How Health Reform will Affect You

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If you have no health insurance coverage: Insurance companies are no longer able to deny insurance coverage to anyone based on health status. On 11/15/2014 through 12/15/2014 you will be able to start shopping and applying for coverage that will begin on 1/1/2015. In the state of Texas you will have options on the federal and private markets. If you make between 133% and 400% of the federal poverty level, you will qualify to receive a subsidy to help pay for your insurance. You will report your income on your application for health insurance and your subsidy will depend on the financial information you report. The subsidy will be paid to the insurance company and you will pay your share of the premium to the insurance company. If your income changes throughout the year you could possibly owe money to the government when you file taxes. Also, if you qualify to receive the subsidy, you will only be able to sign up on a plan through the federal exchange. You cannot receive a subsidy if you are enrolled in a plan through the private market or on an employer's plan.

If you wait until between 12/16/2014 and 2/15/2015 to sign up, your effective date will be based on the date you submit your application. Applications that are finalized between the 1st and 15th of the month will have an effective date of the first of the following month and applications that are finalized between the 16th and the end of the month will have an effective date of the first of the second following month.

If you have an individual health insurance plan for yourself or your family: If you are on a plan that started after 3/23/2010, depending on the insurance company you are with, you may be able to keep your plan as it is through December 2015. You would then go on a new plan that meets the new requirements effective 1/1/2016.

If you enrolled in a new plan that began January 1, 2014, you will be able to either keep your current plan without doing anything or you can use the Open Enrollment period to shop for other plans.

If your plan falls in one of these two categories, you will be receiving more in-depth information about your options as we get closer to November.

If you have coverage through your or your spouse's employer: If your employer has under 50 employees they will not be required to offer health coverage to their employees. If they have over 50 employees, they will eventually be required to offer health coverage. If your employer's plan is not affordable to you, you will have the option to purchase insurance through the federal or private exchange in the state of Texas. If your employer offers coverage, they will be required to provide you with a "Summary of Benefits and Coverage" that will outline in easy to understand terms the benefits of your plan. You can use this document to easily compare your employer plan with the plans in the marketplace.

As with other categories, if you make between 133% and 400% of the federal poverty level, you will qualify for a subsidy. However, if your employer offers coverage that meets the new legal standards for 2014, the subsidy may not be available to you.

If you are enrolled in Medicare: As far as what information has been released, it doesn't look like Medicare beneficiaries will see any major changes in 2015 besides slight changes in the Part A and Part B deductibles as happens every January 1. In most cases you will not need to do anything to keep your current coverage. If you are on a Supplement policy you will have the same basic coverage you have now. If you have a Part D (prescription) plan, coverage in the donut hole will change slightly, with more medications covered at a slightly higher percentage. This percentage is said to continue to increase every year until 2020 when the donut hole is supposed to be closed completely. If you know you want to change your Part D policy or shop for other prescription coverage, the Open Enrollment period will still be October 15th through December 7th.

For everyone: For those under age 65 and not on Medicare, the Open Enrollment period will be the same for everyone, whether you are on a plan through your employer or on your own. In 2014, Open Enrollment spans from 11/15/2014 through 2/15/2015.

In most cases you will be able to quote health insurance similarly to how you do now. Our website includes quotes for both the federal and private insurance marketplaces, however we have to go through the federal government's website to get a subsidy determination.

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