Sign UpYes!  Open enrollment for 2015 health insurance runs until February 15, 2015.

This means you can purchase a new individual or family health insurance plan — for any reason — until that date.

Once open enrollment ends, however, you will not be able to purchase 2015 individual or family coverage unless you have a qualifying event.

Effective Dates for 2015 Health Insurance

The date your 2015 coverage is effective depends upon the date you enroll:

If you enroll between … Your coverage will begin …
December 16, 2014 – January 15, 2015 (deadline passed)
February 1, 2015 (deadline passed)
January 16, 2015 – February 15, 2015 March 1, 2015

Can I Switch Plans During Open Enrollment?

Yes!  If you are currently insured, but would like to change your plan, you may do so for any reason during open enrollment.  Keep in mind the effective dates shown above, and make sure you time the cancellation of your old plan so you don’t have a gap in coverage.

Deductible Will Reset

But there is an important caveat to switching plans between now and February 15.

All Affordable Care Act-compliant individual or family health insurance plans (vs. employer-sponsored coverage) run on a calendar year basis: from January 1 to December 31.

If you are currently covered by a plan and switch to a new one effective February 1 or March 1, your deductible will reset when you enroll in new coverage.  Any medical bills you incurred before switching plans will not count toward your new plan’s deductible.

Consider All Options

If you are thinking of changing plans, make sure you consider all options.  Also be sure you are aware of how a plan change will affect you.

If you are eligible for a subsidy, you can review your options here:  www.enrollvirginianow.com.

If you are not eligible for a subsidy, you can get instant quotes here:  www.vamedicalplans.com.

We are available to discuss your situation and look forward to helping you determine the best course of action.  Please call our office 703-707-8270 or 1-888-396-2341.

 

Holding handsPrior to 2014 and the implementation of the Affordable Care Act (ACA), if you are lesbian, gay, bisexual, or transgender (LGBT), you may have found it difficult to access affordable and comprehensive health insurance.  You may have even been denied coverage altogether due to a pre-existing medical condition.

But did you know that the new law establishes significant protections for LGBT individuals, making health insurance more accessible than ever before?  The  Affordable Care Act …

Prohibits Discrimination Based on Sexual Orientation or Gender Identity.  You cannot be discriminated against by the marketplace, health insurance companies, health plans, agents and navigators, and any health plan or organization (hospital, doctor, clinic, etc.) that receives federal funding.

Eliminates Pre-Existing Conditions.  Under the ACA, all health plans are guaranteed issue.  This means you cannot be denied health insurance for any reason — including pre-existing medical conditions like HIV, mental or behavioral health conditions, diagnosis of gender identity disorder/gender dysphoria.

Prohibits Charging Higher Premiums for Pre-Existing Conditions.  You cannot be charged a higher premium based on your health status.

Provides Income-Based Financial Assistance.  If you meet certain income requirements, the government will give you a premium subsidy to help you pay for coverage.

Grants Rights to Legally Married Same-Sex Spouses.  If you were married in a state where same-sex marriage is legal, AND you file a joint federal tax return, you can apply jointly for a subsidy through the marketplace.  This is true no matter where you live today.

Offers Family or Spousal Coverage to Legally Married Same-Sex Spouses.  Starting January 1, 2015, if an insurance plan offers family or spousal coverage in the first place, it must offer that coverage to all married couples — regardless of sexual orientation — as long as you were married in a state or country where same-sex marriage is legal.  This is true no matter where you live today, where the insurance company is located, and where the plan is sold.

Requires Coverage for Care Related to Gender Transition for Transgender People. Any care that is covered on the plan must be covered for you if you are transgender.  For example, things like hormone replacement therapy, mental health counseling, and gender-specific care (e.g., mammograms, Pap tests, prostate exams) must be covered for ALL policyholders, regardless of gender identity or gender expression.  The same holds true for surgeries like hysterectomy or mastectomy — if it’s covered under the plan, then it’s covered for you if you are transgender.

Requires Coverage for Essential Health Benefits. This coverage — including prescriptions, mental health services, preventive services, etc. — must be offered to all policyholders.

