So the healthcare.gov website is down – and has been the last few days I checked. Hopefully it will be up and running smoothly very soon! The Presidents statement that the site will be fully operational for nearly everyone by the end of November is concerning, to put it mildly. This would only give us 15 days to complete January 1, 2014 enrollments; as all January 1 enrollments must be completed by December 15th, 2013. For many people who are losing their current plan January 1st, this is frightening!
For example, 28,000 Carolina Care Plan customers will lose their individual plans on January 1, 2014. Many of these residents have no option but to choose a guaranteed issue policy from the Federal Marketplace.
South Carolina residents will have until March 31 — not Feb. 15 — to sign up for Obamacare marketplace coverage without any penalty under the individual mandate, according to new guidance issued by the CMS.This guidance is to clear up confusion about the two dates. The Obamacare open enrollment period runs until March 31st 2014 — but initially people would only have had until Feb. 15 to meet the deadline to avoid a tax penalty under the individual mandate / shared responsibility laws.
Date: October 28, 2013
Subject: Shared Responsibility Provision Question and Answer
Q: Will any individual who enrolls in coverage through the Marketplace by the end of
the open enrollment period for 2014 have to make a shared responsibility/individual mandate payment in 2015 for the months prior to the effective date of the individual’s coverage?
A: Starting in 2014, the individual shared responsibility provision requires each
individual to maintain health coverage (known as minimum essential coverage), qualify
for an exemption from the requirement to maintain minimum essential coverage, or make a shared responsibility payment when filing a federal income tax return. To help make coverage affordable for millions of individuals and families, the Affordable Care Act provides, among other things, a premium tax credit to eligible individuals and families to help pay for the cost of health insurance coverage purchased through Health Insurance Marketplaces.
The shared responsibility payment generally applies to people who have access to
affordable coverage during a taxable year but who choose to spend a substantial portion of that year uninsured. The Affordable Care Act gives the Secretary of the U.S.
Department of Health and Human Services (HHS) the authority to establish hardship
exemptions from the shared responsibility payment for individuals who “have suffered a hardship with respect to the capability to obtain coverage under a qualified health plan [QHP].”1 Under this authority, HHS has enumerated several situations that constitute such a hardship.2
Furthermore, the Affordable Care Act provides the Secretary of HHS the authority to
determine the initial open enrollment period for individuals to enroll in coverage through the Marketplaces for 2014. 3Pursuant to this authority, the final rule entitled “Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers” and published on March 27, 2012, at 45 CFR 155.410(b) (“Exchange Final Rule”) specifies that the initial open enrollment period for individuals begins on October 1, 2013, and extends into 2014. The Exchange Final Rule also provides the coverage effective dates for individuals enrolling in coverage through the Marketplaces during the initial open enrollment period.4
For plan selections made between the 1st and the 15th of a given month, the coverage effective date is the first day of the immediately following month, and for plan selections made between the 16th and end of a given month, the coverage effective date is the first day of the second following month.
To ensure that the shared responsibility payment generally applies only to the limited
group of people who have access to affordable coverage during a year but who
nonetheless choose to spend a substantial portion of that year uninsured, the Affordable Care Act provides nine statutory exemptions relating to the individual shared
responsibility provision within the Internal Revenue Code.5
The short coverage gap exemption specifies that an individual is exempt for “[any] month the last day of which occurred during a period in which the applicable individual was not covered by minimum essential coverage for a continuous period of less than 3 months.”6
The length of the initial open enrollment period and the coverage effective dates, in
tandem with the terms of the short coverage gap exemption, created the possibility that an individual who enrolled in coverage through a Marketplace during the initial open
enrollment period could nonetheless be liable for a shared responsibility payment for
months prior to the effective date of that coverage, if the individual were not otherwise
exempt. More specifically, under this structure, an individual who enrolls between
February 16, 2014 and the close of the initial open enrollment period will have coverage
effective as of April 1 or later. As a result, such an individual would not be eligible for
the short coverage gap exemption, which applies only when the coverage gap is less than (but not equal to) 3 months.
HHS recognizes that the duration of the initial open enrollment period implies that
individuals have until the end of the initial open enrollment period to enroll in coverage
through the new Marketplaces while avoiding liability for the shared responsibility
payment. Yet, unless a hardship exemption is established, individuals who purchase
insurance through the Marketplaces towards the end of the initial open enrollment period could be required to make a shared responsibility payment when filing their federal income tax returns in 2015. HHS has determined that it would be unfair to require individuals in this situation to make a payment. Accordingly, HHS is exercising its authority to establish an additional hardship exemption in order to provide relief for
individuals in this situation.
26 USC § 5000A(e)(5). 2
“Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions;
Miscellaneous Minimum Essential Coverage Provisions”, published on June 26, 2013, at 45 CFR
§ 1311(c)(6)(A) of the Affordable Care Act.
