Health Insurance for the Self-Employed: A Comprehensive Guide
Being self-employed comes with its own set of challenges, and securing health insurance is one of them. With health insurance not being offered by an employer, just knowing where to turn can be rather difficult. We'll guide you through the maze of options available and how to choose the best one for you.
Challenges Faced by the Self-Employed
Variable Income: Fluctuating income can make budgeting for health insurance difficult.
Lack of Employer Support: The financial burden falls entirely on you without an employer to share the premium costs.
Finding options: Knowing where to look and what to look for
Insurance Options
Marketplace Plans: These are available during the Open Enrollment period and offer various coverage options. In addition, multiple carriers to choose from.
Exclusive Private Plans: These are specialized plans not commonly offered by traditional agents. They are designed to be more affordable and can be customized to fit your specific needs. Most of these are based on health status, which, if eligible, can provide more affordable rates.
Short-Term Plans: Ideal for those in transitional phases, these offer coverage for a limited period, and that coverage is very, very limited. Plan duration is also usually less than a year. (not a full coverage option)
Supplemental plans & gap Coverage: Provide coverage to fill in the gaps where out-of-pocket expenses may incur. This includes critical illness benefits, accident benefits, and short-term disability.
Dental & Vision
Tax Advantages
One of the often-overlooked benefits of being self-employed is the ability to deduct health insurance premiums from your taxable income, potentially leading to significant tax savings. The Self-Employed Health Insurance Deduction allows you to write off premiums for yourself, your spouse, and your dependents, reducing your overall tax liability. However, there are specific eligibility criteria, so it's advisable to consult a tax professional for personalized advice.
Ongoing Support
Our consultants are not just available during the enrollment period; they provide year-round support. The consultant who assists you in selecting your plan will remain just a phone call away, ensuring you have the guidance you need to navigate any changes or issues that may arise.
Navigating health insurance options as self-employed doesn't have to be daunting. Contact RKA Insurance Advisors for expert advice tailored to your unique needs. We are licensed in 32 states and offer a variety of plans to suit you.
Contact Us:
561-806-9913
Open Enrollment 2024: What You Need to Know
Open Enrollment 2024 is just around the corner, and preparation is crucial. Whether you're new to shopping for health insurance or looking to switch plans, this period offers a golden opportunity to secure the coverage you need. We will cover the essential details you need to know. Changes to your current health plan are to be expected.
Important Dates
Mark your calendars for these key dates:
Open Enrollment Starts: 11/01/2023
Open Enrollment ends: 01/15/2024
Coverage Begins if Enrolled by 12/15/2023 on 01/01/2024
Coverage Begins if Enrolled by 01/15/2024 on 02/15/2024
Types of Plans Available
At RKA Insurance Advisors, we offer a variety of plans to suit your needs:
Marketplace Plans: These are government-regulated plans available during the Open Enrollment period.
Private Plans: We specialize in private plans for individuals, families, the self-employed, and small businesses. These plans often offer more customization and potentially more affordable rates based on your health.
Supplementary Plans: Critical illness benefits and accident coverage are intended to help offset out-of-pocket costs, not intended as stand-alone coverage.
Telemedicine plans: Virtual Healthcare services for non-emergency medical services
Dental & Vision
How to Choose the Right Plan
Choosing a health insurance plan can be overwhelming. Consider factors like your medical needs, budget, and the network of healthcare providers, deductibles, & Max Out of Pocket. If you're unsure, professional advice can make all the difference.
Don't navigate the complexities of Open Enrollment alone. Contact RKA Insurance Advisors for personalized quotes and find the right plan for you. We are licensed in 32 states and offer a range of options to fit your needs.
Contact Us:
561-806-9913
Navigating the Rising Tide of Health Insurance Premiums in 2024: Why Exploring All Options is Crucial
OPEN ENROLLMENT 2024
As we approach 2024, the health insurance landscape is undergoing significant changes, with premiums on the marketplace expected to rise. This cost increase makes it more important than ever to explore all available options, including private health coverage. In this blog, we'll delve into the factors contributing to the rise in premiums and why considering all avenues for health insurance is essential for your financial well-being and overall healthcare experience.
The Surge in Premiums: What's Driving the Increase?
Several factors contribute to the anticipated rise in health insurance premiums for 2024:
Inflation: The general increase in the cost of goods and services affects healthcare costs.
Medical Advancements: While new treatments and technologies improve healthcare, they also come at a price.
Administrative Costs: The overheads for insurance companies are also rising, which is passed on to the consumer.
Why Exploring All Options is Vital
Relying solely on marketplace options may limit your access to affordable options if you are not eligible for a subsidy provided by the government based on your income. Private health plans often offer more affordable health options, and approvals are subjected to a health-based risk assessment. These options are not found online. They must be administered by a licensed agent/broker.
Cost-Effectiveness
Private health insurance plans can sometimes offer more competitive rates, especially for individuals, families, and small businesses.
Flexibility
Private plans often provide more flexibility in choosing healthcare providers and services, giving you more control over your healthcare experience.
The Importance of Expert Guidance
Consulting with a Licensed Health Insurance broker can provide you with insights into the most cost-effective and comprehensive plans tailored to your unique needs. They can guide you through the maze of options, ensuring you make an informed decision.
Don't let the rising premiums catch you off guard. Take control of your healthcare experience by exploring all available options. Contact one of our Licensed Health Coverage advisors today to find a plan that's right for you.
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561-806-9913
Navigating the Changes and Important Updates for the 2024 Open Enrollment Season
Navigating the Changes and Important Updates for the 2024 Open Enrollment Season:
As the year unfolds, so does the healthcare landscape, bringing with it new opportunities and considerations for individuals and families. The 2024 open enrollment season is just around the corner, and it's crucial to stay informed about the changes and updates that will shape your healthcare decisions. At RKA Insurance Advisors, we are committed to providing you with the latest insights and guidance to ensure you make informed choices about your health coverage. In this article, we'll explore the key changes for 2024 open enrollment, shed light on the availability of private medically underwritten PPO plans year-round, and emphasize the importance of consulting licensed health advisors or brokers throughout the process.
What's New for the 2024 Open Enrollment Season?
Each open enrollment season brings its own set of changes and updates that can impact your healthcare coverage. For 2024, here are some of the important developments to be aware of:
Extended Enrollment Periods: Many states and insurance providers are extending the open enrollment period to provide individuals and families with more time to select the right healthcare plan. This extension offers added flexibility, enabling you to thoroughly research and compare different options.
Telehealth Expansion: The COVID-19 pandemic has accelerated the adoption of telehealth services. In 2024, more insurance plans will likely include expanded telehealth coverage, allowing you to access medical consultations conveniently from the comfort of your home.
