Navigating the Federal Insurance
Marketplace for 2017 

 

NEXT OPEN ENROLLMENT PERIOD  11/1/17 TO 12/15/17.

     The Affordable Care Act (ACA) requires that you have a 'creditable' health plan at least 10 months out of the year to avoid the tax penalty.  This next Open Enrollment period will be shortened to just 6 weeks to set up coverage for 2018.   I'll be here to help.

SPECIAL ENROLLMENT OPPORTUNITIES FOR 2017:

 

   You can still buy new coverage for 2017 through a "Special Enrollment" if you have a qualifying event such as loss of group coverage (60 day window to apply), loss of Oregon Health Plan (60 day window), moving to a new state, getting married, adopting a child. These are the most common situations.

BROWSE TO SEE WHAT BENEFITS YOU MAY QUALIFY FOR:

   Before you jump in I encourage you to begin by just browsing plans and potential tax credits. The Marketplace has a link to do this at https://www.healthcare.gov/see-plans/ So why is this important?   

   Sometimes just $1000 different in income can be the difference between a large tax credit and no tax credit.  Ask me personally about your situation.

 Broker support comes with no cost to you

    I am only compensated (at no cost to you) by the insurance carriers when you enroll and list me as your agent.  This is much appreciated.   If you are doing the application on your own, near the beginning of the application it asks in small print "Is someone helping you complete this application?" In this box I appreciate your adding  Dan Neils, agent/broker,  and my National Producer number of  757811.  If you forget and want me as your agent, you can later request this via a 'Broker or Record' request to the carrier.   

 

Start your SPECIAL ENROLLMENT APPLICATION for 2017 coverage. 

STEP 1:  Begin by going to http://www.healthcare.gov

 

 GO THROUGH IT ON YOUR OWN OR TOGETHER    

    I encourage you to call me to go through the application together.   If you can be in front of a computer, we can do a screen-share.  I can help you accurately complete the process in 25% the time it would take you to go through it alone.

  Some of you may prefer to go through this on your own for privacy or other reasons.  I totally understand.  However, you are best served if we go through it together to catch potentially costly errors.

SCHEDULE A TIME WITH ME:  If you have internet, we can schedule a 'screen share' appointment where you can see my computer screen and I can do the application for you (with you watching). It's easier than it sounds and I will help you avoid costly errors that they are easy to make.   If you are new to the Marketplace you will be prompted to create a username and password-- Write this down where you can find it again!

If you want to go at it alone, here are some tips:

1.  Family members/Household definition:  
    Your 'Household' includes everyone who will be on your 2017 tax return (not 2016), whether they are applying for coverage or not, living in your home or not.  If your child will not be on your 2017 tax return, you should do a separate application in their own name.    

2.  Projected Income: 

    Your goal here is to project as best your can an estimated 'Modified Adjusted Gross Income' for every person on your tax return, even if they are not applying for coverage.  If your spouse has untaxed Social Security, you need to list this as a source of income as well.  A good guide is to look at the first page of a prior tax return to see what your 'Adjusted Gross Income' was for a past year. This is on line 37 of a 1040 Federal tax form.

      This can be a tricky guesstimate, particularly for the self-insured as you are trying to project income you have not yet earned yet. You are wise to project your income a little higher than you expect. This way when you do your taxes it will not sting as much if you are incorrect in your projection.  Please ask me about this step as it is consequential.

Qualifying for Advanced Tax Credit is based on your Modified
Adjusted Gross Income:
 
 
  (Sweet!....so what's that!)


    "Generally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income and any tax-exempt interest income you may have (these are the amounts on lines 37 and 8b of IRS from 1040). Adjusted Gross Income (AGI, as defined by IRS) + Excluded foreign income. + Tax exempt interest.    I know, how much clearer than that can you get?   For most people your AGI (Line 37 of your tax return) is close to your MAGI.

3. So who gets the Marketplace Tax Credits?  

   Now that's a little complicated to answer, but it's based both on your Family Size (those who will be on your 2017 Tax return as dependents) and your age and income....

