This months marks the start of open enrollment. You will have the opportunity to change plans if you are unhappy with the one you are currently on. 

Medicare Open Enrollment Period: October 15th, 2013 through December 7th 2013

If you have a Medicare Supplement Plan here are some of your options.

1. Move to a Medicare Advantage PPO program
   
2. Move to a Medicare Advantage HMO program
   

Currently, you do not have a network of providers to deal with. You have access to any provider or hospital that accepts Medicare. With all of the Medicare Supplement plans we offer Part D for prescription drug coverage.

The Medicare Advantage PPO and HMO Programs have networks to access to receive the most cost effective care. The Medicare Advantage program allows you to go outside the network but with higher out of pocket costs

If you have a Medicare Advantage PPO here are some of your options.

1. Move to a Medicare Advantage HMO program, however you lose the ability to use out of network providers.
   
2. Move to a Medicare Supplement program with no restrictions on network providers. You have access to any provider or hospital that accepts Medicare.
   
   

If you have a Medicare Advantage HMO here are some of your options.

1. Move to a Medicare Advantage PPO program and have the option of going to doctors out of network.
   
2. Move to a Medicare Supplement program and have access to any provider or hospital that accepts Medicare.
   
   

Programs that Mainline Insurance Offers:

• United Healthcare Medicare Supplement offered through AARP
  
• Part D prescription drug coverage.
  
• United Healthcare Medicare Advantage HMO program
  
• Empire BCBS Medicare Advantage PPO program.
  
• Empire BCBS Medicare Advantage HMO program
  
• Emblem Medicare Advantage PPO program.
  
  

Programs Costs

• Medicare Supplement plans with Part D come in the  $200 to $300 range monthly. Most clients enjoy the comprehensive benefits of Plan F with the Part D prescription drug coverage.
  
• Medicare Advantage plans as an HMO or a PPO run between $0 to $200 monthly depending on which county you reside.

Best Regards,
Vincent Reda

Purpose:
To help individuals and families pay for their health insurance.

Here's how you qualify:

• Household income must be between 133% and 400% of the Federal Poverty Level. (FPL)
  
• Covered individuals must be legally present in the USA.
  
• Covered individuals must not be eligible for “affordable employer sponsored healthcare coverage”.

This is how it works..

• The individual will pay their portion of the premium and the government will pay the balance each month.
  
• If the amount of advance credit payments you get for the year is less than the tax credit you're due, you'll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit.

Family Example:

• Family of 4 with household income of $50,000
  
• Income as a percentage of the FPL is 212%
  
• The approx. premium for a Silver plan is $1,200 monthly. You can select whatever Metallic Plan level you wish.
  
• The Government says you can pay $435 monthly
  
• The Advance Premium Tax Credit will be $765 monthly, payable by the government directly to the insurance company.
  
  

Individual Example:

• Single person with household income of $25,000
  
• Income as a percentage of the FPL is 217%
  
• The approx. premium for the Silver plan illustrated is $420 a month. You can select whatever Metallic Plan level you wish.
  
• The government says you can pay $220 a month.
  
• The Advance Premium Tax Credit will be $200 payable monthly by the government directly to the insurance company
  
  

The Advanced Premium Tax Credit is A key component in the new Affordable Care Act to help make healthcare affordable. See our article for the Metallic Plans Available on the NYS Health Benefits Exchange. www.mainlineins.com/metallicplans

Regards,
Vincent Reda & the staff at Mainline Insurance

Insurance companies will offer their programs:

• On and Off the NYS Health Benefit Exchange
  
• Off the Exchange only
  
  

There are two Health Benefit Exchanges:

• Individual Marketplace
  
• Small Business Marketplace AKA the SHOP Exchange (up to 50 employees on the payroll)
  

Level of Plans on the Exchange (the Metallic Plans)

• Platinum
  
• Gold
  
• Silver
  
• Bronze
  
• Catastrophic: very inexpensive and only available to individuals under 30 years of age.

Individual Marketplace:

1. Affinity Health Plan
   
2. Empire BCBS
   
3. Fidelis
   
4. Freelancers Co-op dba Health Republic
   
5. Emblem
   
6. Healthfirst New York
   
7. MetroPlus Health Plan
   
8. Oscar Insurance
   
9. North Shore LIJ
   
10. United Healthcare
    

Small Business Marketplace:

1. Freelancers Co-Op dba Health Republic
   
2. MetroPlus Health Plan
   
3. North Shore LIJ
   
4. Oxford

Private Market Insurance Companies Offering Plans we know of so far.

