There will be no more medical underwriting for plans, that means a few things; first you can not be denied coverage for a pre-existing condition nor can you be rated up (charged more) or ridered (coverage excluded) for a condition. This is a big positive for the consumer, but will more than likely increase cost when compared to current individual plan prices. The only “medical” condition that will be evaluated is smoking status. Initially that law stated that you can be charged up to 50% extra premium for being a smoker, but as of the last report we’ve read they have waived this for the first year due to other factors in the law.

Plans will have Minimum Essential Health Benefits that the government has mandated. The biggest changes, when compared to current individual plans, is that plans must contain coverage for maternity and labor as well as mental health benefits. Many current providers do not include this as standard coverage, but will have to do for new plans as of Jan 1st, 2014. A complete list of the Minimum Essential Health Benefits can be found at here: Essential Health Benefits

All plans must include Free Wellness and Preventative Services, this has been part of the law that was established in 2010. Many common things must be covered under this, such as Pap Smear, mammograms, routine physicals, routine blood testing a physical, children’s immunizations, age recommended cholonoscopy, etc. The biggest thing to remember is if you have all ready had a condition, such as high cholesterol, then a test for cholesterol would be diagnostic and not preventative, so it would not fall under the free provision.

As a broker, we are certified in the exchange to help consumer enroll (at no cost to the consumer). This training/certification process was completed in the summer of 2013. We were trained to walk you through the process of figuring out your advanced tax credits and assist you in applying for the plan of your choosing.

Brokers are an essential element of the enrollment process. We will still be needed to help explain plan options to you, explain your tax credits, how your max out of pockets work, and the specific aspects of your plan. We are licensed an trained to provide this for consumers at no cost to them.

You can prepare to have this conversation with the broker of your choice, but they will need some information from you to get you the most accurate comparisons: your anticipated 2018 income (mainly for modified adjusted gross income), names, dates of birth, citizenship status, smoking status, and if you have workplace insurance options.

If you would like for us here at Nemetz Insurance Services to assist you then please call us at 512-262-0044 and we would be glad to speak to you now and schedule a time at a future date when the exchange is up an running to go over your options with you.

When filling out your application, DO include:

• Yourself
• Your spouse
• Your children who live with you, even if they make enough money to file a tax return themselves
• Your unmarried partner who needs health coverage
• Anyone you include on your tax return as a dependent, even if they don’t live with you
• Anyone else under 21 who you take care of and lives with you

DON’T include:

• Your unmarried partner who doesn’t need health coverage and is not your dependent
• Your unmarried partner’s children, if they are not your dependents
• Your parents who live with you, but file their own tax return and are not your dependents
• Other relatives who file their own tax return and are not your dependents

To learn about who qualifies as a dependent, refer to IRS Publication 501.

Estimating your income

When you apply for lower costs in the Marketplace, you’ll need to estimate your income for 2018. You can start by adding up the following items for:

• You and your spouse, if you are married and will file a joint tax return
• Any dependents who make enough money to be required to file a tax return

For each of the following sources, estimate what your income will be in 2018:

• Wages
• Salaries
• Tips
• Net income from any self-employment or business (generally the amount of money you take in from your business minus your business expenses)
• Unemployment compensation
• Social Security payments, including disability payments–but not Supplemental Security Income (SSI)
• Alimony

Other items to include when estimating your 2018 income are: retirement income, investment income, pension income, rental income, and other taxable income such as prizes, awards, and gambling winnings.

DON’T include the following:

• Child support
• Gifts
• Supplemental Security Income (SSI)
• Veterans’ disability payments
• Workers’ compensation
• Proceeds from loans (like student loans, home equity loans, or bank loans)

When you fill out the Marketplace application, your estimated household income will be calculated using the information you provide. Your household income determines your eligibility for lower costs on Marketplace coverage.

Your household income is your modified adjusted gross income (MAGI) (joint MAGI if you’re married), plus the MAGI of your dependents who make enough money to have to file a tax return.

MAGI is generally your adjusted gross income plus any tax-exempt Social Security benefits (except for Supplemental Security Income (SSI), which is not counted), tax-exempt interest, and tax-exempt foreign income.

You don’t have to figure out your household income or MAGI yourself when you fill out your application. It will be done for you with the income information you include on the application.