Prescription Drug Coverage: Keep an eye out for changes in prescription drug formularies and pricing. Understanding how your medications are covered under different plans will help you choose the one that best suits your needs and budget.
Private Medically Underwritten PPO Plans: Year-Round Availability
Private Medically Underwritten Preferred Provider Organization (PPO) plans to offer an alternative option for those seeking more personalized healthcare coverage. Unlike traditional plans, medically underwritten PPOs consider your health history and medical conditions when determining coverage and premiums. Here's why these plans are worth considering:
Tailored Coverage: Medically underwritten PPO plans allow for a more personalized approach to healthcare coverage. Your unique medical profile is taken into account, ensuring that you have the coverage you need where it matters most.
Access to Quality Providers: PPO plans often grant you access to a wider network of healthcare providers, giving you the freedom to choose doctors and specialists that align with your preferences.
Year-Round Availability: Unlike the standard open enrollment period, private medically underwritten PPO plans are available throughout the year. This means you have the flexibility to enroll when it's most convenient for you without being restricted to a specific time frame.
Why Work with Licensed Health Advisors or Brokers?
Navigating the world of health insurance can be complex, and making the right choice requires careful consideration of various factors. This is where licensed health advisors or brokers play a crucial role:
Expert Guidance: Licensed advisors possess in-depth knowledge about different plans, coverage options, and recent changes in healthcare regulations. They can help you understand complex terms and make sense of the fine print.
Tailored Recommendations: Advisors take the time to understand your unique healthcare needs, budget, and preferences. With this information, they can recommend plans that align with your individual requirements.
Savings Potential: Advisors can help you identify cost-saving opportunities, such as subsidies or tax credits, that you might not be aware of when shopping for insurance on your own.
Take Action Today with RKA Insurance Advisors
As the 2024 open enrollment season approaches, and even throughout the year, RKA Insurance Advisors is here to guide you through the process of selecting the right healthcare coverage for you and your family. Our team of licensed health advisors is well-equipped to provide you with expert insights, personalized recommendations, and a thorough understanding of private medically underwritten PPO plans.
Visit www.rkainsuranceadvisors.com to learn more about our services and to connect with one of our experienced advisors. Together, we'll ensure that you make informed decisions about your health coverage that align with your unique needs and aspirations. Your health and peace of mind are our top priorities, and we're committed to helping you achieve them every step of the way.
Lost Health Insurance?
Life is full of unexpected turns; one such twist can be the loss of health insurance coverage. Losing health insurance can be daunting, whether due to a change in employment, life circumstances, or other factors. At RKA Insurance Advisors, we understand the challenges that come with this situation, and we're here to guide you through the steps to take when facing the loss of health insurance. We will provide you with a comprehensive roadmap to ensure your health coverage remains secure and your well-being protected.
Step 1: Assess Your Situation The first step is to assess your current situation and understand why you are losing your health insurance. Is it due to a job change, expiration of coverage, or other reasons? This evaluation will help you make informed decisions moving forward.
Step 2: Seek Professional Guidance Navigating the world of health insurance can be complex. Reach out to a licensed insurance advisor, like those at RKA Insurance Advisors, who can provide expert guidance and help you make well-informed decisions based on your unique circumstances.
Step 3: Check Eligibility for Special Enrollment. In many cases, losing health insurance qualifies you for a special enrollment period. This window of opportunity allows you to enroll in a new health insurance plan outside of the regular open enrollment period. Make sure to explore your eligibility for special enrollment to avoid a coverage gap.
Step 4: Research Alternative Coverage Options Research and compare alternative health insurance options available to you. Consider medically underwritten private plans, government-sponsored programs, COBRA continuation coverage, or short-term plans. Evaluate each option's benefits, costs, and coverage to determine the best fit for your needs.
Step 5: Budget for Healthcare Costs Losing health insurance may mean increased out-of-pocket expenses. Create a budget to account for potential medical costs, including premiums, deductibles, copayments, and prescription medications. Understanding your financial responsibilities will help you plan accordingly.
Step 6: Secure New Health Coverage Once you've assessed your options and received professional advice, it's time to secure new health coverage. Enroll in the plan that best meets your needs and protects you and your family.
At RKA Insurance Advisors, we're here to support you every step of the way during times of transition. If you're facing the loss of health insurance or have questions about securing new coverage, we're just a phone call away. Our dedicated team of experts is ready to provide personalized assistance and help you find the right health insurance solution for your situation.
Don't navigate the complexities of health insurance alone. Call us today to speak with one of our experienced advisors and take the first step toward securing your health and well-being.
Facing the loss of health insurance can be overwhelming, but with the right guidance and proactive steps, you can ensure a smooth transition to new coverage. Remember, RKA Insurance Advisors is your trusted partner in navigating life's uncertainties and protecting what matters most – your health and peace of mind.
For expert assistance and personalized health insurance solutions, contact us at or visit our website at www.rkainsuranceadvisors.com. Your well-being is our priority, and we're here to help you every step of the way.
Why Health Insurance Matters
At RKA Insurance Advisors, we understand the significance of safeguarding your health and well-being. We proudly offer free health insurance quotes for individuals, families, self-employed professionals, and small business owners. In this blog, we'll explore the critical importance of having health insurance coverage and how our tailored plans ensure affordability and security for you and your loved ones.
Why Health Insurance Matters:
Protecting Your Health: Health insurance provides a safety net for unexpected medical expenses, ensuring you have access to quality healthcare when needed. It covers doctor visits, hospitalization, prescription medications, and preventive care, promoting early detection and better health outcomes.
Financial Security: Medical emergencies can be financially crippling, but with health insurance, you can avoid the burden of high medical bills. Having coverage means you can focus on recovery rather than worrying about healthcare costs.
Coverage for Loved Ones: Health insurance plans for families extend protection to your loved ones, offering peace of mind knowing that their health needs are taken care of. You can rest assured that your family's well-being is a top priority.
Accessible and Affordable: Our health insurance quotes cater to individuals, self-employed professionals, and small business owners' specific needs. We offer customizable plans that fit your budget and provide access to a broad network of healthcare providers.
Coverage Outside of Open Enrollment: Plans are available year-round if you are outside of open enrollment, offering flexibility and options to secure coverage regardless of the time of year.
Affordability Based on Health:
We understand that one size does not fit all regarding health insurance. Some plans consider your health conditions and can be medically underwritten, potentially leading to more affordable premiums based on your health profile. This way, you can receive comprehensive coverage without compromising your budget.