45 CFR 155.410(c). 5
26 USC 5000A(d) and (e). These categories of exemptions are: individuals who do not have access to
affordable coverage; individuals with household income below the federal income tax filing threshold;
members of federally recognized Indian tribes; individuals who experience a hardship; individuals who
experience a short coverage gap; members of certain religious sects; members of a health care sharing
ministry; incarcerated individuals; and individuals who are not lawfully present. 6
26 USC 5000A(e)(4)(A). This statutory provision is implemented in final Treasury regulations entitled
“Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage” and published on
August 30, 2013, at 26 CFR 1.5000A-3(j)(2)(i).
Do you have questions about the Individual Mandate and Shared Responsibility Provisions of the Affordable Care Act?
Kathleen Sebelius, Secretary of Health and Human Services
Saturday, October 26, 2013
To give Americans a better way to shop for health coverage, the federal government and states recently launched Health Insurance Marketplaces. Yesterday, we announced a clear path forward so that by the end of November, HealthCare.gov will work smoothly for the vast majority of consumers. But you probably haven’t heard about the Data Services Hub which serves as a critical resource for the Marketplaces, both state and federal. The Hub is a tool to help you and your family get affordable, quality health care.
What Is the Hub?
The Hub is a routing tool – an information sharing tool. It is an efficient and secure way to rapidly verify the information submitted by consumers seeking a determination of what coverage options and financial assistance are available to them.
You see, one of the great things about the new Marketplaces, which are getting better every day, is that through them, you can apply for health coverage, and check to see if you and your family may qualify for lower premiums, or for Medicaid or the Children’s Health Insurance Program (CHIP). But that one-stop shopping is possible only if information can be shared quickly, accurately, and securely.
The Hub provides one connection to the common federal data sources needed to verify consumer application information for income, citizenship, immigration status, access to minimum essential coverage, etc.
What the Hub Is Not
It’s important to understand that the Hub is not a database. It doesn’t retain or store information. And the Hub queries only those systems necessary to determine your eligibility for what you apply for. It is a model of efficiency and security because it eliminates the need for each Marketplace, state Medicaid agency, and CHIP agency to set up separate data connections to each of the systems that are in place to help you and your family.
How Many People Has It Helped?
As of yesterday, nearly 700,000 Americans had completed an application through the Marketplaces – more than half of them through the federal Marketplace. This does not count applications directly to Medicaid and CHIP agencies that also can use the Hub.
A few more stats of note:
State-based Marketplaces and the Federal Marketplace are getting real time and accurate eligibility determinations from the Data Services Hub in less than 1.2 seconds.
The Social Security Administration has reported 4.2 million transactions involving individuals or households who have elected to establish an account. The current overall verification rate for Social Security numbers is 96%. With respect to those we’re unable to verify, consumers are notified online with instructions for resolving their verification issues. The highest numbers of transactions continues to involve individuals and households in the following states: Pennsylvania (323,000), New York (310,000), California (290,000), West Virginia (240,000), and Washington (135,000).
The Internal Revenue Service (IRS) has received and responded to more than 1.3 million requests for historical household income and family size tax data from the hub. The number of requests received does not reflect the number of people about whom the requests were made (i.e., a single request can involve everyone in a household). Thus, the number of individuals about whom the requests were made could be higher than 1.3 million. The IRS has provided data responses electronically via the hub in “near-real” time (average actual response time is 0.37 seconds).
The IRS also offers an advance premium tax credit computation service, which is optional for state Marketplaces. If a Marketplace chooses to use the IRS service, it sends a few data points, without identifying the applicant, and the IRS provides a math result in response. More than 330,000 requests have been received for the computation service with an average actual response time of 0.21 seconds.
States are reporting that they are satisfied with the hub’s performance. The technology program manager for Kentucky’s Marketplace said recently that 92% of applicants have been successfully verified through the hub: “We’re overjoyed with that 92 percent. I don’t know that we thought it would be that high of a success rate.” Connecticut has also reported few problems with the hub.
The Hub is a 21st century way to assess eligibility for coverage and premium assistance, and it’s working for residents of all 50 states and DC. We’ll continue to monitor and optimize its performance. And we won’t stop working 24/7 until the doors of HealthCare.gov are wide open. If you need health coverage, it’s our mission to be sure these tools are here for you, running smoothly. The Hub is on the job, and so are we.
10/03/2015 – We can now confirm that there will be at least one South Carolina Platinum plan offered in EVERY South Carolina county for 2015 on the Health Insurance Marketplace. According to our sources, this will be a PPO based product offered by Assurant. This means that SC residents will now be able to use tax credits to purchase a Platinum level plan
SC Platinum Plan Quote
through the health insurance marketplce. Our private exchange, which opens on November 15, 2014, will allow customers to apply for tax credits, compare prices and plans, and enroll (in a Platinum plan, if you wish!) in less than 15 minutes!
