Crystal: Anyway, I hope you all got some papers I put in front of you. First of all, my name is Crystal Budd from Health Plans for Less and I’m here to talk to you, this morning, about health insurance and in particular, Obama Care which is the new Affordable Care Act. And you should have one of our little pamphlets that shows a lady with a headache. So, maybe you’ve been one of these people or maybe you’ve been one of the lucky few that haven’t had any headaches because maybe you have a group plan and you haven’t had to make any changes yet. So, there is lot of questions, a lot of confusion going on in the market place today. So, what I’m going to do this morning is, hopefully, take you through some of these questions. Maybe I’ll help answer some of the questions that you may have and eliminate some of the confusion and if I don’t do that this morning, of course I’m always available at a later time to help you answer the questions that you may have.
Today, mostly, what I’m going to talk about is how it affects individuals, not small group or large group. That’s a very different animal, I call it. There is different regulations that you need to follow. So, if you’ve questions regards to small group and large group, we do that as well. I also do Medicare for seniors or disabled people under the age of 65. So that’s what I am going to, I’m going to let you know those are the things that I can assist you with if you’ve questions. But today, I’m going to focus primarily on the individual plans that people have today.
So, when is open enrollment? It used to be October 15th. That has been moved back to November 15th and it’ll be, or go through to February 15th. So you have 90 days to get enrolled in a plan. If you choose not to enroll in a plan in that time, you will not be able to enroll in a plan for the rest of next year, 2015. It used to be, you could enroll whenever you wanted, no longer can you do that. You must enroll during open enrollment if you want an individual plan. Now there is exceptions, we have plans that are non-compliant plans that we can sell you that are temporary but you’ve to qualify for those on your own health. So, that doesn’t work for everybody.
So, if you want, if you start a new business, yes, you can start up a group plan at any time during the year but the thing about the business, you no longer can be a mom and pop business. You have to have at least one common-law employee meaning not family. So these mom and pop groups can be no longer. So, if you don’t have an employee, they’re going to be phasing out all these small groups that don’t have an employee that are not family, okay? So that’s something really important to remember.
Now, can I keep my doctors and hospitals? Well that’s a very confusing question right now. The doctors don’t even know if they’re in the plans. It is true. A great example is a [inaudible 00:03:10] can’t find a pain management center. Took me half an hour of going through website information isn’t all is accurate. Doctors don’t even know if they are parts of these plans. It is so confusing out there. So, it takes time and he was lucky that I was able to assist him. I can go to my resources and I can’t even tell you if they’re 100% accurate and that’s frustrating, as a broker. I’m sorry for what’s happening in the industry and I hope it’s going to get better, we can only hope.
For example, Hope hospitals, you think Blue Cross has always had Hope hospital. Hope hospital is not really a Blue Cross provider on these new plans. They’re tier two provider. What does that mean? That means, tier two provider means you can only go there if your doctor, originally, was a provider for that hospital. You will pay more in your co-insurance… Oh, somebody is upset. You will pay more in your co insurance and so, if you end up in hope, you’re max out of pocket will be the same, 63, 50 on a lot of these plans but you will pay more on your co insurance.
So, it’s very confusing to everybody how they are doing this. Blue Shield was not a provider for Hogen till March of this year. So people bought different plans based upon the information that was available in January and February and then it changed again. So, there is lot of class action law suits with these different companies because of the confusion. So, I can only hope that things will improve for everybody this next go around. So, if you have a doctor that you want to keep or hospital, please don’t sign up on your own. You need to get assistance, you need to make sure what you want is what you can get and if not, you are going to know what you’re going to have to choose from because it is not the same playing field that we had before. It is very different environment.
If I have a pre-existing health problem, can I be turned down? This is one of the benefits of Obama Care. No, you cannot be turned down. Everybody is enroll able. You don’t have to jump through any hoops, you apply within the open enrollment period and you’ll be covered. That in itself is one of the reasons why Obama Care came about, is for those people who could not get coverage, okay?
So, now, how much will my insurance cost? Well, it depends on the family size and their ages. There is now every individual is looked at separately. There is no longer a family rate like for children, you have up to three children that are under the age of 19, you’ll pay for the first three. You have five children, you pay for three. If you have children that are aging 19 and over, now you pay the separate adult rate for them. I had a family’s premium that was $1100, it went to $2600, why? Because they have family of seven. Several of those children were 19, 21, 23, wow. That was very difficult to hear when they came to me and said, “Are you kidding me? I now have to pay $2700 for less insurance coverage.” So it is not the same as it was. It’s never going to be the same as it was. So we have to learn to live with it. It’s important to have somebody that can help you navigate through this.