Please don't wait for life's uncertainties to take their toll. Secure your health and your future today with our free health insurance quotes. Click the link below to explore our plans and discover the peace of mind that comes with comprehensive health coverage:
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At RKA Insurance Advisors, we believe that everyone deserves access to quality health insurance. Our tailored plans for self-employed professionals, small business owners, individuals, and families provide the coverage you need at an affordable price. Take the proactive step towards safeguarding your health and future by contacting us for a free health insurance quote today.
For inquiries or to get started, contact us at INFO@RKAINSURANCEADVISORS.COM or visit our website at WWW.RKAINSURANCEADVISORS.COM. Our team of dedicated advisors is ready to assist you in finding the perfect health insurance plan for your needs.
Truckers Health Insurance (2025–2026): Owner-Operators & CDL Drivers Guide | RKA
Truckers need coverage that works in every state they drive. We compare ACA vs. private PPOs, verify doctors along your routes, model subsidies for variable income, and set up telehealth/Rx for life on the road.
Guide • Owner-Operators & CDL
Truckers Health Insurance (2025–2026): Simple, Road-Ready Options
Fast take: Trucking life crosses state lines—your coverage should too. We compare ACA Marketplace options (often with subsidies) against private, medically underwritten PPOs for eligible drivers, then confirm your doctors, pharmacies, and hospitals along the routes you actually run.
Your main paths
1) ACA Marketplace (with possible subsidies)
- Pro: Guaranteed issue, tax credits can lower premiums.
- Watch: Networks can be local—confirm out-of-area rules for multi-state routes.
- Best for: Drivers with variable income who likely qualify for credits.
2) Private, medically underwritten PPO
- Pro: Broad nationwide PPO access; may beat unsubsidized ACA pricing for healthy drivers.
- Watch: Health underwriting applies; we pre-screen quickly.
- Best for: Owner-operators who want consistent nationwide networks and predictable costs.
Road-ready tips
- Check your lanes: Tell us your common routes—TX-FL, I-10, I-80—so we verify in-network care along the way.
- Telehealth first: Virtual visits cut downtime between loads; many plans include 24/7 telemedicine.
- Rx strategy: Confirm formulary tiers and use nationwide pharmacy chains for easy refills.
- HSA play: With an HSA-eligible plan, contributions may reduce taxes and cover on-the-road expenses.
- OccAcc ≠ Health: Occupational accident is useful but does not replace major medical coverage.
How RKA helps truckers
- Nationwide network checks: We confirm providers where you drive—not just near your home base.
- Subsidy modeling: We map variable income by quarter to estimate credits accurately.
- Fast enrollment: Avoid gaps between contracts; coordinate effective dates with dispatch schedules.
Quick FAQs for Truckers
Will my plan cover me in other states?
Can I switch outside Open Enrollment?
Do telehealth visits count as in-network?
Can I use an HSA as an owner-operator?
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Millions of people who rely on Medicaid could lose eligibility & be without coverage.
Millions of people who rely on Medicaid could lose eligibility & be without coverage.
As we approach the end of March, there is a looming threat to Medicaid funding that could have a significant impact on individuals and families who rely on this program for their healthcare needs. The American Rescue Plan, which was passed by Congress and signed into law by President Biden, includes a provision that would increase Medicaid funding. However, this funding boost is set to expire at the end of March, which could leave millions of Americans without access to affordable healthcare.
At RKA Insurance Advisors, we believe that everyone deserves access to quality health coverage, regardless of their income or circumstances. That's why we're calling on our clients and partners to help spread the word about the potential loss of Medicaid funding and to explore other options for healthcare coverage.
One option is to enroll in a Marketplace plan through the Affordable Care Act. The Open Enrollment period has already ended, but individuals who experience certain life events, such as losing their Medicaid coverage, may be eligible for a Special Enrollment Period. RKA Insurance Advisors can help individuals navigate the Marketplace and find a plan that meets their healthcare needs and budget.
Another option is to explore medically underwritten private plans. While these plans may not be suitable for everyone, they can offer more flexibility and potentially lower premiums than Marketplace plans. RKA Insurance Advisors can help individuals determine if a medically underwritten plan is right for them and assist with the enrollment process.
It's important to note that losing Medicaid coverage can have serious consequences for individuals and families, both financially and in terms of their health outcomes. Without access to affordable healthcare, many people may delay or forgo necessary medical treatment, which can lead to more serious health problems down the line.
More so, why it’s very important to contact us today if this is your situation or if you have general questions regarding health coverage or need quotes for new plans.
Time is Running Out: The Open Enrollment Deadline for Health Insurance Quotes is December 15th!
Take advantage of your chance to secure health insurance quotes for the upcoming year. The Open Enrollment Deadline for 2023 is quickly approaching, and time is running out. December 15 marks the last day individuals and families can apply for or renew their existing health insurance plans to start January 1st. So don't delay - take advantage of this window of opportunity to make sure you have the coverage you need for the coming year.
How do I know if I'm eligible for a subsidy?
During the Open Enrollment period, which runs from November 1 to January 15 each year, individuals and families can shop for, compare, and purchase health insurance coverage. Small business owners and the self-employed also have the opportunity to find quality coverage during this time. December 15 is the cut-off for a plan to start January 1st.
Speaking to a licensed health coverage advisor, you can get an estimate of your costs and premiums and see how much you could save on a qualified health plan. The amount of savings you may qualify for depends on your income level, the size of your family, and the type of coverage you select. Five out of six people generally qualify for savings when purchasing a health plan. In addition, you can compare and check eligibilty for medically underwritten private plans not available on the marketplace exchange.
Don't wait to take advantage of Open Enrollment! Make sure to speak to a licensed advisor who can compare all your coverage choices. Doing so will help ensure you get the coverage you need at an affordable rate. For example, suppose you're eligible for a subsidy and don't get health insurance quotes by the Open Enrollment deadline of January 15. In that case, you may have to wait until the next Open Enrollment period to get a plan at a discounted rate. Especially if you are not eligible for medically approved coverage options, so take advantage of the chance to save on family and individual health insurance or small business and self-employed health insurance coverage. Get your health insurance quotes now and take advantage of affordable plans before it's too late.
How do I enroll in a health insurance plan?
When enrolling in a health insurance plan, it's vital to ensure you are getting the best coverage for your needs and budget. One of the best resources you can use to help you choose the right plan is a Licensed health coverage advisor. They can provide personalized advice, guidance, and information about the plans available and what will work best for your situation.
