2017 Open Enrollment for the Health Insurance Marketplace
November 1st, 2016 to January 31st, 2017
(Apply Before December 15th for a January 1st Effective Date)
PEORIA PHONE # 928-252-2493
Why should you use an independent Arizona Health Agent?
Shopping for Arizona Health Insurance is a difficult task in itself when comparing premiums, deductibles, copays, networks and drug lists. But when you combine it with a very complicated Affordable Care Act law (ACA), involving complex income calculations and the tax code; it becomes overwhelming for many. An independent Arizona Health Agent works with many or all of the government and state approved health insurance carriers. In addition, health agents have access to the easiest application methods, tax credit calculators, software to match your doctors to the networks, and special agent portals with client status updates.
What are the BEST reasons to use an agent?
Health insurance is what I do all day. I specialize in it, and have for 10+ years. I’m licensed, insured, and been an avid student of the ACA health care law since it passed in 2010. My clients get my advice and year round responsive service all year long.
I assist clients with navigating a complicated and not so user friendly government website, and assist with any follow up documentation that might be required by them. I have an incentive that your policies never lapse, and practice best methods to avoid future headaches for both of us. I read a LOT, so you don’t have to. Whether it’s industry articles, carrier webinars, or the constant government updates…………I’m prepared for your questions. Believe me, there is a right way and a wrong way to buy health insurance in today’s complex market, and you only get one chance a year to do it right.
WHO should buy a health plan ON the Marketplace?
Consumers who have low enough income to qualify for financial assistance. If so, you MUST buy your health insurance plan “ON the Marketplace” in order to receive financial assistance (called advanced premium tax credits or APTC). This financial assistance or APTC can lower your monthly health insurance premiums.
Am I eligible for APTC? APTC is determined by your Modified Adjusted Gross Income (MAGI), your household size, and how that relates to the Federal Poverty Level (FPL) guidelines. In Arizona, if you’re between 138% – 400% FPL, then you may be eligible for APTC. If below 138%, then you may be eligible for AHCCCS / Arizona Medicaid. If above 400% FPL, then you are NOT eligible for APTC.
Am I eligible for lower deductible plans? In addition to APTC, if a consumer is between 138% and 250% of FPL, you’re also eligible to buy a Cost Sharing Reduction (CSR) plan with reduced deductibles and out of pocket maximums, but only if you buy a Silver plan.
WHO should buy a health plan OFF the Marketplace?
Many consumers believe the only way to buy health insurance in today’s market, is “ON the Marketplace” through the ACA / “Obamacare” website at healthcare.gov. That is simply not true. What is true, is that it is the only platform to receive financial assistance if you’re eligible.
Many consumers bypass the government website altogether, and buy direct from their insurance carrier of choice for one reason or another. Examples of consumers who seek coverage OFF the Marketplace are:
- Higher Income: Your Modified Adjusted Gross Income (MAGI) is too high (Above 400% FPL) to qualify for any financial assistance with Advanced Premium Tax Credits (APTC).
- Cheaper Alternatives: Many compare full priced ACA plans to what’s being offered by their employer, especially when comparing child only plans and premiums.
- Nationwide PPO Networks: Snowbirds or college students MAY need a plan with a PPO network that covers them in both places. Sometimes, these plans with larger PPO networks are only available OFF the Marketplace.
If any of these describes your situation, you have the option to buy a ACA compliant health insurance plan directly from a carrier with or without an agent during OEP, or if you have a SEP. Of course, it’s always best to call me to assess your situation and suitability for an OFF Marketplace plan. For more information, visit our “OFF the Marketplace” page.
How much is the penalty for not owning ACA compliant health insurance?
If you’re reading this answer, you’re contemplating going uncovered. To see if you are subject to the penalty, here is a link to an ACA penalty calculator. You may be exempt from the penalty if the lowest cost bronze plan on the marketplace is more than 8.16% of your income. You can read more about it here: Affordability Exemption at Healthcare.gov.
If you do not have compliant health insurance in 2016, you will pay the HIGHER of these two amounts:
- 2.5% of your household annual income, OR
- $695 per adult and $347.50 per child under 18 (Adjusted for inflation each year)
What and when is the Open Enrollment Period (OEP)?
An Open Enrollment Period (OEP) for ACA Health Plans occurs once a year, and typically lasts 90 days. It’s the period of time where consumers are free to purchase or move to a new plan, for any reason, from any approved insurance carrier ON or OFF the Marketplace.
The upcoming 2017 plan year OEP is November 1st, 2016 through January 31st, 2017.
If you need a January 1st, 2017 effective date, you need to apply by December 15th.
Am I eligible for a Special Enrollment Period (SEP)?
Outside of Open Enrollment (OEP), you may be eligible for a Special Enrollment Period (SEP) if you have a Qualifying Life Event (QLE). This allows the consumer to buy a health plan outside of the OEP period with effective dates of March through December. Examples of QLE’s include: Loss of group health plan, loss of Cobra or Medicaid, marriage, divorce, birth, or if you move to a different county or state. A full QLE list can be found here at healthcare.gov
What health benefits must all ACA compliant health plans include?
Whether you buy “ON” or “OFF” the Marketplace, all ACA compliant plans include:
- Guarantee Issue – no medical questions (except tobacco), and you cannot be declined.
- Pre-existing Conditions – are covered with no waiting period, but subject to policy benefits.
- Free Preventative Care – before any deductibles and with a $0 copay. A list can be found here.
- The 10 Essential Health Benefits – are based on federal guidelines, and the state benchmark plan.
- Maximum Out of Pocket Limits – adjusts each year, approximately $6850 per person in 2016.
Who should consider combining a supplemental plan with an ACA policy?
Supplemental plans (Gap plans) are used by consumers to “fill the gaps” of the high deductible ACA compliant plans. They are NOT to be used as a substitute, or instead of, a Major Medical ACA compliant health plan. Examples include accident, heart/cancer/stroke or dental plans.
You can find a list of my recommended gap plans and links on the supplemental plans page.
How do I apply for Arizona Medicaid / AHCCCS?
If your income for your household is below 138% of FPL, then you may be eligible for Medicaid / AHCCCS in Arizona under the Medicaid expansion completed in 2014 under the ACA. There are many other reasons or qualifying events that may allow your eligibility. Check for details and apply anytime during the year at Healthcare.gov or directly from the Health E Arizona Plus website.
William A. Steffen
Steffen Financial Inc / President
Arizona Agent License 895997
Arizona Agency License 897198
National Producer Number (NPN) 7939021
20+ Years in the Financial Industry
10+ Years in Health Insurance Business
NAHU Member – Agent Association
William graduated with a B.S. in Business Administration & Finance from California State University of Northridge (CSUN) in 1992. After working at Invesco Funds in various capacities for 7 years, and distributing Janus Funds through Financial Advisors for 5 years; Steffen Financial Inc was launched in 2004. I found my niche in private health insurance and Health Savings Accounts (HSA’s), and allowed my security licenses to expire. The massive health care reform law (PPACA) was passed in 2010, and I found a new purpose for my career.
The launch of ArizonaHealthAgent.com coincides with the inevitable trend of consumers seeking out the professional advice of a licensed career agent, given the complicated nature of the ACA law. The website name conveys exactly what I do for a living….. when you hear it, read it, or see it. My clients can remember it, and it’s easy to refer their family and friends. I enjoy being your Arizona Health Agent.