Maine’s three providers of individual health insurance on the Affordable Care Act marketplace have revised their rate requests for 2020, significantly lowering their projected rates.
This is good news for anyone who plans to enroll or to renew their coverage in health insurance via the Affordable Care Act for 2020.
Maine’s two leading providers of Affordable Care Act-compliant individual health insurance are requesting average rate increases of just over 9 percent in 2019, and smaller increases if a state-run reinsurance program is revived.
Maine media has covered this news, including this story from the Portland Press Herald. Click here.
Open enrollment is when you can change plans or change insurance companies. The open enrollment period for individual health insurance coverage for 2018 under the Affordable Care Act has been shortened significantly to Nov. 1 through Dec. 15.
We are working with as many of our existing customers as possible. We will not be taking on any new individual health customers.
For more information, please read our October Individual Health newsletter, distributed to our customers on Tuesday, Oct. 10.
Open enrollment for individual health insurance coverage ended Jan. 31 and at this time the only way someone can enroll in a health insurance plan is if they’ve experienced a qualifying life event.
At this time our agency does not participate in enrollments outside of the open enrollment period. We have developed a document with information where to get assistance outside of open enrollment.
Click here for PDF.
Beginning this tax filing year, there are several new documents being issued from various sources to provide information to complete individual tax filings.
These notices are intended to provide the Internal Revenue Service with proof that individuals had health insurance coverage, the months during the year the health insurance coverage existed, and for full-time employees of companies with 50 or more employees, proof that affordable and minimum value coverage was offered.
The form 1095A is from the “Health Insurance Marketplace.” This is provided to an individual who enrolled in coverage through the Marketplace (healthcare.gov), which family members were covered on the health insurance plan and what months the insurance coverage was in place. This form is intended to provide the IRS with proof that the individual and any family members had coverage that satisfies the individual shared responsibility provision of the Affordable Care Act.
The form 1095B is from the health insurance provider. This most often will be the health insurance company itself. They will provide this notice to individuals they cover, with information about who was covered and when. Again, this is intended to provide proof that the individual and any family members had coverage that satisfies the individual shared responsibility provision of the Affordable Care Act.
The form 1095C is from the employer with more than 50 full-time employees or equivalents. This provides information about the health plan that is offered (or not), and that it meets the minimum value as determined by the affordable care act. It also certifies that the health insurance coverage offered is “affordable.” This affordability percentage will change each year, but for 2015, the rule was that the coverage could not cost more than 9.56% of a full-time individual’s annual salary. This illustrates the individual’s eligibility for a premium tax credit if they had purchased coverage through the Health Insurance Marketplace.
It is possible that an individual will receive these notices from several sources. If the individual had more than one job in 2015, or was covered by more than one insurance company, there will be multiples. If family members were enrolled on separate contracts, that will require multiple notices as well.
Please feel free to call us for assistance with understanding these forms or for a more in-depth, detailed explanation.
Call 207-236-4311.
We have had a number of calls from Community Health Options members about their January invoices and when payments are due. The deadline for January payments has been extended to Thursday, Jan. 7 at 6 p.m.
Also, we’ve been told that the Community Health Options service center is experiencing high call volumes resulting in extended wait times for callers. If you would like to make a payment by phone, you may want to use their automated payment system by calling 877-254-3508.
For debit card payments, please have your member identification number and debit card account number, security code and expiration date ready. For payments by check, please have your member identification number, bank routing number and account number ready.
By Jan. 31, 2016, the Health Insurance Marketplaces will be mailing Form 1095-A to all individuals who enrolled in Marketplace health insurance coverage. Form 1095-A acts as proof of insurance, and is sent to individuals who had Marketplace coverage to allow them to:
Purpose of Form
Form 1095-A is not a form that you have to complete; it is simply used to report certain information to the IRS about individuals who enroll in a qualified health plan through the Health Insurance Marketplace.