In addition, you can also utilize an online enrollment platform to get instant quotes from multiple insurers. This will help you compare rates and features between the various plans to choose the best fit your requirements. Online quote comparisons do not consider or compare medically underwritten plans. These plans must be provided by a licensed advisor. Rates can be, at times, 20-30% more affordable than marketplace plans if you do not qualify for substantial savings. Don't miss out on this important opportunity - December 15 is the Open Enrollment Deadline for coverage to begin January 2023. Act now to secure your health insurance coverage for the coming year.
Reach out to us today to ensure you have the best coverage at the most affordable rate!
IMPORTANT OPEN-ENROLLMENT INFO AND DEADLINES
Important Open-Enrollment Information
With Open Enrollment well underway, which started November 1st, 2022. Some important & key dates to be made aware of. The Federal Open Enrollment Period runs from November 1, 2022, through January 15, 2023, for health insurance coverage beginning in 2023. To get coverage starting January 1, 2023, you MUST sign up by December 15, 2022.
When does the Open Enrollment Period end?
The OEP for the federal exchange ends on January 15, 2023. With plans to start February 1, 2023, if enrolled between December 16 to January 15.
What are the exceptions to Open Enrollment?
Unless you experience a qualifying life event, the Open Enrollment Period is the only time you can enroll in health insurance plans. Suppose you suddenly lose health care coverage due to divorce, moving primary living to a different zip code, childbirth, or any other significant changes in your life. In that case, however, you may be qualified to enroll in a health plan during a Special Enrollment Period. A Special Enrollment Period will allow you to get health insurance for up to 60 days after a qualifying event for the remainder of the year. However, remember that you will not qualify for a Special Enrollment Period if you lose coverage because of failure to pay insurance premiums.
Is there an Open Enrollment for dental insurance?
There is no Open Enrollment for other insurance products, such as dental and vision.
Can I make a change to my marketplace plan outside of Open Enrollment?
No, you can't change your marketplace plan outside of Open Enrollment. However, you may need health insurance outside the Open Enrollment Period or are unsatisfied with your current health coverage selection. In that case, you may qualify for private health-based, medically underwritten plans that are available year-round. These plans, due to the healthier risk pool, rates usually are more affordable than the marketplace if you do not qualify for a subsidy. Also, there are select guaranteed-issued plans available outside of open enrollment. These options are limited.
What do I do if I have questions or need help picking a plan?
That's exactly where we step in. Our team of specialists are licensed in 32 states. Our primary job is to advise, educate and help pick a plan that will work best for you, your family, or your small business. Your health coverage will significantly impact your overall healthcare experience, so it's an important decision.
CONTACT US TODAY FOR QUOTES, QUESTIONS, COMPARE PLANS, OR ENROLLMENT ASSISTANCE
OPEN ENROLLMENT IS HERE
Open Enrollment 2023
THE 2023 OPEN ENROLLMENT PERIOD FOR ACA/MARKETPLACE PLANS HAS ARRIVED!
This is the time of year you can check eligibility & savings, compare plans, view newly released plans, and enroll in health coverage. If you make under 30k, you could be eligible for plans as low as 0 dollars a month. The marketplace is a great option for securing health coverage as you cannot be denied the right to coverage based on medical conditions.
The marketplace is not your only place to shop for affordable health coverage, as private, medically underwritten plans are also available. Knowing which plans are best for you, what type of network, how much your deductible and max out-of-pocket should be, which insurance carrier you should choose, and do my doctors accept this plan are all questions were can assist in answering.
At RKA Insurance Advisors, these are the exact things we specialize in. We pride ourselves on making sure we first advise and educate, so you can select the best plan for you in the event the worst happens. Your medical coverage can significantly impact your healthcare experience, so it’s an important decision. You don’t have to make it alone. Contact us today!
Can you afford to NOT have health coverage?
Can you afford to NOT have Health Coverage?
For the uninsured and mostly healthy individuals who feel the added monthly cost of health insurance is not worth it. We understand how you may feel that way. Paying for something you don’t use or rarely use doesn't make sense to most people, and it's hard to justify the cost.
There is a vast misconception regarding the purpose of health insurance. Of course, we want it to cover our day-to-day needs. Doctor visits, yearly wellness check-ups, and prescriptions, especially if I’m paying a monthly premium. Many plans do, but not all. So the frustration people have when they do not use their insurance often, then the one time they do, they have a copay, a deductible, or something not covered can, of course, lead to frustration. This is more a lack of understanding, not just about the purpose of health insurance but an overall understanding of your current insurance plan and how to use it.
Having a licensed advisor to help you navigate to pick a plan that not only covers the day-to-day but covers the large claims is the best way to go. Let's say for a moment you didnt use a licensed advisor, and you went to the marketplace and picked the cheapest plan. In that situation, more than likely, you'll be paying out of pocket for most medical claims other than annual wellness. So we understand the frustration and apprehension to even having health coverage.
This leads to the primary purpose of this topic. Health coverage is intended to cover major things. There are deductibles, Co-insurance, and Max out of pocket, which are the insured's responsibility. But let's look at the avg cost of some medical services.
Surgical treatment of a broken arm $16,000.00 +
Surgical treatment of a broken leg $ $17,000 to $35,000
Non-Surgical Broke Nose realignment $2,000 to $5,000
These services, of course, are not including the cost of:
X-Rays provide a two-dimensional picture of the broken bone
Bone scans are used when fractures don't show on an X-Ray
CT Scans use computers to show detailed slides of broken bones
MRIs create a very clear image using a magnetic field
These services can cost thousands in themselves. Also, they aren't considered major medical or catastrophic claims. However, let's examine the cost of some unexpected catastrophic claims.
The average cost of a less severe heart attack is $760,000. And if you spread those figures out over 20 years of payments, that's $38,000 per year for a less severe heart attack.
Managing heart disease can cost upwards of $20,000 a year.
Now ask yourself, would you rather have $38,000 in medical bills annually over the next 20 years? Or would you prefer a minor monthly premium to cover most of this cost?
Let's take a look at some other conditions:
People who have cancer can quickly amass six-figure medical bills. In 2018, AARP reported average cancer treatment costs of around $150,000.
Now ask yourself, would you rather have this medical bill or a small monthly premium to cover most of this cost?
Heart Valve Replacement: $170,000
Heart Bypass: $123,000
Kidney Transplantation: $87,538 and $124,271
Disc Replacement Surgery: $16,700 – $45,800
Spinal Fusion Cost Average: $15,700 – $94,300
Gallbladder surgery: $54,041
Now ask yourself, would you rather have this medical bill or a small monthly premium to cover most of this cost?
These are just some of the many conditions & treatments Americans face daily. Insurance is not going to cover all of this at 100%. It is NOT a credit card. There is a portion you would be responsible for. Mostly, that is to help offset claim loss & to keep rates reasonability affordable. We understand that word affordable can be subjective.
