RW Insurance Agency Blog

What Are Health Insurance Marketplaces? Am I Required to Buy From One?

The Patient Protection and Affordable Care Act (PPACA, or ACA) is a federal law intended to give more people access to affordable health care coverage and medical care. The ACA requires that beginning in 2014, if you do not get health insurance through your employer you must purchase an individual health plan or pay a penalty. This is often referred to as the individual mandate.

If you already have coverage that you purchased on your own, you can keep your current plan if it is a “grandfathered” plan, or a plan that was purchased on or before March 23, 2010. These grandfathered plans are exempt from many changes required under the ACA. However, Anthem BlueCross Blue Shield—New Hampshire’s only health insurance exchange participant—has announced that even renewals of grandfathered plans effective on or after January 1, 2014 will be impacted by some of the ACA’s requirements (eliminating lifetime limits, coverage for students up to age 26).

If you have made changes to your individual health plan since March 1, 2010, your plan will not be grandfathered and it will be subject to other changes required by the ACA beginning on January 1, 2014. Your RW Insurance agent can help you determine if your existing individual health plan is a grandfathered plan.

If you do not have health insurance now, you will need to purchase a plan that is effective in 2014.

What Are Health Insurance Marketplaces?

The Health Insurance Marketplace—or the Health Insurance Exchange—is where individuals and small businesses can go to purchase health insurance. Most people will purchase through their state’s exchange website, but you can also compare plans and purchase by phone or by mail. Your RW Insurance agent can also help you navigate the exchange and work with you to find you a plan (on or off the exchange) that fits your needs, at no additional cost.

The exchanges are for people who are currently uninsured or who currently buy insurance for themselves or their family on their own. They will allow consumers to compare and choose health plans offered by private companies that have agreed to sell their plans on the exchange. Insurance companies and the plans they offer will vary by state, but all plans will have to comply with a certain level of federally mandated coverage.

Consumers will also be able to use the exchanges to find answers to questions and to find out if they are eligible for federal subsidies or other special programs. The ACA and all of its requirements are new to everyone and very complex. Remember that you are not alone; we can help you work through the system and find answers to all of your questions.

What Types of Plans Will Be Offered?

The marketplaces will include plans with several different levels of coverage offered by one or more insurance companies. You can choose among the plans according to your personal situation and needs. Every plan is required to offer the same essential benefits, such as doctor visits, hospital care, prescriptions, and maternity care, as well as certain preventive services at no cost.

Plans in the marketplaces will be grouped by coverage level into Bronze, Silver, Gold and Platinum categories. The categories are designed to make it easier for people to compare plans. Bronze plans, for example, will offer lower premiums with higher out-of-pocket costs (deductibles, copays, coinsurance). Platinum plans, on the other hand, will generally have higher premiums and lower out-of-pocket-costs.

If you need to purchase individual or family health coverage because of the ACA’s individual mandate, RW Insurance can help you determine if you qualify for a tax credit or cost-sharing assistance. If you qualify for federal financial assistance, we can help you sign up for a plan through the exchange, which is the only way to receive any tax credits that you may have coming. If you do not qualify for a tax credit, we can help you find a plan off of the exchange as well.

Plans outside of New Hampshire’s health insurance exchange will be offering more comprehensive provider networks, and may be more appropriate for those who do not qualify for federal financial assistance for health insurance.

When Can I Begin Using My State Marketplace to Purchase Coverage?

The health insurance marketplaces will open on October 1, 2013. Coverage purchased from an exchange will be effective on or after January 1, 2014.

Where Can I Go to Find Out More?

Some state insurance exchanges will be run by the state, while the federal government will run others. New Hampshire will have a federally operated exchange. The state will control plan management and consumer assistance, while the federal government maintains control over every other aspect of the exchange.

Despite the goal of encouraging competition among insurers in the individual market, only Anthem BlueCross BlueShield will be authorized to “compete” on the New Hampshire exchange when it opens on October 1. Other insurers may elect to participate in future years.

Individuals who wish to purchase insurance from the New Hampshire health insurance marketplace don’t have to go at it alone. Contact RW Insurance today to discuss your rights and responsibilities under the new health care law. We can help answer your questions, navigate the system, and find the best plan to fit your needs.

What is Health Care Reform and What Do I Need to Do Now?

Health care reform refers to the Patient Protection and Affordable Care Act (PPACA, or ACA). The ACA is a federal law that was passed in March 2010. It is intended to give more people access to affordable health care coverage and medical care.

What Do I Need to Do Now?

The answer depends on what your particular situation is now, and what you think it will be beginning in January 2014. Most of us will be impacted by the ACA in some way, either by changes to our employer-sponsored or privately purchased plan, or because of the requirement for individuals without coverage to purchase it or pay a fine. You first need to find out how your existing coverage (if any) will be affected, or if you will be required to purchase coverage on your own.

