This week, Donna Hill, E2E Benefits Services' Individual/Medicare Specialist & Compliance Director, was a guest on Gwinnett Business Radio X with Rick Strawn. Donna shared some important details and healthcare insurance options for individuals who need coverage.
Here are four of the most pressing questions Donna answered.
Question: Who is eligible to purchase individual health insurance during the open enrollment period that began February 15, 2021?
Answer: Due to the COVID-19 Emergency, open enrollment for 2021 was reopened on February 15, 2021 and originally was scheduled to end May 15, 2021. However, it was recently announced that enrollment would be available through August 15, 2021. You are eligible to purchase a plan if you:
• Live in the United States;
• Are a U.S. citizen or national (or are lawfully present);
• Are not incarcerated;
• Do not have Medicare coverage.
This coverage is available on the marketplace or directly from the carrier.
Question: There are federal subsidies available for qualifying individuals to help pay for health insurance. How are those calculated and has there been a change due to the Emergency?
Answer: In the past, subsidies have been available to people whose adjusted gross income for 2021 was expected to be at least 100% of the Federal Poverty Level, but not to exceed 400% of the FPL. The American Rescue Plan Act of 2021 changed that calculation to relate subsidy eligibility to the percentage of expected income the premium will be. That is calculated by determining the premium for a benchmark plan. The benchmark is calculated to be the second-lowest cost Silver plan in that market. The subsidy calculation then determines if that benchmark premium is more than 8.5% of your expected adjusted gross income. If so, you are eligible for a subsidy. This method is expected to result in a 20% increase in the number of people who qualify for a subsidy, and to increase the amount of subsidy for most people.
Question: How many insurance companies are offering coverage in the individual health insurance market in Georgia?
Answer: There are currently six insurance companies offering coverage in this market in Georgia, although not all companies offer coverage in all counties. here are nine counties in Georgia where there is only one carrier offering coverage, and 47 where there are only two carriers. The six carriers are Alliant Health Plans, Ambetter, Anthem/Blue Cross of Georgia, CareSource, Kaiser, and Oscar. Only one county, Walton, offers all six.
Question: Are there other options available if an individual does not qualify for a subsidy but cannot afford the premium on plans offered?
Answer: There are other options that are not Affordable Care Act compliant. This means that they do not have to adhere to the standards of an ACA plan. For example, such plans can, and usually do, ask health questions and exclude/limit pre-existing conditions. They may not cover some conditions, such as maternity. Health sharing ministry plans like Medi-Share are not insurance and are not covered by the guarantees an insurance plan must offer. Short term medical plans only last for a specified time and may not be renewable. The plans can be a viable solution in some circumstances (for example for someone who is between jobs), but the buyer should be certain they understand what is covered and their liability, if any.
Please reach out to Donna Hill with your questions by calling 770-736-9190 or sending her an email firstname.lastname@example.org.