What Am I Eligible For Chart.pdf

     In the chart above, for your family size, you can see what income levels qualify you for Oregon Health Plan, Private Coverage with a Tax Credit, or the joy of paying full price.   The chart is just a guide, but you will receive a determination when you apply at www.healthcare.gov.    The good news here is you can earn a lot of money and still get help.   A family of 4 can earn up to $97,000 and still get a tax credit (though that number varies by age).  Self Employed people have different ways to adjust their MAGI lower by 1.  Contributing to an HSA Account  2.  Contributing to a Sep IRA or Traditional IRA, and a few other options.   

Case Study:  John and Sara are 59 and 60 and their MAGI was $70,000, not qualifying for a tax credit.  I showed them how, if they contributed $10,000 into a Traditional IRA, their MAGI would go down to $60,000, thus qualifying them for a $9500 Tax Credit.   Did this advice put $9500 into their pockets?  I think so.  Let's talk about your situation.

4. Submit the application and view your Eligibility Determination:

   After you submit your application or Life Change,  you can view a Marketplace Determination Report.  This will show the benefits you qualify for (if any), and any required documentation that the Marketplace requires, such as evidence supporting your income claim, proof of citizenship, proof of residency, etc. These documents should be uploaded into your account within the first month, but you have some time.  PLEASE let me help you upload these into your account, or guide you to do it yourself.  Avoid mailing in the documents as they are frequently lost or non-processed.

  The consequences of not submitting required documentation can result in your losing your tax credit, or even being terminated from coverage.  The key section to take note of is the 'What Should I Do Next?" Section.  Please ask me if you have questions about this.

What if it says my kids may be eligible for CHIPP, or Medicaid or Oregon Health Plan?    

   If the Marketplace determines your kids are eligible for free coverage, they send your information to the Oregon Health Authority for processing--which can take a few weeks to months.  The number for Oregon Health Plan to verify if your kids are enrolled is 800-318-2596.  The folks at Clackamas County Health can sometimes see the enrollment from their system.  Their number is 503-655-8336.  

  3 WAYS I HELP?   

1.  PHONE:  We can have a phone conversation and I can offer a few tips that may save you a lot of headaches down the road and potentially thousands of dollars.  Call Dan at 503-650-4325.

2.   SCREEN-SHARING APPOINTMENT :   We can talk via phone, and I can share my computer screen if you are in front of a computer or laptop.   I can do the application with you watching, or renew your plan for you.   This will save you 1/2 the time and 95% of the potential errors, which can be costly.   Just go to http://www.join.me and then call me.  I'll give you a code to enter in the box 'join meeting', and we can do screen-sharing.   

3.  IN PERSON:   You can set up an appointment with me to come to my office to do the application if this is boggling and face-to-face is preferred.   Call 503-650-4325 to set up a time.   

 

STEP 2:  SELECT A PLAN FOR 2017

     OK now that you did your application on your own, you would be wise to call me to let me walk you through the plan selection.  It is so complicated and near impossible to adequately understand the plan differences.   Not only are the comparison tools inadequate, but they do not adequately prepare you to understand Networks, Alternative Care differeniations, HSA Plan information, and many other factors you need to know to make an informed decision. 

After you know your tax credit ( or lack of one), you can go onto the enrollment section. There are 86 plans being offered in 2016, likely around 65 plan for 2017.   Here are a few tips prior to picking a plan:

1.   SHOPPING GROUPS: 
 
      Once you start the enrollment process, the first step it asks is if you want to enroll on the same plan/policy, or do you want to be on different policies with different benefits.  The Marketplace calls this option "Shopping Groups".   I often recommend my clients choose different policies to reflect the different healthcare needs their families may have.

      I also am a strong believer in Health Savings Accounts (HSA's).   You can read my HSA page if you want to learn more.

2.   NOTE BOTH THE DEDUCTIBLE AND 'OUT OF POCKET MAXIMUM  ARE PER PERSON, WITH A FAMILY MAXIMUM':  

      When you look at the plans for more than 1 person shopping, note that the individual deductible is 1/2 of what is shown often shows on the Marketplace website.   Ask me about this and I'll explain it better.