Let's say you have an insurance plan; you pay 300.00/ month for the last year. You have a $5,000 deductible with a max out-of-pocket of $7,000. You then have a heart attack. The claims start to pile in, and the above figure of $760,000 is the final bill.
The current example plan will pay 753,000 of the cost in that instance. Leaving you with your responsibility of the max out-of-pocket of $7,000. If you want to calculate the cost of the 12-month premium, that still would only be $10,600 compared to $760,000. It seems like a pretty fair deal, right? Even the scaling across 20 years of $38,000. This is a much better alternative than being uninsured.
This is precisely the primary purpose of health insurance—to cover major claims.
Coincidentally, why 2/3 of all bankruptcies are medically related, so it’s very important to have a full coverage insurance plan that makes sure you’re in the best position in the event the worst happens.
Hopefully, we have put some things in perspective for you as to why it's essential to have health coverage. Not just why it's important to have but also to understand your current health plan. With the upcoming open-enrollment season, it's a perfect time to speak to a licensed health advisor to review your current plan, check newly released plans, make sure you know how it works, or receive quotes for a new plan if you do not have one. We look forward to hearing from you!
Benefits of Telemedicine
Benefits of Telemedicine
Telemedicine, which enables video or phone appointments between patients and their health care providers, benefits both health and convenience. As technology advances, telemedicine will continue to become more popular as more health care providers offer to "see" patients by computer and smartphone.
There was a growing trend pre-Covid-19 of telemedicine, also known as Telehealth. However, since early 2020 when the spread of Covid-19 was at its peak, health care providers have rapidly implemented this virtual service into their practice for safety and to continue serving and treating patients. In addition, there are many vital aspects and benefits telemedicine offers that traditional in-person visits cannot offer.
Convenience
With telemedicine, you don't have to drive to the doctor's office & sit in a waiting room when you're sick for an hour before seeing a doctor. Instead, you can see your doctor from the comfort of your home.
Virtual visits are much easier to fit into your busy schedule. With telemedicine, most often, a quick refill of a routine medication can be done from the comfort of your house or workplace.
Mitigate the spread of Illness
To help prevent the spread of infectious diseases and other illnesses, doctors can use telehealth appointments to prescreen patients for possible contagious diseases. Less exposure to other germs helps everyone, especially chronically ill, pregnant, elderly, or immunocompromised.
Primary Care and Chronic Condition Management
Regular visits with primary care practitioners, such as those specializing in family medicine, internal medicine, and pediatrics, are essential to your family's health. Telemedicine makes it easy to connect with a doctor or nurse practitioner. In addition, some platforms and providers are available 24/7.
Cost
Telemedicine collectively can decrease costs not only for the overall healthcare system but for the patient specifically. Most insurance plans cover telemedicine visits at 100% without having to satisfy a deductible. Claims to insurance companies for these visits tend to be less than an in-person visit as well. When telemedicine is used as opposed to utilizing your local ER as a PCP when you have a non-emergency medical event, this alone can decrease overall health care and coverage costs. Most importantly cost you less. Most cash-pay telemedicine visits cost less than an actual in-person doctor's visit.
Doctors can treat more Patients
Telemedicine provides alot of flexibility to both patients and healthcare providers. This flexibility allows providers to see patients after hours. Thus, opening healthcare providers to treat more patients more frequently and faster. Most telemedicine can be completed within 15 minutes.
Implementing telemedicine in our healthcare system can drastically improve medical outcomes, drastically reducing patient and healthcare costs. If you are uncertain if your current coverage has telemedicine service, reach out to us so we can review your plan benefits. With the open-enrollment period for 2023 fast approaching, now is the perfect time to speak to one of our licensed advisors to review your current coverage or get quotes. Options can be tailored to your specific situation, preferences, and budget. We aim to not only provide you with flexible options but to advise and educate you in today's market.
Health Insurance “Hacks”
Health Insurance “hacks” & tips!
In today's day and age, it seems to be there are "hacks" or tips for just about everything. For example, you can get lost on social media watching hack after hack about anything & everything you can imagine. Coking, saving money, building, etc.
What about health insurance? Are there hacks for health coverage or hacks for health coverage savings? Now, largely this will depend on the plan you have. For starters, if you're uncertain how to best use your plan, it might be time to reach out to a licensed advisor to review your current policy.
Many health coverage plans include Telehealth or Telemedicine, providing access to board-certified physicians via video chat or call. Most visits via telemedicine for sickness, if it’s on your insurance plan, are free. Using Telehealth saves time, as the visits are usually about 15 min. They can be from the comforts of your home or work without visiting an office. You save on cost, convenience, and time. If that's not an option on your current health plan, feel free to reach out to review plans that do have this service included.
For common sicknesses like upset stomach, skin rashes, common colds, and other non-emergency services, many people run directly to the ER for these services. Acting as if the ER is their Primary Care Physician. This will always result in costing you more out of pocket. If it is a medical emergency, absolutely go to the ER. However, non-emergency services are best treated by your primary or nearby Urgent Care. You will likely be treated faster, and the cost will usually be a small copay instead of an ER visit that might require a hefty deductible.
One of the most critical hacks is using providers within your plan’s network. A significant factor is whether you have an HMO, EPO, & PPO. HMO & EPO networks won't cover services outside the provider network unless deemed an emergency. PPO plans do cover outside the provider's network. However, you will usually pay a little more due to not receiving the pre-negotiated rate you would receive while staying within the provider's network. Therefore, it is essential to understand which facilities nearby are within your network. If you are unsure, please reach out, as one of our licensed advisors can check your network.
Lastly, If you are relatively healthy, you may be eligible for health-based coverage that can offer lower premiums if you qualify. Similar to having a good driving record, you'll have better car insurance rates than a person with multiple reckless driving citations on their driving record. So if you are healthy and can qualify, you could save on your monthly premiums and have quality health coverage. Now, these plans are not for everyone. Why it's essential before making a final decision on a health plan, you speak to one of our licensed advisors to make sure you review all your plans and, most importantly, you understand all of your plan's benefits, features, and "hacks."
Reach out to one licensed benefit advisor for questions to compare plans or quotes.
How does the Inflation Reduction Act affect your Health Coverage?
Inflation Reduction Act and Health Coverage
H.R.5376 - Inflation Reduction Act of 2022 was signed into law by Biden on 08/16/2022. Many argue whether this bill will help reduce inflation or not. That topic may be subjective to a degree, per each individual. We are here to discuss how this law directly affects your health coverage and the facts surrounding this bill's direct impact on Healthcare. Not to project our opinions or give a political spin.