It’s more confusing than ever. They say it was going to be simpler, it is not simpler. So anyway, cost is an issue however, what is the benefit if you can qualify? How do I qualify for a subsidy? Each person, if you make under 40, about $46,000 for one person, you’ll qualify for a subsidy under Covered California. If you make less than $62,000 for two people, you’ll qualify for subsidy. For three people, it’s $98,000, four people, about $95,000. Those are the cut offs. If you make less, you’ll get a higher subsidy. If you make more, you’ll get a smaller subsidy. You make over that, you get no subsidy. That’s how that works.
How does filing taxes affect my subsidy? You must file your taxes on time, April 15th, cannot stress this. If you are a business owner and you say, “I’ll file an extension” or you are trying to get a subsidy, it’ll be taken from you. They cannot base the subsidy if they don’t have the information. You must file your taxes on time. So that’s really, really important. If you’re married, you must file jointly or you will not get a subsidy. I’ve people say, “Oh, we file separately.” Well, you don’t get a subsidy if you do that. What is required to prove my income? We have to upload documents like California driver’s licenses, tax returns, pay stubs, check in account information, they get very personal with your, if you want a subsidy, they’re going to check you out with every piece of financial information that they need to say, “Yes, you qualify.” That I’ll guarantee.
What happens if my income changes? You must report it within 30 days. If it’s over 10%, then if you do not then they’ll be able to take part of that subsidy when you file your taxes. You wait until April 15th, this next year, people are going to be screaming because they make more than what they stated, if they did not state it correctly, and they got an $800 subsidy and now they are going to take back $500 a month of that and they are going to have to pay that back. So, you need to monitor your income. It is your responsibility as an individual that you must update that every 30 days. You can make more than 10% of what you stated on the application.
Will I pay a penalty if I do not enroll in a health plan? You bet. You are going to pay 1% of your adjusted gross income if you did not enroll this year. Next year, it’s going up to 2%, the year after, 2 1/2 percent. Why are they doing that? They want you enrolled in a health plan. Eventually, the penalty will be more than what the cost of the insurance will be, that’s the goal. Everybody needs to pull on the same rope if this plan is going to work.
Will I pay more if I use Crystal Budd as my broker? No. You will not pay any more to use my services. The insurance company pays me a small commission to handle and bring the business to them. It doesn’t come out of your money, it does not make your rate higher. You just get my services and my expertise if you want to take advantage of that. Why would I choose Crystal Budd as my health insurance broker? One of them is to alleviate the headache. I know another example is Jean Tegenson wanted to do it on his own. He went on to the website. There is questions there that are worded that are little bit confusing and he would have been denied.
I looked at it and I was like, exactly, he got denied. I went in, looked at everything, made the changes that were absolutely necessary, saw the problems because I know where they exist. I know where the problems are, what to look for. Made the changes, there was probably six or seven changes I needed to make and he was able to get, I got him applied, I got the rate, the subsidy, got the enrollment number, all within just a couple of hours. I was able to resolve everything for them and he’d been trying for weeks to do.
I had another one of Mark [inaudible 00:10:39] employees. She tried to do it herself. By the time she called me, she was in a rage. She was so angry, “I can’t do this. They can’t get anybody to call me back and no body helps me.” And I said, “Okay. Let me take care of it for you.” Got it done in about an hour, everything was done. And she just said, “Thank you, thank you. I am going to kill myself.” So, on that note, please, there is going to be, again, a lot of confusion and there is probably going to be more changes to come.
My responsibility is, I’m doing my continuing education to continually find out what’s happening with the changes. I’m here to help you and assist your friends and your families. Please don’t let them do this by themselves, doesn’t cost them anything. They’ll be your best buddy forever. If they do it in their [inaudible 00:11:25] here, have them call me, okay? And it is my pleasure to help you. This is what I do. I can’t say I love what I do right now but it is what I do and, again, I want to be supporting the health [inaudible 00:11:37] I can.
Any questions? Yes?
Pat: I signed up last year in the Obama Care program, the [inaudible 00:11:45]. But the thing is, we filed an extension for our taxes, so we’re not going to get our subsidy?
Crystal: You could be in trouble, yeah. You could be in trouble, yeah. So all I suggest to you Pat, is you need to get on that immediately because the law says you must file your taxes on time in order to qualify. So that was for last year, so if you didn’t file, you need to get on it and I told people, you have a little wiggle room that there is not much and it may be too late for you, I don’t know. Okay, I got to go. Anyway, thank you.