3.     READ THE FINE PRINT:   Just looking at the healthcare.gov website plan descriptions, you would never know the Providence Connect plans require you to pick a "Medical Home" clinic go there for Primary Care, then get referrals to see other providers in the Connect Network.  Reason #365 to work with a knowlegeable broker!  Each company and plan has their own little twists that are often missed.   

  You just can't see this when reviewing the plans.  Before you make your final decision, you would be wise to send me an email or call to double check that your understanding of the plan meets reality.  That's why I'm here.  Read from the company brochure the plans limitations and exclusions, so you know what to expect.

     When you pick your plan, then view the final review there is a button that says "Did someone help you select your plan?".  Here I'd appreciate your checking to see if I am still listed as your agent,  Dan Neils,  NPN 757811, even if you did it on your own.  Thank you!  

4.   TAKE YOUR TIME DON'T RUSH:   Health insurance is likely one of your largest bills each month.  Just a second caution to make sure you understand the plans and networks prior to enrolling and locking in your coverage for the year.  It can be very consequential financially.  Keep in mind if you want January 1st as your start date, you have until December 15th to select a plan.

HOW CAN I HELP?  
    With 25% rates increases, more than ever it's wise to get counsel before pulling the trigger on new coverage.   There can be hidden issues you haven't even considered.  In light of this, narrow down to the plan you want, but please run it by me to make sure your understanding of the coverage and provider network is in line with your expectations.  

 

COMMON QUESTIONS AND ANSWERS

 

I've included some  of my own Q and A for common areas people mess up.  I've included other various Q & A on related topics.

Q:   If I'm doing my Marketplace renewal, which Dental plan would you recommend?

A:    I would not purchase coverage through the Marketplace, rather check out my direct-written dental plans on my web page.  Currently the Magnum Dental plan is the best plan I offer.

Q:   If I'm doing a new application for the first time on my own, what general tips do you have?

A:    1.  Write down the Marketplace customer service number, your ID number (your email used, which is your login) and the Password you create.   When listing on the application people in your household, list everyone expected to be a dependent on your 2016 tax return, even those not applying for coverage. It will ask you who is applying for coverage.  When it ask you if you have current insurance, answer no. What they are really asking is whether you will have secondary coverage in addition to what you are applying for.  There is much more but there's are a few tips.

  Q:  My son is 23 and is will do his own taxes for 2016, should I put him on my application if I intend to pay his premiums?

A:   No, to be on your application he has to be a dependent on your tax return.   He is not part of your 'household' for purposes of this process.  To get coverage through the Marketplace he can do his own application.  You can always pay his premium if that's your goal.

Q:   My husband is 66 and on Medicare.   Does he need to be on my application?

A:   Yes!   If you file taxes jointly, your household income includes everyone on your tax return for that year.   When you put him on the application, you say no to when they ask you if he is applying for coverage.   You also need to include his income, including Social Security in your income declaration.   You don't need to income income from SSDI.  

Q:  When adding up our income projection for 2016, should I put down my husband's untaxed Social Security income?   

A:  Yes, the FFM counts untaxed Social Security income in the equation.    

Q:  How about that $10,000 I earned over 3 months, now do I report this?

A.   List the income for each family member on the application, then when asked if it is monthly or other, put down the income as 'Yearly'.  If you're self-employed, the only option is to report your monthly average.  So take what you expect to be your 2016 net profit, and divide by 12.   

Q:   If my kids are already on Healthy Kids, do I list them on my application?

A:  Yes.  You list everyone who will be on your tax return for 2016, and answer, yes, that you are applying for coverage for them.

Q:  Up to what income do my kids qualify for Healthy Kids? 

A:    You can earn up to 300% the Federal Poverty Level chart amount for your family and still qualify for free coverage under the Healthy Kids program, which is essentially Oregon Health Plan.  For your family size, refer to the chart below:

2016_Federal_Poverty_Level_Chart.pdf

 

Q:   If they say I qualify for a $300 tax credit monthly, do I need to take the whole thing every month or can I defer it for later?   

