Affordable Care Act

How to Understand Health Insurance from the Marketplace

by ClaimLinxJune 23, 2022August 1, 2022Leave a comment

If you’re new to the world of health insurance, there are several technical terms that may make it seem very daunting at first, but we aim to clear things up within this article. The health insurance marketplaces has provided insurance coverage to millions of individuals over the years. Selecting the right insurance plan is important, because getting an expensive plan that doesn’t contain coverage for what you need is of no use.

The Health Insurance Marketplace

This marketplace offers visitors an opportunity to purchase all types of health insurance plans ranging from individual to family health plans. The primary benefit of this marketplace is that it allows users to compare plans to evaluate pricing, coverage and more. Each state has their own version of the marketplace, while some only utilize the federal one. There is an enrollment period every year where you can purchase plans in the marketplace.
The insurance marketplace stems from Obamacare through the ACA in 2010. As the years passed, around fourteen different states have chosen to create their own health insurance marketplace. One of the biggest benefits is that the plans listed on these health insurance marketplaces provide coverage for the ten necessary health requirements.

Categories of Insurance Plans in the Marketplace

There are 4 different categories, i.e. Bronze, Silver, Gold and Platinum. Platinum level plans are the most expensive, but they also provide the maximum amount of expense coverage. Users can view and compare the coverage of each plan alongside their costs.

While you do need to keep your budget in mind as well, it is important to remember that the price of healthcare in the US is extremely high. Getting a plan that provides better coverage is always the best option.
One important thing to remember is that the platinum level plans do NOT guarantee quality care. You need to go through the list of accepted healthcare professionals to see if the plan is a good fit.

You may also be eligible to obtain financial assistance for your plans if you meet a certain criteria. This can help take care of the high costs of monthly premiums. Once you select a plan, more details about financial assistance will be available to you on the health insurance marketplace.

Eligibility Requirements

To shop in the marketplace, you have to meet certain eligibility requirements. For example, you must be a lawful U.S. Citizen, or a U.S. National. Individuals who are incarcerated cannot purchase healthcare. Another important thing to remember is that you cannot be enrolled in Medicare when purchasing the health insurance marketplace.

Conclusion

If your current employer offers healthcare benefits, do evaluate those options first instead of purchasing directly from the marketplace. This is because employer-based premiums are normally lower with better coverage since the employer obtains them at bulk pricing.
However, if you’re handicapped or unemployed, purchasing directly on the health insurance marketplace is a perfect choice. With numerous options available for you to compare and select from, it is important to take your time to carefully evaluate coverage, premiums, and more.

Is Medicare Supplement Insurance Right For You?

by ClaimLinxOctober 10, 2021October 29, 20211 Comment

Medicare is available for people who are 65 or older or individuals that suffer from disabilities. Original Medicare, which is more of a basic form of the program, provides just the most basic form of coverage.

While original Medicare covers most of your medical and hospital bills, you’ll still have to pay for 20% of approved doctor treatments.

If you’re in the hospital for even three days, the cost of the hospital stay can be as much as $60,000. Paying 20% of these costs still leaves you with a $12,000 bill that you need to pay.

Medicare supplement insurance can help.

What is Medicare Supplement Insurance?

Supplement insurance, or Medigap insurance, is just like it sounds: insurance that fills in the gaps. For example, in the scenario above, this type of insurance would kick in and cover the $12,000 that original Medicare doesn’t cover.

Roughly 24% of all beneficiaries on Medicare purchase Medicare supplement Insurance

What’s Included in Medicare Part A and B?

If you’re on original Medicare, this means that you’re on both Medicare Part A and Part B. Medicare Part B covers about 80% of the costs for approved:

Doctor services
Medical equipment
Outpatient therapy

On top of the 20% of the costs, you’ll be required to pay a deductible of just over $200 in 2021. While you may not pay for Medicare Part A, you will be responsible for paying for Part B if you want this additional coverage.

Supplement insurance is sold through private insurance companies and will offer additional coverage, such as:

Costs of doctor visits
Services rendered outside of the US

Insurance companies cannot disqualify you from these programs based on preexisting conditions either.

Cost of Medicare Supplement Insurance

Is this type of insurance worthwhile for you? It depends. You’ll be required to pay additional money to these programs, and they can be very expensive. While the average person paid $152 per month for supplemental insurance in 2018, prices may be much higher for the individual.

Depending on multiple factors, the cost of these plans can range from $50 to $650. Factors that contribute to the overall cost are:

Age
Location
Deductible

However, some individuals may benefit from state programs that offer to pay for some or all of these costs.

Often, low-income individuals will qualify for state assistance, so they’ll benefit from low or no cost for their supplemental insurance. Additionally, there may be options to help cover the cost of prescription medications, too.