1. Oxford
   
2. Aetna
   
3. Empire BCBS
   
4. Health Republic
   
5. Oscar
   

Please bear in mind that finding your provider will be a more daunting task than in the past.
Many insurance companies although not advertised and disclosed openly, to hold down costs have created smaller networks of doctors and hospitals. Those providers will be paid less. It is easy to see why the networks are smaller. Participants in the exchanges should be prepared for the much tighter narrower networks. The insurers say that with a smaller number of doctors and hospitals they can offer lower cost policies and have more control over the quality of the health care providers. They also say that this is better than no coverage.at all. Health plans having narrow networks that exclude many doctors, may discourage patients with expensive pre-existing conditions who have established relationships with doctors. Basically saying they do not want  patients who for medical reasons require a broad network of providers

We will be ble to help you navigate to see which insurance company’s networks and plan design best works for you.

We expect there to be a combination of large legacy insurance companies, new insurance companies and existing insurance companies looking to expand their geographical footprint all offering market rate plans. This comes about since everyone has to have health insurance or be fined.This should provide ample competition thus keeping rates stable.

Regards,
Vincent  

Small Business Health Care Tax Credit

Finally, a break for small businesses.

Purpose:
To help small business and small non-profit organizations afford the cost of covering their employees.



How Do You Claim the Credit?

• in 2014 you have to have fewer than 25 employees and provide affordable health insurance coverage you may qualify for the tax credit of up to 50%. For the non-profit sector the maximum is 35%. This helps to offset the cost of providing health insurance to employees.
  
• The business must cover at least 50% of the premium for  single health care coverage for each of the eligible employees.
  
• The average of the employees wages must be less than $50,000 annually
  
• The smaller the business the larger the credit. It works on a sliding scale.
  
  

Forms to Obtain Credit:

• for profit------form 8941
  
• non profit-----form 990T
  
  

The Small Business Tax Credit

A key component in the new Affordable Care Act to help making healthcare affordable.

Regards,
Vincent and the Staff at Mainline Insurance

A major component of the Affordable Care Act is the Health Benefits Exchange.The Exchange is a tool for small businesses and individuals to obtain health insurance. We are prepared to help you navigate amongst the Business and Individual Exchanges along with the private market programs.

The Affordable Care Act comprises of two Exchanges.

•       The Individual non business exchange.
  
  
•       The Small Business Exchange ( 2-49 employees).
  
  

Along with the Exchanges there will be regular market programs for additional benefit options.

We are still waiting for guidance from the State concerning the rules and regulations.

The first phase is to begin October 2013 for implementation January 2014.

Note: the penalty for large employers (50+ on the payroll) has been pushed off till 2015

However:

The penalty for employees still remains. Those employees will have to obtain coverage or be penalized.

At Mainline Insurance we are prepared to deliver guidance to navigate during these changing times.

Many employees that have to go to the Individual Exchange will receive subsidies from the government to help them afford their coverage.

The education and certification process has started. Mainline Insurance has been certified and authorized to offer plans on the NYS Health Benefits Exchange.  It appears it is taking the State some time to get the curriculum together along with the insurance companies still not delivering plan design and rates for plans offered on the exchange and in the private market.

I anticipate the pace to pick up now since October is right around the corner.

Stay tuned as the Affordable Care Act unfolds and we break it down for you.

Regards,

Vincent

We have entered the last quarter of the year and there are important items to discuss. This circulation addresses Emblem and HIP policyholders. Many of you have received notification that Emblem is terminating all plans for small groups effective 12-31-13. This also applies to groups that have Emblem through the LIA and HealthPass. Over the last several months we have brought notice of Emblem’s intention to leave the small group marketplace. In the future, Emblem  wants to offer plans that are compliant with the Affordable Care Act. The irony Emblem’s current offerings are more than compliant already.

A transition will not be automatic and the industry does not know how Emblem will proceed with this change. As of the writing of this article, Emblem has not disclosed plan designs or rates for 2014. This same lack of information is concurrent across all insurance companies that offer plans in New York.

I want you all to know that I am staying up to date on the situation. I hope to have a variety of options from Emblem and other providers shortly for review. Mainline will be able to illustrate and council on health insurance programs offered both on and off the Health Benefit Exchange. It appears there will be a larger selection of insurance companies offering plans in 2014. Under the Affordable Care Act, insurance providers that offer plans on the Health Benefit Exchange are also required to offer market rate plans off the Health Benefit Exchange.

As I mentioned earlier, I will be keeping you informed. Please look out for our articles and newsletters. Mainline will be posting articles periodically detailing the Affordable Care Act and issues that are important to you. Please visit our website  www.mainlineins.com to see  articles previously posted.

Regards,

Vincent and the Staff at Mainline Insurance