If you received a premium tax credit to help pay for your Marketplace coverage, you’ll use the information on Form 1095-A to fill out your Premium Tax Credit Form 8962. This form will allow you to claim additional tax credits or to repay amounts if you got too much assistance based on your income. Most people who received tax credits will need to fill out Form 8962, since even a slight change in income will change the amount of any tax credit that they are owed.
Who Has to File the 1095-A Form?
The Health Insurance Marketplace (state, federal, regional or subsidiary) must file Form 1095-A. Individuals don’t have to file the form; they will use the form furnished to help them complete other forms, including Form 8962.
If you enrolled in health insurance through the Marketplace and received a premium tax credit, you’ll use the information on Form 1095-A to fill out your Premium Tax Credit Form 8962.
Can I File Form 8962 Without a Form 1095-A?
If you received tax credits, then you’ll want to wait until you have your Form 1095-A. It would be very difficult to correctly fill out the Premium Tax Credit form without the information from your 1095-A. If you are running up against the deadline, you can file for an extension on your taxes and request another form from the Marketplace. Don’t forget: you can also view your form online after it has been filed.
What if I Had More than One Provider?
If you had more than one type of health insurance throughout the year, then follow this rule of thumb: for 2015, you’ll get a Form 1095-A from every provider that you had a Health Insurance Marketplace plan with. If you don’t have your Form 1095-B or Form 1095-C from your employer or coverage outside of the Marketplace, then use the honor system to report those types of coverage.
For 2016 and beyond, you’ll get forms from anyone who provided you with coverage by early February.
Throughout 2015 Community Health Options (formerly Maine Community Health Options) has provided its Members with $0 co-payments on Tier 1 medications at Hannaford Pharmacies, Community Pharmacies, and The Pharmacy at Maine Medical Center. This pilot program will be ending Dec. 31, 2015, and will not continue into the 2016 plan year.
The pilot was designed to be of limited duration and to determine if $0 copays and pharmacist involvement could move utilization from higher cost generics to lower cost generics.
The regionally-based pharmacies chosen for this pilot were those identified as best positioned to move Members to higher generic dispensing rates (GDR), having a local presence, and having the ability to help move Members from higher cost generics to lower cost generics.
While CHO has seen positive changes and improvements occur, the costs of foregone copayments are not made up by similar gains in the shift to lower cost generics. Given the results of the program as well as the cost constraints in 2016, CHO is moving to end this pilot at the close of the year.
CHO’s Chronic Illness Support Program (CISP) continues to waive co-payments on certain plans for Tier 1 drugs specific to the proper management of five major chronic conditions on certain plans throughout our pharmacy network. Community Health Options Members do not need to apply for that program, but simply need to have their prescriptions filled. Adjustments to those claims occur at the point of sale and are automatic. The 2016 HDHP Preventive Drug list will still be available for some HSA-compatible group plans.
For more information, a PDF from Community Health Options.
Open enrollment is the time of year when consumers can make changes to their benefits selections. Unfamiliar terms can make this process confusing. We invite everyone to download this handy reference sheet to help in the navigation of benefits options.
For example:
Coinsurance:
Deductible:
Click here for a PDF with many more definitions. (PDF to print and save, new window)
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Starting Nov. 1, consumers can fill out or update a Health Insurance Marketplace application to enroll, renew, or change plans.
The assistance of an independent insurance advisor, such as those at Allen Insurance and Financial, doesn’t cost the consumer anything additional. And working with Allen Insurance and Financial means that when it comes to claims issues or questions during the plan year, an Allen advisor will be available to answer those questions.
According to Dan Wyman, manager of the insured benefits division at Allen Insurance and Financial, an independent advisor can help explain basic health insurance terminology and can help a consumer calculate the impact of out-of-pocket costs, premiums and deductibles. Wyman notes that it is this kind of assistance that can make an important difference in helping to determine the level of health insurance plan a consumer can afford, with or without a subsidy from the government.
Said Wyman: “Our staff specializes in health insurance. We can explain the differences in plans, right down to the smallest of details. We work with businesses, families and individuals every day to help them pick the insurance plans that best serve their needs.”
Call 855-710-5700 or start with information and an online form at AllenIF.com/healthcare.