Part 1-- Addresses prescription drug costs.
Lowering Prices Through Drug Price Negotiation. The bill requires the Centers for Medicare & Medicaid Services (CMS) to negotiate the prices of certain prescription drugs under Medicare beginning in 2026. Specifically, the CMS must negotiate maximum prices for brand-name drugs that do not have other generic equivalents and that account for the most significant Medicare spending. The CMS must negotiate the prices of 10 drugs in 2026, 15 in 2027 and 2028, 20 in 2029, and each year thereafter. Drug manufacturers that fail to comply with negotiation requirements are subject to civil penalties and excise taxes.
Part 2--Prescription Drug Inflation Rebates
In addition to negotiations, the bill requires drug manufacturers to issue rebates to the CMS for brand-name drugs without generic equivalents. Under Medicare, that costs $100 or more per year per individual, and for which prices increase faster than inflation. Manufacturers that fail to comply are subject to civil penalties. The bill provides funds through FY2031 for the CMS to implement the rebate programs.
Part 3--Part D Improvements and Maximum Out-of-Pocket Cap for Medicare Beneficiaries
The bill eliminates beneficiary cost-sharing above the annual out-of-pocket spending threshold under the Medicare prescription drug benefit beginning in 2024 and caps annual out-of-pocket spending at $2,000 in 2025 (with yearly adjustments thereafter). It also establishes a program under which drug manufacturers provide discounts to beneficiaries who have incurred costs above the annual deductible beginning in 2025. The bill provides funds through FY2031 for the CMS to implement these changes and requirements. The bill also establishes a process through which certain beneficiaries may have their monthly out-of-pocket costs capped and paid in monthly installments beginning in 2025. It provides funds for FY2023 for the CMS to implement this process.
Part 4--Continued Delay of Implementation of Prescription Drug Rebate Rule
The bill further delays until 2032 implementation of a Department of Health and Human Services rule relating to the treatment of certain Medicare prescription drug benefit rebates from drug manufacturers for federal anti-kickback laws.
Part 5--Miscellaneous
The bill establishes additional programs and requirements relating to coverage under the Medicare prescription drug benefit and other programs. For example, the bill eliminates cost-sharing under the Medicare prescription drug benefit for adult vaccines recommended by the Advisory Committee on Immunization Practices.
It also requires coverage, without cost-sharing, of such vaccines under Medicaid and the Children's Health Insurance Program (CHIP).
In addition, the bill caps cost-sharing under the Medicare prescription drug benefit for a month's supply of covered insulin products at (1) for 2023 through 2025 $35; and (2) beginning in 2026, $35, 25% of the government's negotiated price, or 25% of the plan's negotiated price, whichever is less. The bill provides funds for FY2022 for the CMS to implement these provisions.
Subtitle C--Affordable Care Act Subsidies
The bill extends 2025 certain adjustments and expansions of the premium tax credit, allowing taxpayers with income above 400% of the federal poverty line to qualify for the credit. Meaning the additional subsidies approved with the passage of the American Rescue plan were extended. Initially, there was an expectation that they would have expired.
Those are the facts of this bill that is now signed into law. We also know, and it's being reported, the expected price increase for 2023 marketplace plans. The analysis finds that the median proposed rate increase is 10% across 72 insurers in the markets reviewed. Insurers' rate requests are preliminary at this point. As a result, they may change during the review process before being finalized in early fall. Please be sure to reach out with any questions about this bill, rates, or general insurance. Our goal is to advise and educate.
HOW TO PREPARE FOR OPEN ENROLLMENT AND WHAT TO EXPECT
HEALTH INSURANCE OPEN ENROLLMENT REMINDER
Open enrollment is the time of year when you can sign up for health insurance or change your current plan on the government marketplace. The open enrollment period for the marketplace is available from November 1, 2022– January 15, 2023. With coverage to begin January 1, 2023, so long you enroll before December 15, 2022. From December 16, 2022, to January 15, 2023, plans will start on February 1, 2023.
Before you dive in and start shopping around, it's essential to ensure you're prepared and educated for what lies ahead. So here are some tips on how to get ready:
Check if your income has changed from what you previously reported. Any underreporting income can result in a tax penalty when you file taxes.
Know what you are looking for, HMO, EPO, or PPO. High Deductible & Lower Premium? Or Low Deductible & Higher Premium?
Know what your max out-of-pocket will be in the event of a significant medical claim.
Understand the above insurance terms & what they mean.
Are your medical providers within your chosen plan's network?
Has there been a diagnosis of a pre-existing condition?
Did you move & are unsure if your current plan will cover you in your new area?
Know Your Options - Ensure you understand what coverage is available to you. You may want to consider buying coverage through the marketplace or getting a private plan outside of the marketplace.
Speaking to a Licensed Health Coverage Advisor is always the course of action. Our priority is to answer any questions you have and offer an educational approach to individual coverage in today's market.
What to Expect
Suppose you're currently enrolled in a plan through the marketplace. In that case, you can expect to receive information about open enrollment from your insurance company. You may also see open enrollment reminders on this website and social media.
This year there will be substantial changes to this open enrollment. Some of those changes are insurance carriers leaving specific markets and others adding plan options to others.
A few things have contributed to the above-average increases this year, such as inflation & Covid-19. Additional subsidies, also known as cost-sharing reduction, will continue into this year's Open Enrollment. Therefore, if you are receiving a subsidy, you may receive a notification about potential changes to premium costs.
It will be imperative in the event you do, you speak to a licensed health coverage advisor. By not doing so, you may be subjecting yourself to overpayments of premiums or potential penalties for income reporting.
Marketplace plans, although an excellent option to obtain coverage, due to ACA laws & protecting the rights of individuals to get coverage. The marketplace, however, is not the only place health coverage is available.
Finally—and most importantly—it's crucial that everyone speak to a licensed advisor when considering any change! We know how confusing these situations can be; that's why we're here for you at every step!
Be proactive and reach out to us today regarding any questions you may have or quotes you need. Let us assist you in determining which coverage provides you with the most protection at the most affordable rates.
What Is A PPO Health Insurance Plan?
What is a PPO Health Insurance Plan?
You may have heard the term PPO & HMO, maybe even nodded your head in conversation and acted as if you know precisely what a PPO is. You may know it's popular and realize it's better than an HMO. But when it comes to many of these different insurance terms, it leaves you scratching your head.