Guarantees a Review Process for Any Claim that is Denied.  Both an internal and external review process will allow you to appeal any decision.

Protects the Privacy of Your Sensitive Information.  The ACA, along with the Health Information Portability and Accountability Act (HIPAA), protects you from improper disclosure of your medical or other sensitive information without your consent.

Things to Consider if You Are LGBT

When looking for health insurance, here are a few tips:

Be sure you fully understand the terms of coverage included with any plan you are considering.  Be aware of any exclusions that may impact you, particularly if you are transgender.  Be aware of phrases like “services related to sex change” or “sex reassignment surgery” or “gender change,” “transexualism,” “gender identity disorder,” or “gender identity dysphoria.”  These are red flags and may be unlawful discrimination.  If you are already enrolled in a plan, you have the right to appeal any denial of a claim.

Be sure you fully understand a plan’s drug formulary.  Be sure any medications you take on a regular basis are covered under your plan.

Be sure your preferred doctor or other medical provider is included in your plan’s network.  The Gay and Lesbian Medical Association (GLMA) can be a resource for finding LGBT-friendly providers.

When applying for coverage on the marketplace, when it asks if you are married, as long as you are legally married, and you and your spouse plan to file a joint tax return, select “yes”.

When applying for coverage — either through the marketplace or directly with a carrier — use the name and sex that is on the majority of your ID documents such as your driver’s license or Social Security card.

Virginia Medical Plans Can Help

If you live in Virginia, Maryland, or the District of Columbia, we can help you find the best coverage to meet your needs.

Please call our office at 703-707-8270 to speak with someone today!

But please keep in mind, open enrollment for 2015 plans ends on February 15, 2015.  After that date, you can only secure 2015 coverage if you have a qualifying event.

Gavel and stethescopeIf you live in Virginia, an upcoming Supreme Court decision may have you wondering if your health insurance subsidy is in jeopardy.

Last year several lawsuits were brought against the government challenging the authority of the IRS to distribute health insurance subsidies to people who buy their coverage on the federal exchange (aka healthcare.gov).  The issue was whether or not the language in the Affordable Care Act — which refers specifically to state-run exchanges — allows subsidies for plans purchased through the federal exchange.

(Note: Virginia is one of 36 states which did not set up its own exchange and instead relies upon the federal exchange.)

In one case, Halbig v. Burwell, the court ruled the IRS does NOT have the authority.  However, in King v. Burwell (coincidentally decided the very same day), a Virginia court ruled the IRS DOES have the authority.  No action was taken at the time, but all eyes were on the U.S. Supreme Court to see if it would eventually weigh in.

Not surprisingly, the Supreme Court did agree to hear King v. Burwell, and will do so this March.  A ruling is expected in July, 2015.

Significance of King v. Burwell

This case is significant mainly because of the attention it is drawing, both from lawmakers and residents of states that, like Virginia, use the federal exchange.

Understandably, consumers are worried about what will happen if the Supreme Court nixes subsidies in these 36 states.  Will millions of Americans owe back the subsidies they already collected?  Will their “affordable” health insurance suddenly become unaffordable?

Most legal experts agree Congress did not intend to disallow subsidies for plans bought on the federal exchange, and that this amounts to nothing more than an ambiguity in the law’s language.  In fact, the IRS determined it could resolve the ambiguity by declaring that anyone whose income qualifies them for a subsidy — regardless of how they signed up for their coverage — would get a subsidy.

So has this become a political battle over the law itself?  Most assuredly.

Do we believe there is cause for concern among consumers?  Most assuredly not.

Here’s why:

As of today, nothing has changed.  If your income qualifies you for a subsidy, you will get a subsidy.  Period.

As far as owing back any subsidy you have already received, everything we’ve read indicates that if the Supreme Court does rule against subsidies through the federal marketplace, the ruling will not be applied retroactively.  That’s because the Internal Revenue Code itself gives discretion to the Treasury Secretary as to whether or not to apply court decisions retroactively.  Would any sitting Treasury Secretary do that?  Highly unlikely.

