Ask Jo: Health Insurance

Every so often questions and comments come from readers that I think others would like to hear my response to.  That’s when I feature them on the blog.  This is one of those days.

Today’s question is about health insurance.  I’ve told you all that when Kramer, my husband, passed away I had to go off the insurance that was provided by Kramer’s employer.  I told you all that my only real option was getting health insurance through Marketplace, Obamacare or whatever you want to call it.

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Since then several people who were paying outlandish healthcare premiums of over $1000 per month have contacted me and asked about Obamacare.  Most have been able to find some much more reasonable through Marketplace.  I still get questions and I hate answering them as I really don’t know much about it except that it is working for me.  My premiums are manageable and I feel my care hasn’t at all been compromised.

I ended up talking to our daughter Kalissa’s good friend Regan, who is my insurance agent, and asked if she would write something up that would cover the questions that she gets asked most frequently.  Here’s what Regan wrote:

Health insurance is one of the most talked about, important and to many people confusing policy individuals should have. Even though many employers offer health insurance, people are left in the unknown if they lose their job, retire, have a death in the family or are self-employed or work for a small business. So many people find themselves in one of these scenarios, unsure of what to do. In today’s world if you are under 65, and not offered health insurance through an employer, you are often stuck between a rock and a hard place. Either pay big bucks for a grandfathered health insurance plan or try to understand this thing called “ObamaCare.” I hope today we can clear up the confusion over “ObamaCare” and explain how it works as a potential option! What is ObamaCare?​ “ObamaCare” or “Marketplace” or “Affordable Care Act” health insurance is essentially laws and mandates that went into place several years ago to include rules that insurance companies by law cannot ask health questions, cannot exclude people with pre-existing conditions, must cover certain preventive services, pregnancy, cannot have limits on coverage, and many other rules. Insurance companies in each state can offer plans through a government run website called What do plans look like?​ Plans themselves are built just like your health insurance plan you would maybe have at work or through a grandfathered plan. Plans have deductibles, co-insurance, and a max out of pocket. All plans include prescription drug coverage and some even give copays for doctors or specialists visits. People still have options on the kind of coverage they want and the company they go with. Individuals can choose a high deductible health plan to save money, or if they want better coverage they can choose to take a plan with a lower deductible. The Marketplace has a system of categorizing plans based on their coverage levels into Bronze, Silver & Gold categories. ● Misconception​: A big misconception is that Obamacare in itself is health insurance. Such as the idea that people who are on it have an ID card that says “ObamaCare.” That’s not the case. Obamacare is the laws and mandates that private insurance companies must follow. Someone who enrolls onto a plan still has their insurance coverage through a private company- like Wellmark BCBS or Medica. These are the companies that currently offer plans in Iowa. What do premiums look like?​ This is where Marketplace plans are way different than any other health insurance program in history. Individuals are able to qualify for tax credits to help cover the premium of the insurance plan they choose. Some people qualify for tax credits and some people don’t. It’s primarily based on your household income. The tax credits are available and can be paid directly to the insurance company you chose- you pay the balance. What happens if I don’t know my income?​ It is purely an estimate. If you qualify for a tax credit to go towards your premiums, you must file a Federal Income tax return. The Marketplace uses your taxes to reconcile premiums. If you overpaid for the insurance, you may receive money back on your tax return. Vice versa if you underpaid, you may owe premium back to the Marketplace. As an agent we help our clients estimate their income the best we can but essentially truth time is tax time.

For example: Plan A Full Cost = $500/month. John Smith, single with a yearly income of $30,000 qualifies for a tax credit of $450/month. John owes Plan A insurance company $50/month.

Another example: Plan A Full Cost = $500/month. Jane Smith, estimated her income at $30,000 and received a tax credit of $450/month. She pays Plan A insurance company $50/month. She picked up extra shifts and another part time job so her total income was higher at $40,000. Jane must pay back some of the tax credit. Who can be on a Marketplace Plan?​ Really anyone can choose to go on a marketplace plan, but if you want a tax credit that is where qualifications come into place. You cannot be offered insurance through an employer, Medicare or Medicaid. If this is the case, you could go on it but most likely will not qualify for a tax credit. Without the tax credit, you would pay the full cost of the health insurance plan. Also, if your household income exceeds the income threshold for your family size, you would not qualify for a tax credit but can still enroll into coverage. ● The main point is that these plans can be very affordable options for people who meet the income guidelines for their family size and do not have other health insurance offered to them through another source. ● If you have a Grandfathered health plan, you can choose to drop your plan to go on the marketplace during the open enrollment period. However, you cannot get back your grandfathered health plan once you disenroll. We will advise you on the benefits/disadvantages of both options. WHERE​: Plans are determined by your state of residence and the county you live in. Different companies and plans are offered in different areas. Make sure to talk with your insurance agent to discuss plan doctor & hospital networks. WHEN:​ Open enrollment runs from Nov 1- Dec 15th each year. Plans become effective Jan 1. There are special enrollment periods if you are losing coverage such as from retirement, death, a job change, turning 26, loss of COBRA, and many other situations. Key Points:​ Marketplace plans can be very affordable for people who qualify for tax credits. Sometimes even $0 premium. ● You can enroll during a Special Enrollment Period or during the Open Enrollment Period Nov 1- Dec 15th. ● No health questions or pre-existing conditions ● Multiple plans to choose from ● No limit on what the insurance pays To find more information on Marketplace Health Insurance I would recommend visiting​ or please reach out to me and I would be happy to answer questions or run quotes for you! We are local, independent agents and help many people with these types of plans as well as Medicare. If you live in Iowa we are happy to help advise you on your health insurance options.

Regan Schmitt: 563-568-1036 Wayne Schmitt: 563-568-1037

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I hope your questions were answered with that.  If you want to ask questions you can do that in the comment section or contact Regan.  She was excellent to work with.  Regan also does work with other insurance needs so if you’re in Iowa she’s your girl.

8 thoughts on “Ask Jo: Health Insurance”

  1. That is a very clear explanation, and I’m sure it will help many of your readers. I know the affordable care act has helped a lot of people with preexisting conditions. Thanks for sharing this.

  2. I was covered under my husband’s retirement policy. When it came time for renewal, they suggested that I check out the Marketplace for other options. Sure enough, the same exact policy was half the price on the Marketplace as his former employer was charging for the policy. We don’t qualify for any tax credits, this is just the difference in premiums offered to us. We do run the risk of losing insurance if the Marketplace ceases to exist, as once we dropped my husband’s retirement policy for my coverage, I can never re-enroll. But at $6,000/yr savings, it is worth the risk.

  3. Jo, you always go the extra mile, like you did today with the health insurance questions. I’m sure you helped many to be better informed about their options. Such a blessing you are in so many ways!

  4. Thank you for this. I am on medicare now, so I didn’t really understand what people where talking about when Obama care was mentioned. This clarifies alot for me. Basicly it is a set of laws that make insurance accessable to lower income families. Those with more money have to pay more.

  5. Teresa Harfner

    Thanks for the detailed response. I am glad you mentioned Iowa regulations – just a reminder to check local state regulations, which may vary. Thanks again.

  6. SusanfromKentucky

    Funny you should post this. My COBRA plan, through my husband’s former employer, discontinues at the end of this month. I have been working with an insurance agent to get a new policy through this. I have 3 more years until I will be eligible for Medicare.

  7. I’d always wondered about this but didn’t research any further because I still have my employer plan. This is helpful to me as I am sometimes called upon to advise departing employees on health care options. At least I can point them to and have a bit of a clue what it’s about. Thanks!

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