With all the different insurance terms, such as PPO, HMO, EPO, Deductibles, Max out of Pocket, Coinsurance, etc. Were going to focus on what is PPO Health Insurance in health insurance? The acronym PPO stands for Preferred Provider Organization and is one of the most popular types of coverage. PPO health insurance plans contract a network of medical providers, doctors, and facilities agreeing to charge a set rate for their services. By staying in-network, members will enjoy significant savings on all healthcare-related costs compared to seeking medical attention outside the network.
One of the most popular features of a PPO plan is its flexibility. While most health insurance plans, like HMOs, require you to select a Primary Care Physician, Preferred Provider Organizations don't. You also won't need a referral to see specialists. You even have the flexibility to go outside of the plan's network if need be.
How Preferred Provider Organizations Work
Now that you know what PPO means, let's take a closer look at this type of coverage. We briefly touched on how Preferred Provider Organizations use provider networks, but how does that save you money? Well, it boils down to this simple idea. Health insurance companies and medical providers are in the business of making money. While health insurance providers have an extensive list of members, medical providers have the skills and experience to look after the health and wellbeing of those members. They arrange a contract to provide care to the insurer's members for a predetermined contracted rate. By doing so, health insurance companies will save money by cutting costs, and medical providers will receive more business as preferred providers. The arrangement is typically a win-win situation for both parties and, most importantly, benefits you.
What's Covered?
Suppose you're purchasing a PPO insurance plan through the Marketplace. In that case, it will need to cover the minimum essential benefits mandated by the Affordable Care Act (Obamacare). On the other hand, suppose you opt to purchase health coverage outside the marketplace. In that case, your coverage will largely depend on your plan and who the insurance provider is. Although, most PPO plans provide extensive coverage as they have contracts with a large provider network at lower rates.
Flexibility
With PPOs, you don't need to choose a Primary Care Physician (PCP). Instead, you choose which doctors you want to see and how often you wish to see them. Here are three examples of why flexibility in seeking medical care can be helpful:
If you need to see a specialist, you can make an appointment without getting a referral from your primary doctor prior. Ideally, this saves you time and one less co-pay you have.
If you visit a doctor you don't like. You can make your next appointment with a different in-network doctor. No questions asked, and no waiting for approval from your insurance provider to switch doctors.
If you don't want to see a doctor for routine check-ups, you don't have to. You have the freedom to seek care whenever you want and from any doctor in your PPO network.
How Much Does A PPO Cost?
There are a few factors that determine the cost, such as age, how many people are insured, and zip code. Each plan also can differ in network size, copays, deductibles, and Max out of Pocket, which are all factored into rates. PPO plans on the marketplace are harder to come by. A large portion of country PPOs are not even available on the marketplace. If in the event they are, we generally see them much more expenses than HMO & EPO networks. Private PPO plans are available in most areas. These plans are short-term medical plans, which, although usually a PPO, provide limited benefits. Always speak to a Licensed Advisor before enrolling in any plan, especially short-term plans. Also, there are private plans that are subjected to a medical risk assessment, which typically results in more affordability bc the risk pool is healthier for individuals who have a smaller claims history. The insurance company can offer lower rates, PPO networks, and more benefits.
Where To Start Your Search
If you want to learn more about PPO health plans and whether or not it's your best coverage option, the best place to start is right here. RKA Insurance Advisors has helped thousands of individuals and families find the best policy by taking an educational approach and reviewing ALL the options available in your area. Getting started is as simple as going to our appointment page. Scheduling a time and day, you would have a few moments and speaking to one of our Licensed Advisors. We are here if it’s even to get a second opinion on your current plan. We look forward to hearing from you!
www.RKAinsuranceadvisors.com
561-806-9913
Robert@RKAinsuranceadvisors.com
Nationwide PPO Health Plans for Truckers
Not everyone knows how the trucking industry plays a vital role in our economy. CDL truck drivers are necessary for not only economic growth but the modern marketplace's ability to exist at all. Often these truckers are overworked and, in reality, not compensated enough for their role in the economy and our day-to-day lives. Without them, our lives do not function and are drastically impacted. Recently, we have seen surging prices for gas, food, and other goods. According to U.S. Bureau of Labor Statistics, this has catapulted U.S. inflation to a 40-year high in June, further pressuring all Americans, especially truckers.
As a result, truckers, in particular, have been one of the occupations hit the hardest. With record fuel prices and an occupation predicated on driving, this is not an ideal situation for truckers. In addition, many truckers are self-employed & contracted, further exacerbating the issue for them as they are responsible for all their costs.
Times like this are when you can start looking at areas to reduce cost—figuring out which areas we can cut to save some extra cash. One of the last areas truckers usually check is how much they are paying in health insurance costs. Once they have coverage, most people don't think to check to see if there are more affordable options. Or, at the very least, get a second opinion to ensure they have the best level of coverage at the most affordable rate and make sure the plan will cover you outside your resident state.
Truck drivers are among the most vulnerable workers in the U.S. labor force. They have one of the highest injury and illness rates for any occupation in America. Unfortunately, they are among the least likely to have health insurance coverage. According to HD Fleet, the average cost of a truck accident with one injured driver is $148,279. The cost can reach up to $7 million when it involves a fatality. Over-the-road and long-haul truck drivers are prone to accidents, leading to severe injuries. As a result, truck drivers end up in emergency rooms. Even using ERs for non-emergency services when it would have been much more cost-efficient for them with online telemedicine or urgent care treated by a Doctor or Nurse Practitioner. According to the U.S. Department of Transportation, long-haulers are more vulnerable to developing severe health conditions due to the nature of their job, making health insurance for truck drivers an essential need. These conditions are hypertension, insomnia, sleep apnea, spinal disorders, headaches and migraines, stress and depression, arthritis, sinus problems, and lung diseases.
The same research report highlights that prevalence of obesity in the average American worker is 31%. In addition, the prevalence of diabetes in truck drivers is 14% compared to 7% of the average American worker. The report shows that 17% of American workers don't have a health insurance plan. On the other hand, over-the-road and long-haul drivers are the most underprivileged regarding health insurance because 38% of drivers lack a proper coverage plan.
Due to the long-haul truck driver experiencing higher health risks, every truck driver needs health insurance. But unfortunately, most drivers don't have insurance to cover their health costs or their families' medical expenses.
This is why it's important for truck drivers, especially long-haul truckers, to secure Nationwide PPO coverage. Most options available on the marketplace exchange, otherwise known as ACA plans or Obamacare plans, are HMO or EPO networks, limiting your coverage area. These plans are terrific because they do accept everyone. Still, again you can be subjected to limited or smaller localized networks. Typically not allowing services to be covered outside of your resident state. That is not a good position to be on for an occupation requiring being out of the state more often than not. Also, being Self-Employed and not having a group health plan through a large employer.