Business as Usual for Virginia Residents

So as we first wrote when Halbig v. Burwell was decided last year, it is business as usual at Virginia Medical Plans.  If you live in Virginia, we encourage you to pursue a subsidy for your health insurance if your income allows it.

If you are curious as to how much your subsidy may be and what type of coverage is available, please visit www.enrollvirginianow.com.

By simply entering your zip code and a few other pieces of information, you will get a quick quote on several available plans.  You can also actually enroll in coverage through the site in less than 15 minutes for an average family.  Here’s how:

Virginia Medical Plans Can Help

Choosing health insurance can be complicated.  But we can help — at no extra cost to you.

Call our office at 703-707-8270 to go over your options.

Don’t delay!  Open enrollment for 2015 plans ends on February 15.

If you enroll between … Your coverage will begin …
December 16, 2014 – January 15, 2015 February 1, 2015
January 16, 2015 – February 15, 2015 March 1, 2015

 

Tax Time AheadHave you started thinking about filing your 2014 taxes?

April 15 may be a few months away, but this year — the first year the Affordable Care Act (ACA) is in effect —  filing taxes will be more complicated for millions of Americans.

That’s because certain provisions of the new law — namely, penalties and subsidies — will be reconciled at tax time.

If you got health insurance through your employer and were covered for all of 2014, filing your taxes will be not much different than in years past; you will simply check a box indicating you were covered.

But for those who either went without coverage for all or part of 2014, or those who collected a subsidy to help buy coverage on the exchange, things may get tricky, with new forms to fill out and new calculations to make.

If You Were Uninsured for All or Part of 2014

The individual mandate provision of the ACA requires most Americans to have health insurance starting January 1, 2014.

If you went for more than 3 consecutive months during 2014 without health insurance, you will be assessed a penalty unless you are exempt from the individual mandate — and can prove it.

The IRS will deduct the penalty you owe from any tax refund you may be due.  And if you aren’t expecting a refund, don’t think you’re in the clear.  You will be assessed interest if you don’t pay the penalty on time.  Furthermore, the IRS can deduct any amount you owe from future refunds for up to 10 years!

Planning tip: Avoid a penalty for 2015 by purchasing 2015 health insurance during open enrollment until 2/15/15.  To get an instant quote click here for plans without a subsidy; click here for plans with a subsidy.

Claiming an exemption can get tricky because, depending on the reason, you may need to actually apply for the exemption — either in advance through the health insurance exchange or on your tax return.  Click here to learn more about the exemptions available and how to apply for each one.

Planning tip: Be sure to allow yourself enough time when applying for an exemption. Some require a few weeks to process and involve waiting for an exemption certification number to enter on your tax return.

If You Bought Subsidized Health Insurance on the Exchange

If you collected a subsidy in 2014 to help pay for your health insurance, you may be surprised to learn that the IRS will reconcile the amount of subsidy you collected with the amount you should have gotten based on your actual 2014 income.  Remember, if you collected a subsidy in advance, the amount you received in 2014 was based on your anticipated income for the year.

If your actual income ended up being higher than anticipated, you could owe money back.  Conversely of course, if your income was below what you anticipated, you may get a refund.

Also, any changes in life circumstances — divorce, marriage, job status change, etc. — can also have an impact on your subsidy amount.

Planning tip: You may be able to reduce your 2014 income enough to qualify for the subsidy you collected by, for example, contributing money to a retirement account. Contributions for 2014 can be made through April 15, 2015. Consult a tax professional for details.

Plan Ahead!

Industry experts predict the IRS will be inundated with calls from taxpayers and tax preparers sorting through new reporting rules and regulations.  The IRS itself has said it is unlikely to be adequately prepared to answer the volume of calls it receives.

Just another reason to get ahead of the curve and start looking at things now.

If you need more information about your options, or need to purchase 2015 health insurance, please contact our office by phone:  1-888-396-2341 or 703-707-8270.

Open enrollment runs through February 15, 2015.  You can view your options for 2015 health insurance:

  • Click here if you may be eligible for a subsidy in 2015.
  • Click here if you will not be eligible for a subsidy in 2015.