A:   No, you can choose to not take it up front, then get the money at tax time instead.   The purpose of their advancing you the tax credit is to make it more affordable to pay your premium each month.  You can also chose to take a percent of what's being offered, like $200 per month, and get the rest at tax time.  Most people take the whole credit being offered.

Q:   When enrolling, how do I put different family members on different plans?

A:  When you start the Enrollment process, it will allow you to chose 'shopping groups'. Put family members in shopping groups according to the plans they will select, or leave it alone if you want everyone on the same plan/policy.

Q:  When should I put different family members on different policies?

Here's a few common situations:

1.  Let's say daughter Sara is in Colorado in college.  I'd recommend a plan for her that has a strong national network of providers in Colorado.     For other famly members you may choose a different plan.   In this case created a different Shopping Group for daughter.

2.  Let's say Dad wants a Health Savings Eligible (HSA) plan so he can drop the $3350 pre-tax into it, but Mom and kids want to be on a plan with a lower deductible and copays.   In this situation put Dad on a separate shopping group.

3.  Dad want's the HSA Plan, Mom is healthy and wants a high deductible plan, Daughter is an athlete and should have a low deductible plan.    In this situation put all 3 on different shopping groups/policies to meet their deductible.

In these 3 senarios you would never get advise of this nature from online sellers like www.esurance.com, the Marketplace, or direct from a carrier--this is the benefit of working with an experienced broker.

Q:  How do I know if a plan on the Marketplace is HSA Eligible?  

A:  Some will be labeled as HSA-eligible plans, but in addition the Oregon Standard Bronze plans are designed to be HSA compliant by design.    Ask me!   I have an entire tab on HSA Plans to help you better understand them.

Q:  Why would I want to open an HSA Account anyway?

A: I added a whole page on HSA plans, but basically, if you have an HSA eligible plan, you can make all your eligible medical, dental, vision, alternative care, RX, and more expenses a tax-advantaged situation.   The money you contribute to your HSA bank account is an above the line (pre-tax) deduction.  More specifically, you take the deduction on line 25 on the front page of the 1040 tax return.   

Q:  What can your use your HSA funds for?   

A: We can use our HSA account for any out of pocket medical, dental, vision, alternative care, massage, prescription drug, and more.   See my Health Savings Account page for detailed listings

Q:   Why should I list you as my agent if I did the application alone?

A:  Fair question.  Listing Dan Neils, , NPN 757811 is much appreciated as this is how I am compensated.  I present this info (analysis on this website)  to your each year,  I am here to advise you 12 months out of the year, and I'm here to act as your advocate, both with the Marketplace and direct with the Carrier.  My services come at no cost to you.  A single piece of advice I offer you could save you literally thousands per year.   Finally, things will continue to change, and your best source of help when things do is an informed Broker.

Q:   Are all the plans in HealthCare.gov available if you instead buy direct from the carriers?

A:   No.  HealthNet only sells their plans direct with the carrier, not through HealthCare.gov.  Other carriers also have some plans that are only available direct.  For example Life wise plans are only through the Marketplace for 2016, and HealthNet plans are only direct....another reason to have a Broker.

Q:   This complicates things Dan.  Come on man, who created this madness!

A;    Well, things were mad prior to ObamaCare as well.   Declined applications for small things, massive out of pocket maximum benefits, no caps on out of pocket costs, skyrocketing premiums with no assistance.   There is much room for improvement.

Q:    Why shouldn't I instead buy from a cool online web-seller like esurance.com or healthplans.com rather than work with you?

A:    We all offer the same rates, there are no discounts available.   That said, they provide you with the data, but I offer you the wisdom on how to interpret and apply it.  
I am also a local expert, and you will always talk with me, not a call center, CSR, or associate.  

Q:   Why are companies raising their rates so high in 2016?

A:   Tough one.  Many factors.   Probably the largest factor is the very sick whose massive claims sink the profitability of the insurance carriers.   ObamaCare has built in programs to help compensate the carriers for their losses, but Congress refused to fund these mechanisms, instead leaving the carriers to flounder and carry the losses, to the tune of hundreds of millions of dollars (hoping the program fails).  Consequently for 2017 in increasing number of carriers are fleeing the Marketplace.   For a private company to succeed, it must be able to make a profit.

