ahead of the start of open enrollment) and each Sunday from 12 am to 12 pm ET except on November 1 and December 13. Federal officials selected the Sunday morning time period because this is when the website receives the least amount of traffic. During any website downtime, HealthCare.gov will be unavailable for consumers to select a plan and enroll in coverage. As in prior years, CMS anticipates that actual maintenance periods will be much shorter than the scheduled slots. Despite the maximum allocation of 72 hours of maintenance last year, the website was down for only 24.5 hours and HealthCare.gov was reportedly available 96.9 percent of the time.

Healthcare Insurance Coverage for Business 2021

Posted on November 2, 2020August 27, 2021 by Shield Insurance Agency

The pandemic has made everyone acutely aware of the need for healthcare Insurance coverage. Small businesses struggling to survive are challenged to find ways to offer health coverage as a fringe benefit to employees. Premium costs are high.

Nonetheless, there are several ways in which small employers can help employees get coverage for the upcoming year.

5 Things to Know About Healthcare Insurance Coverage in 2021

Don’t wait until the last minute to explore your options. Here are 5 things to keep in mind.

1. Coverage Requirements for ALEs

If you have at least 50 full-time and full-time equivalent employees, you are an Applicable Large Employer (ALE) subject to the employer mandate under the Affordable Care Act. This means you must offer minimum essential health coverage that’s affordable to your full-time employees or pay a penalty. What’s affordable Healthcare Insurance? The IRS has released this information for 2021. The cost to employees can’t be more than 9.83% of household income in 2021.

2. HSAs

Health savings accounts (HSAs) allow individuals to cover their out-of-pocket costs. But to make contributions—whether by employers or employees—to such accounts, individuals must be covered by a high-deductible health plan (HDHP). For 2021, this means insurance with a minimum deductible of $1,400 for self-only coverage or $2,800 for family coverage and a cap on out-of-pocket expenses (deductibles, co-payments, and other amounts other than premiums) not exceeding $7,000 for self-only coverage or $14,000 for family coverage.

If you have group insurance that is an HDHP, then you can decide whether to contribute to employees’ HSAs. If not, then employees can choose to make deductible contributions to their accounts for 2021. More information about HSAs is in IRS Publication 969.

3. HRA Options

Health reimbursement arrangements (HRAs) facilitate tax-free reimbursements to employees. While the business can deduct these reimbursements, they aren’t subject to employment taxes. For 2021, consider these HRA options:

Qualified small employer health reimbursement arrangements (QSEHRAs). These plans reimburse employees for premiums on their individually-obtained coverage up to a set dollar limit ($5,250 for self-only coverage or $10,600 for family coverage in 2020).
Individual coverage health reimbursement arrangements (ICHRAs). These plans also reimburse employees for their premiums on individually-obtained health coverage. The law doesn’t cap the reimbursement; it’s up to the employer to fix this amount (on a nondiscriminatory basis).
Excepted benefit health reimbursement arrangements (EBHRAs). These plans help pay for certain benefits, such as dental or vision care, not otherwise covered by a general insurance policy. Reimbursement is capped up to a set dollar amount. The cap for 2021 has not yet been announced (it was $1,800 for 2020).

More information about HRAs is also in IRS Publication 969.

4. Premium-only Cafeteria Plans

If you don’t provide a Healthcare Insurance plan or do have a plan (including an HRA) but you don’t pay all of the cost, you can enable employees to pay all or the balance of premiums on a pre-tax basis. The plan must offer employees a choice between cash or reimbursement for health insurance coverage. If they choose the coverage, the amount of what they’d pay for premiums that are withheld from their paycheck is not treated as taxable compensation to them. There are no employment taxes on this benefit. If, however, they choose the cash option, it’s taxable compensation.

5. Notice Requirements

Employers offering a Healthcare Insurance plan are required to give notice to employees about their participation and what’s involved. Depending on the plan, notice may include providing a summary plan document.

Generally, notice is required to be given 90 days before the start of the plan year. So, if the plan year starts on January 1, 2021, notice must be given by October 3, 2020.

Conclusion

Health Care for the Latino population with Shield Insurance Agency

Start shopping now for Healthcare Insurance. Contact the Shield Agency expert Carlos Garcia or another tax advisor to find ways to make this benefit available to employees without busting your budget. And be sure that whichever option you use that you do so in compliance with the law.

Affordable Care Act Open Enrollment

Posted on June 22, 2019August 30, 2023 by Shield Insurance Agency

Shield Insurance Blog | Affordable Care Act | Health Insurance

Affordable Care Act (ACA) Open Enrollment

OK, so maybe this entry isn’t so much as a blog as it is me just unloading my brain…. and with open enrollment starting tomorrow, it’s about all I can think about (sorry Dawn… I’ll get working on that ‘honey-do list soon!!).

Affordable Care Act: Being able to choose new health insurance plans as early as tomorrow, just makes me think of how much of a disaster it was last year. We are all just hoping like heck that the site works better this year!!! PLEASE!!! We are being told that it’s much more streamlined and shorter than last year’s. We’ll soon see! We did sign someone up yesterday and were told that it would be on the new platform, but it didn’t appear to be very different at all. hmmm…

Last year, buying a plan on the Marketplace was not a very fun event. But we did our best to help folks as best as possible! We’re here to do that again this year and are acquiring quite a bit of expertise, so we feel confident that we can help!

This year, the Blue Cross and Priority rates are closer! They still appear to have a lower price overall. And if you’re eligible for a subsidy, don’t forget that you MUST sign up on the Marketplace, meaning that you can’t purchase a plan from United Health Care, for example, since they are not “playing” ON the Marketplace this year in the counties that we work within Michigan.

Our office is doing the actual process of signing everyone up on the website. She can whip through those pages pretty proficiently now! And she knows many of the stopper/pitfall answers to some of the quirkier questions asked so make sure you call us to get signed up!

FYI, ACA means the Affordable Care Act and it applies to all Americans. Some plans are grandfathered and do not need to comply. I don’t dare claim to know ALL there is about this, but it’s interesting to note that some companies are ditching all pre-ACA plans now and some are going on until at least the end of 2017. that goes for Group AND Individual. Oh, and when I say “individual”, I just mean non-group… so that means that it’s not offered through an employer. The individual does not mean ‘just one person’… it can… but it means ‘families’ too.

Have a great day! Andy

Shield Insurance Agency

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Can I get Health Insurance with Pre-existing Conditions?

What is Health Insurance?