When considering whether signing up for one of these programs is the right thing to do, it’s important to note that Original Medicare does not have a limit on out-of-pocket expenses. So, you’ll continue to pay 20% out-of-pocket whether the bill is $200 or $2 million.

There are options outside of Medigap, such as Medicare Advantage plans that will roll Part A and B into one plan as well as offer prescriptions for free.

Medicare supplement insurance is often a good choice if you don’t have coverage through a union or employer and you’re enrolled in Original Medicare.

5 Reasons Small Business Health Insurance Is Critical For Employees

by ClaimLinxAugust 20, 2021August 31, 20214 Comments

Small business health insurance has a variety of programs. For example, personal plans, specific disease plans, etc., as appropriate, should be covered under one type of health insurance. This way, you can get financial help from the insurance company if there are any health problems.

Small business health insurance can be purchased by an employer. Here, the employer buys small business insurance from an insurance company by paying insurance premiums to ensure the health risks to employees in terms of the terms and conditions of the policy. Keep reading to find the value of small business insurance for employees.

There are many options available to businesses looking to provide medical insurance to employees, but usually, small business health insurance comes in the following form:

Health Benefits: Basic: Patient Care, Dependence, International/Regional Availability, Covered Circumstances.
Additional known benefits: maternity and birth control, vision, and dental insurance.
Extended / full benefits: Health screening and vaccination, general health support, and mental health support.

Small Business Health Insurance is health insurance bought by the owner of a small business that covers the company and its employees and provides numerous benefits.

Three characteristics make small business health insurance different from any other type of insurance

They are made functional specifically for a small group
It is available throughout the year.
The employer can contribute to the premium charged to the employee

Now we will look at these characteristics in detail.

Small Business Health Insurance designed for small scale companies:

First, small business insurance schemes are usually run by less than 50 groups. Company owners that have less than 50 full-time employees working under them are not obligated to provide their employee data under the ACA.

Most small business policies include groups of five or fewer people. If your employees were only 1099 contractors last year you may be eligible for health care for small businesses.

Purchase through the year

Second, a difference of small business health insurance is that it is available throughout the year to make purchases. With Small Business Health Insurance, you are not obliged to register during the special registration period open, as much as possible when purchasing special coverage.

Employer contribution to employee premium:

Third, for small business insurance, a business usually has to pay at least 50% of its employees’ monthly health insurance premiums. Exact percentages may vary depending on the situation or system.

It is important to remember that the money you pay in employee premiums is usually deducted from the rules of your business. Ask your auditor or tax adviser how you can save money in this way.

The main goal behind introducing small business health insurance is providing employees of the company a chance at better health facilities and assisting them in managing their health care expenditures. Other benefits, such as financial aid or educational benefits, can be beneficial, but effective medical insurance often adds to global wage benefits.

Most employees rarely ask you to pay for medical expenses out of your pocket, at least without making too much money for the savings they have. Protecting health insurance from your employees will cost less than what they bought for themselves – and, as a group, you will have more control and negotiation power to ensure that the money you spend on insurance is spent wisely.

The importance of small business health insurance for employees

The following points highlight the importance of a small business insurance scheme for employees.

1) Availability of basic insurance

Employees can benefit from basic insurance coverage such as hospitalization due to their employer. The employer usually pays the policy. Therefore, an employee can avail of the benefit of the insurance scheme free of cost.

2) Sub-conditions

Personal health insurance systems have stronger terms than group health policies. For example, the terms of the waiting period, health checkup, and maternity cover are not small compared to a group health plan.

3) Family coverage

With small business health insurance plans not only you can avail of the benefits but your family members are also secured In this way, the financial security attached to the coverage is extended to other family members. You can easily avoid a stressful situation by making the right decision at right time and secure your and your family’s future.

4) Insurance management

Once you are covered under the health insurance policy provided by your employer and after learning about the start and implementation of the plan, you can consider better coverage by opting for a single health insurance plan. For instance, a small business health policy offers all the facilities of basic health insurance ad allows you to buy a critical illness policy.

5) Peace of mind

A medical emergency can quickly lead to a financial emergency. This puts a lot of stress on the patient and family members. A health insurance policy can provide great assistance in difficult times like these.

Be informed

Covering only under the Health Team will not help you. You need to know its availability for insurance. That way, you know what’s included in the system and what’s not.

You must go through the details of the policy of small business health insurance thoroughly whether you are a company owner looking for an insurance company to buy insurance or an employee who is availing the coverage. Do not hesitate to ask the insurance company about your queries and ensure that you understand everything.