Q:  How do I estimate my 2016 income on the Marketplace application  if I am self-insured?

A:   Super hard!  Face it, self-employed people just don't know what they will earn for certain. But, let's say you project $80,000 adjusted gross income for 2016.  By June 1 I suggest you evaluate how much money you have made to date profit.  Are you at $40,000?    If not, you may want to report a 'Life Change' to the Marketplace.  Basically, this take you back into the application, allow you to update your income expectations, and it changes your tax credit to be inline with our actual income.

Q:  How do I best report a life change?

A:   I have seen so many errors from the Marketplace call center, that I plead with you let me show you how to make changes on your own, or I will do it for you.   If a Call Center representative messes up your account, he/she is not accountable, and it can cost you literally thousands.  Please also do NOT let them do your renewal over the phone.   You cannot see what they are doing, and mistakes are consequential.   

Q:  Last year I signed up, got a nice tax credit, then had it taken away mid year!    What did I do wrong?

A;  Normally, the FFM request income or citizenship documentation, but didn't like what you sent, or just plain lost once or twice the documentation you sent it.   Unfortunately, if they mess up, you pay for it. There will not fix it retroactively, but just moving forward.   This has cost some of my clients thousands of lost dollars.  Please let me know at first sign of trouble so I can offer you some advice.

Q:  November 1st starts Open Enrollment, when do I need to act?   

A:  To get new coverage in place for January 1, you need to be done by December 15.  A December 16 re-enrollment will start your new plan on February 1.   Please don't feel rushed, and don't make a quick decision just to 'get it done'.   You have some time so please start asking questions, but be slower to act when November 1 hits.

Q.    Dan, I know you are crazy busy the Fall during Open Enrollment, will you have time to help me?   

A.   Great question.   Since Cover Oregon and 2 years of Renewals Under the Federal Marketplace, I have made time for each and every one of my clients.  I work tirelessly from early morning to late night, Monday-Saturday.     What could you do to help me?

1.   Email or call to set up a 30-60 renewal time appointment.   My wife Lee sets all of my appointments in the Fall.    For many I meet them face to fac, but I can effectively help most of you through a screen-share appointment.   

2.   If you set up your own Marketplace account, please go to www.healthcare.gov and see if you can login.  If you forgot your password, take steps to re-set it, then test to see if you can log in.  I'd hate 1/2 our time together to be spent just trying to access your account.

3.  Think through what your anticipate your income to be for 2017 for each person on your tax return.   Have this ready when we talk.

Q:  You only list 6 or so plans from each type in your recommendations, how do you narrow the 38 Silver plans down to 6?

A: Good question!  First, I get the new years plan designs and rates in October.   Second, I study all of the plans I represent by type (silver, gold, hsa, etc)  I compare not just the prmiums, but the plan designs, unique features, network differences, and other factors. Then I begin to compare one plan compared with another like in "The Voice", putting them head to head.   I look coldly at the numbers, working to set aside my bias.   Finally, I select the top 5-8 plans from each tier that offer not just the best premium, but doctor network variations to meet all the various needs my clients have.

Q: What do you think about Zoomcare Insurance?

A:  I've seen several companies new to Oregon begin to offer insurance. Their website is flashy. I'd like to see them in business a few years, paying claims before I evaluate them. Fortunately they were not approved for the lowest rates as they had requested. Time will tell how they perform.

Q:   What happened to Lifewise, Oregon's Health Coop and Health Republic?

A.  Lifewise will discontinue plans 12/31/16.  OHCOOP was shut down July 31due to finances, and Health Republic closed 12/31/15 due to finances.  Without reforms this trend is likely to continue.

 Q:   What if my income drops mid year?  Should I report it?

A: Yes, you can report to the Marketplace by reporting a "Life Change".  This will either result in an increase or decrease to your tax credit. Your obligation is to contact the Marketplace if your income changes substantially.   I can help you with this.   Please don't let the Marketplace folks do the LifeChange for you over the phone if you can at all avoid this.  You cannot see what they are doing, and they often make mistakes that can be consequential.   A LifeChange reported by the 15th of the month is effective the 1st of the next month.