Stay tuned for more updates. In the meantime, you can find more information about South Carolina Platinum plans in our original article below:
Have you seen the new 2015 South Carolina Platinum Plans? I have heard repeated numerous times in the news and in print, that “Insurance companies are not offering any Platinum plans in South Carolina.”I would like to take a moment to say that THERE ARE, IN FACT SOUTH CAROLINA PLATINUM PLANS OFFERED IN 2014!
Of course, there is a catch – these South Carolina Platinum plans are only offered off of the exchange/marketplace.
What does “off marketplace” mean? Keep reading to find out!
What is a South Carolina Platinum Plan?
Platinum plans, as defined by the Affordable Care Act (ACA, or as some say, “Obamacare”) are health insurance plans that have an actuarial value of 90%. In general, Platinum plans have higher monthly premiums, but lower out of pocket costs. For this reason, South Carolina Platinum plans are more suited to people who expect to go to the doctor often, have regular monthly prescriptions, or expect to have other substantial medical expenditures throughout the year.
Off-Exchange/Marketplace Health Plans
Off exchange plans are plans that are offered outside of the Federal Health Insurance Marketplace. These plans, starting January 1, 2014, must comply with all of the laws that apply to health plans offered on the Federal Exchange/Marketplace at www.healthcare.gov. Just like plans on the marketplace, qualified health plans purchased outside of the federal marketplace must still cover the 10 essential health benefits as defined by the healthcare reform law. The biggest difference to YOU, the consumer? Anyone who purchases an off-exchange plan cannot qualify for Federal subsidies to offset health insurance premiums. Generally, most South Carolina individuals and families making between 100% and 400% of the Federal Poverty level may be eligible for premium assistance through the Federal Exchange. I personally believe, that in certain situations, many South Carolina residents who are eligible for a subsidy, may be better off forgoing the subsidy and buying an off exchange policy. In addition, many off-marketplace plans use more robust provider networks than those found in marketplace plans. Recently, local South Carolina Newspapers such as the Post & Courier and The State Newspaper published articles about the limited networks for many health plans available on the Federal Marketplace. This is why we recommend working with a South Carolina Obamacare agent to be sure that you choose the plan that best suits YOUR unique needs.
Who offers South Carolina Platinum Plans?
Of course, as a full service Health Insurance Agency we offer South Carolina Platinum plans through through Assurant Health. Assurant Health offers 2 South Carolina Platinum Plans: CoreMed Platinum 1 and CoreMed Platinum 2. Each of these plans allows the enrollee to select either the CIGNA PPO Network or the Aetna Signature Administrators Network. For benefit summaries for each of the two South Carolina Platinum Plans, click the links below:
Who is Assurant? Great question. Assurant traces its roots to the founding of the LaCrosse Mutual Aid Association established in LaCrosse, Wisconsin in 1892, formed to provide consumers with disability insurance. Assurant Health now provides quality health care insurance products to customers with an emphasis on individuals who need coverage but are not part of a larger group plan. With a 120-year legacy, the business offers affordable health care products including major medical, supplemental and fixed-benefit plans for individuals, families and small employers. Financial ratings information for Assurant’s various companies can be viewed HERE.
Who should consider a South Carolina Platinum Plan?
Anyone who visits the doctor often, takes many prescriptions, or otherwise has high anticipated medical costs. Our analysis indicates that South Carolina residents under the age of 50 may see the most value in a South Carolina Platinum plan in 2014. In our analysis, many residents with high medical costs were better off paying higher Platinum plan premiums in exchange for much lower out of pocket costs. Please contact us today to help determine if you may be a good candidate for a South Carolina Platinum plan. We can HELP!
Update – 10/28/2013
We really enjoyed this article from the New York Times, especially as it relates to South Carolina Platinum plans :
WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites. Read More Here
Update – 11/12/2013
Platinum plans are 2nd most popular plans on the Kentucky Health Insurance Marketplace!
Young female with pricey tastes: Kentucky Obamacare numbers
If Obamacare data were a horse race, Kentucky would be leading the pack.
Kentucky has released in-depth, demographically detailed information about enrollments in its state-run Obamacare marketplace, setting a high bar for federal authorities to beat when they finally release their own enrollment data from HealthCare.gov later this week for the first time. Read More…
Last weekend a new link/page was added to www.healthcare.gov. This link is titled “See Plans Now” (see image below – you can click to enlarge). This new feature claimed to let users view plans and rates in their area.
Unfortunately, the information provided via this tool is incorrect for nearly all users. Why, you ask? Because the healthcare.gov rate calculator does not estimate rates based on your exact age. Instead, the it simply asks if you are older/younger than age 49.