As mentioned above, small business health insurance is a quite helpful facility for employees as well employers. Where employees avail numerous benefits and are secured through this type of insurance, employers get a chance to grow their business by providing strength to the most important resource of their business. You must decide smartly and choose the right company along with the right package. Making the right decisions will help in the future and give good results. Go through policies before making any decision.

How the ARP makes marketplace health plans more affordable for older buyers

by ClaimLinxJuly 8, 2021July 28, 2021Leave a comment

On 11th March 2011, President Biden signed the American Rescue Plan Act 2021 (ARP) This latest law will give a reduction in premiums who already have health insurance and make it more affordable to increase the number of people who have health insurance.

Additional subsidies will be given to people who get their insurances directly from the health insurance marketplace. Since the start of April, people who have signed up for HealthCare.gov coverage will be eligible for these benefits and lower costs.

The new premium rate for the people who are eligible for these benefits will be $50for each person or $85 for the policy each month.

The premiums after this new savings will be reduced, on average, by $ 50 per person per month or $ 85 per policy per month. Four people out of every five subscribers will be able to access the $ 10 plan or have less after premium tax payment, and more than 50% of the people who enrolled will be able to get a Silver plan for $ 10 or less.

Benefits introduced under ARP

No one will be charged more than 8.5% of the total family income. Individuals and their families may get a temporary rise in tax credits. With this scheme, more people will be eligible to get a higher tax credit and will get help covering their health insurance premiums

The main agenda of this plan is to help people who are unable to get health insurance by subsidizing the costs and also helping people to easily make the payments of the insurance plans to those who already have an insurance plan. This plan apart from supporting people who have a family income of less than 400% but need FPL also supports those who have more than that but need help paying their premiums. It will result in not only people getting better insurance benefits but also increase the number of people who have access to these benefits.

Some clients whose payment is more than the 400% FPL will not be eligible to tax credits in case the cost they are charged for the valuation plan is less than 8.5% of their total home income.

Upon sign up, customers have to select a similar program that is less expensive than the rating system. 8.5% cap is introduced to calculate the premium credit debt but the cost that the customer is charged for a plan may or may not be less than the valuation plan.

Since the introduction of the Affordable Care Act, health insurance has become quite affordable with the help of the American Rescue Plan (ARP). In 2021 and 2022, it increased the amount of premium in the market/exchange and ended the “subsidy fall”.

ARP guarantees that Americans who receive unemployment benefits at any time by 2021 can enroll in the Premium Free Silver Plan with a full reduction in cost-sharing. (Even if you are eligible for this benefit, if you join a non-silver plan, you should switch to the Silver Plan to apply for a cost-sharing discount August 2021, is the deadline for most states. For those who lose their jobs due to some reason or got a reduction in their hours, it provides subsidies to cover the full cost of the spread of state development.

To allow the public to get better marketplace health plans, many provinces have a single special registration window that runs until August 15, 2021. Thanks to this opportunity to register and grow ARP funding, active market registration everywhere, the country has reached record levels.

ARP support for older consumers

The American Rescue Plan helps people to get health insurance and make them affordable for people who can’t afford large out-of-pocket expenses. These improvements will help older adults who are not yet eligible for Medicare.

For more than two years, the law makes health insurance tax bills more widely available and available to more people. Subscribers will not have to pay more than 8.5% of their income to cover access, and households with less than 150% of poverty will receive access without premiums. It also increases the government’s COBRA health insurance subsidy to 100%, making it much easier for employees who leave their jobs but want to maintain health care for their employers.

The move encourages more countries to increase Medicaid by increasing similar government payments by 5% over two years.

Individuals consisting of every age bracket including young individuals have discovered that marketplace health plans are less expensive than the American Rescue Plan implementation. The full cost of health insurance depends on age – and therefore older people get higher premiums, An additional ARP discount is also announced for older Americans.

Some older clients have been buying their marketplace health plans for several years, and now find that their premiums are lower than before ARP went into effect. (This is only true if these customers renew their Market plan to activate a new subsidy or later claim a tax refund. Those with off-exchange bonds need to convert into the exchange to take advantage of this new subsidy either upfront or in tax returns.)

ARP assists individuals in moving from health insurance that is sponsored by employers to self-purchased plans. Elderly applicants get huge discounts on their plans.

So if you have still few years left on Medicare eligibility and are missing out on your employer-sponsored health plan, rest assured you will have options to have access to health care options. And thanks to ACA and ARP, you have a chance to afford it.

Switching to the personal market

You can take a look at the data to find out how much ARP raises premium discounts, especially for older American Americans who are not eligible for a subsidy due to income.