Beginning in 2014, most people will be required to have health insurance or pay a fine. This is often referred to as the individual mandate. The individual mandate will be satisfied by private insurance obtained on your own or through your job, or through government programs including Medicare, Medicaid, CHIP, Veterans Affairs, Indian Health Service, or TRICARE.

I Already Have Coverage Through My Employer

If you have health care coverage from your employer you most likely will continue to do so, particularly if you work for a large employer. Your employer may make changes to plan specifics such as copays, deductibles, premiums, and so on. You can get those details from your employer.

If you work for a small employer, other changes may be coming and your employer should keep you informed. Some small employers are opting to no longer offer coverage to their employees.

I Do Not Get Health Care Insurance From My Employer

Beginning in 2014, if you do not get health insurance through your employer you must purchase an individual health plan or pay a penalty. If you already have coverage purchased on your own, you can keep your current plan or you can shop around for a new plan. If you do not have health insurance now, you will need to purchase a plan that is effective in 2014. Beginning in 2014, adults with pre-existing conditions cannot be denied coverage.

The penalty for individuals who do not obtain qualified health insurance in 2014 starts at $95 per year or up to 1% of income, whichever is greater. The penalty will rise to $695 per year or 2.5% of income by 2016.

If you do not get health insurance from your employer and you cannot afford to buy your own, you may qualify for Medicaid or federal subsidies. If you do not qualify for Medicaid but still can’t afford health insurance, you might be eligible for government subsidies to pay for private insurance sold in the health insurance marketplace or state insurance exchanges. The exchanges are the federal and state-run health insurance marketplaces where you can shop, compare and buy health care coverage.

You can buy coverage on the exchanges beginning in October 2013, but coverage will start no sooner than January 1, 2014.

Premium subsidies will be available for individuals and families with incomes between 133% and 400% of the poverty level, or $14,856 to $44,680 for individuals, and $30,656 to $92,200 for a family of four. If you qualify for federal subsidies, you can only receive the credit if you purchase coverage through the exchange. If you do not qualify for a subsidy, you can purchase coverage through the exchange or directly from an insurance company.

New Hampshire Health Insurance Exchange Run by Feds, Limited to One Carrier

Former New Hampshire Governor John Lynch (D) signed a bill in June 2012 that prohibits New Hampshire from operating or facilitating a state-run exchange, but the bill does allow state agencies to cooperate on a federally operated exchange. On February 13, 2013 Governor Maggie Hassan (D) informed federal officials that New Hampshire would pursue a state-federal partnership exchange. This arrangement allows for state control over plan management and consumer assistance—with the federal government in control of everything else.

The exchanges were designed to encourage competition among insurers in the individual insurance market in order to drive down prices for consumers. Only one company is currently authorized to “compete” in New Hampshire’s exchange for 2014: Anthem BlueCross Blue Shield. Other insurers may elect to participate in future years, but for now consumers will be left with very little choice if they must purchase a plan on the New Hampshire insurance exchange.

It is important to learn all you can about health care reform and how it will affect you, your family and your employer. Will your employer continue to provide coverage, or will you need to purchase coverage on your own? Will you be getting health care coverage for the first time?

Don’t go it alone. RW Insurance has the knowledge, experience and resources to make sure that you are meeting your obligations and making the best choices for you, your family and your business.

Will a BOP Cover My Business Risk?

A business owner policy (BOP) is often marketed as the answer to all of your business insurance needs. A BOP is able to cover a wide variety of businesses and their associated risks. However, it doesn’t cover everything.

What Does a Business Owner Policy (BOP) Cover?

A business owner policy covers damage to your physical assets. If your building and its contents get damaged in a storm, fire or other covered disaster, a BOP will pay to replace the property. This includes property that is stolen.

A BOP also gives you liability protection against lawsuits. If someone is injured on your property and sues you, your insurance will cover your legal losses up to the policy limit. A BOP also covers lawsuits for libel, slander or false advertising.

Lastly, a BOP gives you some business interruption insurance. If an accident forces you to shut down your business, your insurance will pay for your company’s overhead and will also compensate you for your lost profits. With this complete combination of benefits, it is not wonder why many business owners assume a BOP is the only insurance they need.

What Other Business Insurance Might You Need

A BOP misses several important business risks. The most glaring gap is that it does not cover professional errors or negligence. If you make a mistake with your work, such as malpractice for doctors, you will get no liability protection from your BOP. Professionals should buy additional liability coverage to protect against these lawsuits.

A business owner policy only gives limited business interruption coverage. If your business shuts down for an extended period of time, you could get into financial trouble when your BOP runs out of money. By investing in business interruption insurance, you won’t have this problem.

Business owner policies also exclude damage from floods. If you are in a part of New Hampshire that floods regularly, you might need flood insurance on top of your BOP or other policies.

To make sure you are completely protected, contact RW Insurance for a free consultation. We will make sure you have the right combination of business insurance to protect your company and your bottom line.