HEALTH INSURANCE / COBRA

This is where the consumer purchases the health plan directly from the insurance carrier’s website or broker portal. It is always a good idea to utilize the professional advice of a licensed broker as this is an easy insurance product to get wrong. Brokers serve as a valuable resource that can help a consumer navigate and understand doctors and hospital networks and the definitions and mechanics of your policy. Since health insurance prices are fixed by law it only makes sense to get free advice on such a complicated product. If someday insurance companies stop paying commissions then we may see a broker consulting fee come into play.

The nice thing about buying “off exchange” is that the consumer maintains a direct connection and ability to work directly with the insurance company on things like billing and claims. There is no “Obamacare representative” that you must deal on behalf of the insurance company. The other nice aspect is that there is no burden of proof on the consumer for things like proof of income or wages. The only negative is the fact that those who qualify for a financial subsidy will not be able to receive the government assistance unless they purchase their plan via the “Obamacare” website, HealthCare.gov.

When we use the term “On Exchange” we are referring to purchasing your plan through the federal website HealthCare.gov aka known as “Obamacare.” For our clients, the only reason that people should purchase through this site is if we determine that the client is eligible for a sizeable subsidy. We do not want to go through all the headaches and risks for audit that are attached to this process for a few dollars per month. We recommend that unless your subsidized premium is fairly substantial, and you are willing to provide lengthy documentation, that you consider not going “On Exchange” and purchase your plan “Off Exchange.” If that is not an option, then we will help navigate the consumer through the process and help them choose the best plan for their needs. The benefits of the subsidized plans can be the reduction of monthly premiums as well as reduced copays, deductibles also known as “Cost Sharing.”

Cost sharing only works on Silver level plans and the consumer needs to understand that a Silver level plan can often have benefits as good, or better benefits than a gold or even platinum level plan. The formula for determining a subsidy is a moving target determined by the amount and age of the people being insured relative to their household family income compared to the Federal Poverty Limit. This is a floating number and is determined each year and based off the second lowest cost silver plan available in the local market. Bottom line is you want a FFM Certified licensed agent to guide you through this. All our agents at Phoenix Health and Life Insurance are experience in this field.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end. COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice. Contact URA Group AZ to discuss your specific situation further and compare COBRA options vs potential open market solutions. Many times insurance is available through the open market for a lower cost.