Average Health Insurance Plan Rate In Ohio

by ClaimLinxNovember 11, 2020January 11, 2021Leave a comment

We analyzed the health insurance policies all around Ohio and found out that the cheapest health policies in Ohio are CareSource Marketplace Low Premium Silver, Ambetter Balanced Care 29, and Constant Care Silver plans. But it is important to know that all of these insurances are not available in every city within Ohio, so the rates of these plans may differ depending upon where your residence is.

People living in Ohio can find cheap health insurance through places such as United Healthcare or Anthem, there is a wide variety of available options. The health insurance is given according to your income. The best health insurance will depend upon your budget and the cost expected. It is recommended to compare various companies before buying a plan for yourself.

We suggest using low-cost health insurance plans to start with to determine the costs and advantages you are expected to get from a given coverage’s metal tier.

The health insurance policies are divided into metal tiers, which depict the advantages and the expenses you would incur for that particular tier category.

Our team has conducted extensive research on the affordable health insurance policies around Ohio for each tier and have uncovered the lowest cost health insurance plan options in order for you to get the best level of coverage at extremely affordable pricing.

Various factors contribute to the cost of medical coverage. The cost of health insurance majorly depends on the chosen tier and the age of an individual. People with older age face comparatively high premiums.

A 60-year-old individual would be charged 112% higher costs for a health policy as compared to a 40-year old person, and it remains the same for all the levels of a health plan. Similarly, a 40-year-old person is charged 28% higher as compared to a 21-year old person. In 2020, the average price of an individual health plan for a 40-year-old person across all metal tiers of the plan is $495.

Finding your best health insurance coverage in Ohio

The health insurance plan you choose is different depending upon the area where you live in Ohio. In order to choose the plan which is best for you, you need to take your salary and medical expenses into consideration, as it will affect the cost you would have to pay and the coverage required to fulfill your requirements.

The metal tiers of higher-coverage are more and more expensive in regards to the premiums but lower-cost sharing is what makes them ideal for families with heavy and consistent health expenditures.

In contrast, the lower-coverage metal-tier health policies have affordable rates but their high costs from pockets make them helpful only in case you are saving for an emergency and do not expect consistent high-cost medical expenditures

Gold plans: Best for families with high or consistent medical expenses

Gold plan is ideal for the families that expect a time to time high medical expenditure. The gold health insurances have the most expensive monthly premiums but affordable out-of-pocket costs.

This means that you would have to pay significantly less from your pocket before your health plan gives you coverage. This is the best pick if you have ongoing medications or illnesses. Someone in the family is suffering from a chronic disease or expects large medical expenses and you would like to have high but predictable premiums.

Silver plans

These kinds of programs are best suited for families that have low-income sources and don’t have excessive health expenses. The state of Ohio has enacted the Affordable Care Act and has expanded Medicaid. Due to this, the households whose income is 138% of the federal poverty level can avail of Medicaid. Therefore, families with income below the average level can choose the Silver Plan at affordable rates.

What’s unique about this plan is that it is the only plan whose policies are eligible for cost-sharing reduction subsidies, in case income is less than the preset limits. This plan is considered to be a more affordable medical insurance plan as compared to Gold plans. You may not need to save money apart from the insurance for your expenses.

Bronze/Catastrophic plans:

Bronze plans are designed for young families who want to save and spend less. The basic criteria require an age less than 30 and you should qualify for specific exemptions. These plans offer lowest-cost packages and higher cost-sharing options.

However, Bronze health plans should not be your first choice when choosing insurance plans. If you are quite sure that you can afford out-of-pocket expenses while utilizing the plan, you can go for Bronze plans. The services will not be provided to you if you don’t qualify the limits of out-of-pocket deductibles and copays.

Health insurance rate changes in Ohio

The rates of health insurances, the costs, and out of pocket expenditures are analyzed every year by the health facility providers and then are submitted to federal regulators for approval

In 2020, the health insurance rates fell by 4% for all the metal-tiers of coverage. The price of bronze policy fell by the highest amount that is 7% or $26 per month.

Best cheap health insurance companies in Ohio

There are 10 health insurance companies and two others with year over year policy on the Ohio state exchange. But not all the companies provide services in all the countries. So the best one will differ according to your location of living

Oscar Insurance Corporation of Ohio
Summa Insurance Company, Inc.
CareSource
AultCare Insurance Company
Oscar Buckeye State Insurance Corp.
Medical Health Insuring Corp. of Ohio
Ambetter Buckeye Community Health Plan
Molina Healthcare of Ohio, Inc.
Paramount Insurance Company
Community Insurance Company (Anthem Blue Cross Blue Shield)

To conclude, there are various affordable options available all around Ohio and residents can choose according to their requirements and budgets. Hopefully with information within this article will help you choose one to fulfill your medical requirements.