In the next image, you can see that when you choose to “”See Plans Now” you are simply asked if you are “49 or younger” or “50 or older”. Not exactly a great baseline for calculating health plan rates.
For this exercise, I chose Charleston County, SC as my area of residence, and selected “Age 49 or younger”. Of course, I am 35 years old, and my exchange application is still being delayed for Identity verification (2 weeks and counting). So it seems reasonable that I may want to browse rates on the federal exchange while my Identity Verification is processing. Of course, after completing the required information about myself and my family status, I was given a list of every plan available in Charleston county, SC. Unfortunately, the rates given were much lower than what my ACTUAL rates are, based on my South Carolina Health Exchange Rates quote engine! See the image below for the rates I was given:
As you can see, the healthcare.gov plan finder tool gave me estimated rates of $230.27 for the CoventryOne Silver $10 Copay Roper St Francis Plan.
Actual Results: Real numbers from SChealthconnector.org
So after viewing the rates over at healthcare.gov, I proceeded to run quotes for myself here on the schealthconnector.org South Carolina Health Exchange Rates page. As expected, my ACTUAL premium was much higher than that given by healthcare.gov $268.50 (See image below – click to enlarge). IN the age of Google, Amazon & Ebay, it seems obvious that transparency should be the #1 priority for a consumer website – hopefully our government can do much better- and SOON!
Yesterday, the Washington times had an article updating the status of healthcare.gov. Consumer reports was quoted as saying “Don’t bother even trying for another couple of weeks”.
Though I have personally seen some improvements in the site, I would not argue with consumer reports. As an agency we feel that, though the site is improving, the overall enrollment process is still taking longer than acceptable for most people. This morning, I am happy to report that the document upload feature of the Identity Proofing process seems to be working normally. As of late as last week, the document upload process seemed to be broken – giving an error message that files must be less than 10MB, regardless of actual file size! Experian is the entity tasked with Identity Proofing for the Federal Marketplace. In addition, failed identity verification errors gave a toll free number to call Experian. However, the error message gave no reference number in our experience. When calling the toll free number to Experian, the caller is required to have a reference number from the Federal Marketplace in order to address the issue. Obviously, this is quite a problem – we hope it is resolved soon. In the meantime, these examples are more reasons why you need a South Carolina Obamacare Agent to help you navigate the new Federal Marketplace!
www.schealthconnector.org is your #1 source for South Carolina Health Plan Enrollment Information! CONTACT US today for enrollment assistance!
We are pleased to provide our clients South Carolina enrollment Information to help get enrolled and compare health plans on the new health insurance marketplace. However, please follow the instructions below so that we may properly assist you. Please note that we will not have access to your South Carolina health plan enrollment to work with you if you do not complete the registration properly. As experienced South Carolina agents, we have a state of the art software system that allows up to share computer screens during the health plan enrollment process. This allows you to complete your health plan enrollment at your convenience on your computer, when you want to and where you want to, with the added security of having an expert agent advising you!
For our clients wishing to enroll in a South Carolina health plan on their own, directions below!
South Carolina Health Plan Enrollment Information:
When the you are logged in to the healthcare.gov page, you will see a screen labeled,“Help applying for coverage.” On this screen, it is vital that the you enter the following information: agent’s/broker’s name, NPN, and FFM User ID (if the agent/broker has an FFM User ID). Click on the image above to verify information. Accurate entry of our agent’s/broker’s information on that screen will enable the insurance carrier to associate the health plan enrollment with us, your agent/broker.
Our NPN number is 7889453 and our FFM User ID is jtdickerson. Please be sure to enter these codes into the “help applying for coverage” section so that we can access your South Carolina Health Plan enrollment account. Please call us directly if you need assistance or have questions. Be advised that the system is currently overloaded and you may have trouble registering right away. Keep in mind, there is no rush to enroll since all the South Carolina health plans are not effective until January 1st 2014. The cutoff date for January 1st 2014 health plan enrollments is December 15th 2013.
Through our virtual desktop meeting technology, we are happy to serve ALL of South Carolina including: Abbeville County, Aiken County, Allendale County, Anderson County,Bamberg County, Barnwell County, Beaufort County, Berkeley County, Calhoun County, Charleston County, Cherokee County, Chester County, Chesterfield County, Clarendon County, Colleton ,ounty,Darlington County,Dillon County,Dorchester County,Edgefield County, Fairfield County, Florence County, Georgetown County,Greenville County, Greenwood County,Hampton County,Horry County,Jasper County,Kershaw County, Lancaster County,Laurens County, Lee County, Lexington County, Marion County,Marlboro County,McCormick County, Newberry County,Oconee County,Orangeburg County, Pickens County,Richland County,Saluda County, Spartanburg County, Sumter County, Union County, Williamsburg County, York County