PPO Networks provide nationwide access to doctors, facilities & hospitals. You have the freedom and flexibility to go to any medical provider. It's always best to stay within the provider network, of course. However, if you cannot, you'll still have coverage, which is excellent news for Self-Employed truckers. Health insurance is a considerable expense for truckers. That's why it's crucial to have a Licensed Health Coverage Advisor help navigate these complexities. The various networks and what insurance carriers have more extensive nationwide networks. Which options have unlimited telemedicine if you need a quick prescription filled, you have a 15 min phone or video consultation with a board-certified physician, and it's called into a pharmacy near your travels.
Most people are not aware of the vast amount of private nationwide PPO plans available. Most Self-Employed people prefer these plans as they are nationwide PPO plans and usually have low or no deductible options. Most of the time, extensive Networks like United, Cigna, and PHCS, to name a few.
Now not every single private plan is efficient coverage. So, again, more reason to have one of our Licensed Advisors do this work for you and with you. Frequently, this results in individuals finding comprehensive and quality health coverage that you can take anywhere with you nationwide and saving a couple of extra dollars. Saving people money and getting them in a better position with health coverage is precisely what we pride ourselves on. So reach out today and allow us to help you find the coverage that will not let you down when you need it most at a more affordable rate.
561-806-9913
Robert@RKAinsuranceadvisors.com
www.RKAinsuranceadvisors.com
Self-Employed & Health Coverage. What are my options?
It's an exciting time when we take that leap on our own to go Self-Employed & leave behind working for someone else & your traditional 9-5. There is so much that goes into that exciting decision. One of the most significant decisions is where to turn for health coverage.
Most of the time, we have jobs that pay a large portion of our health coverage costs. Most employers pay 50%, and even some will pay 100%. We put all this effort into getting our business set up, and we put in our two weeks with our soon-to-be old employer & then we get the letter stating the cost of Cobra. At that point, we typically lose the employer contribution and are subject to paying the total cost of the coverage. Most of the time, that number isn't a number we are comfortable looking at, let alone paying!
Going Self-Employed, one of the most challenging areas to navigate is obtaining health coverage, especially if you have a family. Most people go online, start browsing around & enter their information. Next thing you know, you're phone starts to ring non-stop, all while you're trying to get your new business up and running. Various companies, brokers, and agents are calling you. It's a story we are all too familiar with hearing. You see some cheap plans browsing online. Then, a little deeper look & you realize those plans do not provide many benefits at all & have a higher max out-of-pocket & deductibles than what you're used to. You may be lucky enough to be able to stumble across healthcare.gov. Losing the previous employer coverage does open a special enrollment period for you. The issue there is, that predicting the total combined household income for the year before taxes is tricky. Also, underreporting income can lead to being penalized when you file taxes the following year if you received a subsidy. Suppose your annual tax filings exceed what you reported to the marketplace. In that case, you will be responsible for paying back the subsidy amount that was provided. It's not something a new business wants to be faced with.
So, the question remains: what do you do, where do you turn?
That's an area in which RKA Insurance Advisors can help. Access to private medically underwritten plans that are not subjected or tied to your annual income are available. They are what a lot of self-employed individuals do prefer. The reason is, that often these plans will be much more affordable than the offerings of Cobra from your previous employer. Unless receiving a subsidized premium on the marketplace, these options will also be more affordable. These plans will have large nationwide PPO networks, where you are covered nationally. Not just the localized coverage like many of the HMOs found on the marketplace. Being medically underwritten ensures the risk pool is healthier individuals; therefore; as a result, rates and out-of-pocket exposure are usually lower because there is less claim loss. Some of these options are guaranteed renewable to age 65. Some are designed specifically for a more affordable option with many benefits upfront without meeting a deductible. There are also select guaranteed issued private plans not based on medical history. Each person & their situation, needs, and budget are different. When deciding to go self-employed, it's always best you speak with a licensed Health Coverage Advisor.
RKA Insurance Advisors can and will ensure to go through ALL your available options with you. Educating you on the important things when selecting a plan. Such as the different networks, making sure your doctors & facility are within the plan's network, & going over co-pays for services, deductibles, and max-out-of-pocket. All the what-if scenarios that may occur. We specialize & pride ourselves in delivering the best understanding of health coverage. How to get the most out of your coverage and provide the education to determine which plan(s) best suits you in your new endeavor of going self-employed. Reach out to us via Email, call, or text. You can schedule a time and day for an appointment directly on our website.
We look forward to hearing from you!
www.RKAInsuranceadvisors.com
561-806-9913
Robert@RKAInsuranceadvisors.com
Potential Cost Increase in Marketplace Coverage for 13 million Americans.
Every day isn’t a good day in the health insurance industry. With premiums set to raise upwards of 50% for individuals that have coverage through the Marketplace (also known as the ACA, or ObamaCare.) In 2021 Congress signed the “American Rescue Plan” into law on March 2021, which increased the subsidy income cap to receive a subsidized premium. Of the 14.5 Million enrolled in a government, 13 Million receive subsidized premiums. If you are one of the ones who does have coverage through the Marketplace & receive a subsidized premium, expect higher premiums next year. Unless Congress acts quickly, enhanced subsidies you’ve been receiving for the last two years will disappear, affecting roughly 13 million Americans.
Most Enrollees, including self-employed & workers with no job-based health coverage, will be significantly affected. It’s uncertain whether Congress will revive the provision via other legislation that may try to get through before Open-Enrollment.
Here’s a hypothetical example, based on a report from the Congressional Budget Office: A 64-year-old with $58,000 in income — about 430% of the 2022 poverty level of $13,590 — has insurance through the Marketplace. The 8.5% limit currently in place means they would pay no more than $4,950 for premiums this year. However, if faced with a 400% cap on eligibility in 2023 (which it was before the “American Rescue Plan”), that same person would pay $12,900 for premiums annually because they’d no longer qualify for subsidies.
This is precisely what we are here for. The Marketplace isn’t the only way to secure coverage. Private Options, not subjected and based on your income, are available. These options are based on a health risk assessment to determine eligibility. These plans, on avg, are more affordable and provide lower deductibles & out-of-pocket exposure. In addition, Nationwide PPO networks. Even some options are guaranteed renewable till age 65. It’s important to speak to one of our licensed health coverage advisors to determine if you can be eligible for these options. Regardless of your current coverage situation, it’s essential to ensure you are in the best possible position from a coverage & cost standpoint. We are here to help. Reach out today if you are insured through the Marketplace, have general questions, need quotes, and want to compare options. Our team of licensed specialists will be here for you.