Q:  My son is turning 19 and is losing the Healthy Kids free coverage, what do I do?  

A:   When you are notified that he is losing coverage (you have it in writing), we can do a Life Change, sharing that he is 'losing coverage'.  This will provide you the opportunity to re-calculated your tax credit, and pick a plan for him.   

Q:  The Marketplace is requiring I send in proof of my income for 2015.  What should I do?  

A: . If you say you are going to make 50,000 adjusted gross, you need to illustrate clearly how you expect this to happen.   If you show them a pay stub for $6000 per month, they will assume you are going to earn $72,000.  Make it clear HOW you came up with the $50,000 (or whatever your number is).   Many of us have variable income and this can be hard.

No cost to have me as your agent/broker

    If you list me as your agent when you enroll (Dan Neils NPN 757811), I can help you with both the Marketplace and the insurance carrier when issues arise.  I can direct you to the answers when you need them, and each year at renewal I can advise you regarding the plan changes.   My fee is paid direct from the carrier at no cost to you.

      When you begin the Marketplace application there's a small box that asks "Is someone is helping you complete this application'.  Please add me in here,  Dan Neils, NPN  757811 (sorry to duplicate, but easily missed) . Without attaching me I am not compensated to be your agent, and cannot represent you via the Marketplace or Carrier for service and renewal help.  If you miss this box you can add my name when you are finishing up the plan selection.  There's a small box that asks, "Is someone helping you complete this enrollment", at that point you can add my name and NPN number.   

Once we get past January 31, 2016 'Open Enrollment', when can you use the Marketplace to apply for coverage mid-year?  

LOSS OF GROUP COVERAGE:

    If you recently lost group coverage, you have a 60 day window to apply for new coverage.  You can also apply up to 30 days prior to losing group coverage.  Losing Oregon Health Plan or Healthy Kids is also a qualifying event.

OTHER QUALIFYING EVENTS:

     Recent divorce, leaving your parents plan, a move to another state,  and a major change of income are all possible qualifying events.    

WHEN'S THE NEXT OPEN ENROLLMENT PERIOD WHEN EVERYONE CAN CHANGE PLANS?

      The next Open Enrollment is scheduled from November 1, 2016 to January 31, 2017. Why is this date different every year?   Ask the Feds.   All of the new 2017 plan information will be on www.healthcare.gov by November 1.   I will have all the plans studied and compared on this site sometime in October.

 UNDERSTAND THE TERM 'COST SHARING'


    When your income is between 138% - 250% of the Federal Poverty Level, you will benefit by being offered a lower deductible and out of pocket maximum if you select a 'Silver Level' plan.  For instance, the Moda Be Aligned Rose City silver plan, which has a $2500 deductible, may be offered to you with a $250, or $500, or $750, or $1500 deductible.   The moral of the story is to check out the 'Silver' plans before you make your final decision.

UNDERSTAND 'DEDUCTIBLE' AND "OUT OF POCKET MAX" ON THE WEBSITE

      At www.healthcare.gov, when you view a quote for more than one person, the deductible that shows up is actually double the individual deductible--which is the more important consideration.  The website also doubles the out of pocket maximum.    Confusing?   Yep, sure is!    For example when viewing a quote for 2 people, let's say the plan displays as having a $5000 deductible, and $10,000 out of pocket maximum.  You should view this as a plan with a $2500 individual and $5000 out of pocket max.   Make sense?

Call Dan prior to making a final decision on coverage to make sure you're not overlooking something critical.   That's what I'm paid for!

 What are the benefits again of buying through the Federal Marketplace?

PREMIUM HELP/ADVANCED TAX CREDIT 

    You may qualify for premium help each month through the advanced premium tax credit.  This can be a large help, paying up to about 80% of the monthly premium.  You can estimate your Tax Credit right now by going to https://www.healthcare.gov/ and clicking on the green box "See Plans and Prices".

FREE COVERAGE FOR SOME OF YOUR KIDS
    Your kids under age 19 may qualify for free Medical, Dental, and Vision coverage under the State's Healthy Kids program if your income is from 138% to 300% the federal poverty level.  Sometimes when kids are eligible

You can only qualify for this coverage if you apply though the Marketplace each year. To see what that 300% the federal poverty level is, click on the purple link below.

2015_Federal_Poverty_Level_Chart.pdf
 

         A FEW MORE THINGS TO KEEP IN MIND REGARDING COVERAGE CHANGES FOR 2015: (There are too many to list...)

1.  RATES VARY BY PERSON: 
   
  There is a different rate for each family member.  Don't be afraid to put different family members on different plans, according to your usage needs.  There is no advantage to all being on the same plan or company and no cost savings.   Kids over age 19 are priced like adults.  However, if you have more than 3 kids...put them all on the same policy and you save with some carriers.

2.  GUARANTEED TO QUALIFY: 
     
Unlike the past, your approval is guaranteed.   No medical questions, denials, or waits for pre-existing conditions.     You have full access to every plan--approval guaranteed, which is exciting to anyone who has been denied by a carrier before.   

3.  ALTERNATIVE CARE: 
      
Many plans will now allow you to use your Naturopathic doctor as your Primary Care Doctor.  Some plans cover Chiropractic, Vision, and Acupuncturist with a limit (such as 6 annual visits).  Health Republic has the most robust offerings with 25 visits annually (including massage), with all of their plans but the KeyCare line.   Ask me about this and check out the provider directories to see if your providers participate.

4.  MAXIMUM OUT OF POCKET:
     The term "Maximum out of Pocket" is an important term to understand as it includes your deductible, co-insurance (like the 20%), your copays and your RX costs for services performed 'In Network'.    When you reach your out of pocket maximum (in network), the plan pays at 100% for the rest of the year which is great!    Understand your coverage.  Take the time to read the fine print, read the exclusions and limitations.  Try to fight having the 'get it done' mentality.   At such a large cost you should understand what you are buying.

5.  PLANNING A PREGNANCY OR SURGERY:  
     
When you see a big out of pocket coming,  you can select a plan with a low out of pocket maximum. My cart under the link "Individual Medical Plans" show the plans with the lowest out of pocket maximum.    We can discuss which company may best meet your needs.

6.  PROVIDER NETWORKS:
   
On  my " Individual Medical" page you can view full brochures and check to see if your doctor is in network with the various plans.   Different plans have different networks of providers.  This is a big topic as many carriers offer 2-4 different networks.   Just because your doctor takes a certain company, doesn't necessary mean that they are contracted for your particular plan.   Know the networks!   Some of the least expensive plans have very narrow networks of providers.

7. HEATH SAVINGS ACCOUNT-ELIGIBLE MEDICAL PLANS (HSA): 
     
If you select an HSA eligible plan, like the Moda Be Savvy plan, you can open and put money into an HSA account pre-tax.  The HSA Medical plans have high deductibles and are less expensive.   I personally have the Moda Be Savvy HSA plan and add money into an HSA account through Key Bank or Advantis Credit Union.   Likewise will act as their own HSA administrator.   I devote an entire web page to understanding these plans better.  

8.  INSURING YOUR KIDS:

      If your kids qualify for the free Healthy Kids plan through the State, this is essentially the Oregon Health Plan.  If you want you can decline this coverage and buy private coverage for your kids, you most certainly can.   The process is to first call Oregon Health Plan and ask them to disenroll your kids from the plan.   Second, you shop my web page, 'Individual Medical', and you can buy a direct-written plan during Open Enrollment.

I hope you found this page helpful.  These changes sound  like a mess to many, but many folks are gaining better coverage and/or a lower premium than before with the tax subsidies.  I'm here when you need me for a consultation.  Whether you go through the process in your office or mine, feel free to call anytime.    

Please leave a message or email me at danneils@gmail.com if we miss when you call.

Best regards,   

Dan Neils 503-650-4325

Healthy Kids overview

Click filename below to access file

2015-6_Guide_to_OHP_and_HealthyKids.pdf

Federal Poverty Level Chart

Click filename below to access file

Poverty_Chart_2017.pdf