Tag Archives: taxes

Medicare Basics Without an App

Vantage Point: There’s Not an App for That – But We Can Help!

Personal fitness trackers—like the Fitbit® or Jawbone®—are popular devices to help you keep your New Year’s resolutions and stay fit all year long. The fitness tracker collects data and sends it to a phone app that tracks physical activity, calorie intake, and sleep quality. Wouldn’t it be cool if the device included an insurance tab to help people navigate their Medicare benefits, too?

Could you imagine how you’d feel slipping on the device if it said,
• “You have adequate coverage for your current health.”
• “Your doctor is in-network, and the out-of-pocket cost for your upcoming appointment is $10.”
• “Warning, you are nearing the prescription coverage gap.”

Until that technology comes along, Health Alliance Medicare can help explain Medicare basics. Most people paid for Medicare Part A through their payroll taxes while they were working, so they don’t pay a premium now. Part A covers inpatient hospital procedures, but not the doctor who does the procedure.

Medicare Part B covers the doctor and requires a monthly premium. Both A and B have deductibles (what you pay before your coverage kicks in) and coinsurance (a percentage of total cost that you pay). Figuring out coinsurance is tricky because it’s hard to plan what the overall doctor visit or hospital cost will be.

Medicare Part D is for prescription drug coverage. If you don’t choose Part D when you become eligible for Medicare, you could pay a penalty, called the Late Enrollment Penalty, if you add it later. If you pay a lot for your medicine, it’s important to read your monthly Explanation of Benefits to see if and when you’ll fall into the coverage gap.

Medicare Advantage plans, like Health Alliance Medicare, are called Part C and cover every benefit of Original Medicare and more, plus you can add prescription drug coverage. Medicare Advantage plans can be an easy transition for those turning 65 because they look a lot like employer insurance plans.

Until someone invents a Medicare app, consider Health Alliance Medicare your source for information. Helping people get started with the right information to avoid common and costly pitfalls later is the best part of our jobs.

Affordable Care

Crunching Numbers for You

The Affordable Care Act is here to make health care affordable! Let’s run through some facts about the kinds of help you can get paying for your Health Alliance individual insurance plan, called premium tax credits and cost-sharing subsidies.

What’s a premium tax credit?

A premium is what you pay monthly to have insurance. A premium tax credit lowers your cost to make a plan affordable for you.

What is a cost-sharing subsidy?

A cost-sharing subsidy makes other health insurance costs affordable, like your deductible, coinsurance, and out-of-pocket max.

Who qualifies for help?

There’s a little math involved here. First, you need to know your individual or family income. If your income falls between 100% and 400% of the federal poverty level, you can get help from the government.

You can get government help if you’re…
An individual with a gross income* of $12,000-$46,000 a year
A family of four with a gross income of $24,000-$94,000 a year

*Gross income is everything you make in a year, before any taxes or deductions.

What’s the federal poverty level?

The federal poverty level depends on your family’s size. In 2013, it was $11,490 for a single adult and $23,550 for a family of four. You can make up to 4 times that amount and still get help!

How much help will I get?

Again, there’s a little math involved. A few tools online will do the math for you, or a Health Alliance rep can help find your subsidy amount. Call or stop by our Champaign location at 206 W. Anthony Drive, near Alexander’s Steakhouse—we’ll crunch the numbers for you.

How do I apply this help to my bill?

The only thing you have to do is pick a plan from the Public Marketplace. Any public plan will let you apply for government help. The government deals directly with us after you enroll to apply its help to your bill.

What can I do if I don’t qualify for help, but I still don’t have a lot of money? 

  1. Think about your individual risk. Your individual risk is the plan’s medical deductible added to the out-of-pocket max. This is the most you’ll have to pay (besides the monthly premium,) before a plan will cover 100% of your costs. What are you OK with paying if the worst were to happen?
  2. Pay attention to a plan’s deductible and out-of-pocket max. The higher your deductible and out-of-pocket max, the lower your monthly premium. Keep in mind that if you get sick or hurt, you will have to pay for all your medical costs until you meet your plan’s deductible.
  3. Call or stop by. It’s not a sign of weakness. It’s smart. When you need medical advice, you call the doctor. When you need health insurance insight, you talk to our helpful reps.
Don't Miss Your Deadline!

The End is Near: March 31, 2014

NPHIt’s crunch time, and tomorrow may be too late. We know you understand the definition of a deadline, but what happens if you miss March 31? In short, nothing good!

Let’s run through a few questions you might have about what this deadline really means and why waiting might mean less money in your bank account.

What happens if I don’t enroll in a plan by March 31?

After the deadline, an individual can no longer enroll in a plan. You’d have to:

  • Wait until the next Open Enrollment Period (in Fall 2015)
  • Qualify for a Special Enrollment Period (for example, marriage or the birth of a child).

On top of that, you have to pay a tax penalty. And that doesn’t mean you’re covered, you’ll still have to pay 100% of your medical costs!

If I wait until the end of March to enroll, will I have to pay the tax penalty? I’ve heard if my gap in coverage is more than 3 months, I still have to pay.

As long as you’ve completed the application process by March 31, an exemption will keep you from having to pay a penalty on your 2015 tax returns.If you want to learn more about this exemption, visit the CMS’s Enrollment Period FAQ.

Does enrolling in a Short-Term plan save me from the tax penalty?

No. Individuals on short-term plans will pay the penalty on their 2015 tax return (unless they meet an exemption).

Can I change my plan after March 31?

No. You’ll have to wait until the 2015 Open Enrollment Period to make changes to your plan.

The only exception to this rule is adding a newborn. You have about a month to add your new little bundle of joy to your plan.

You can cancel your plan at any time, but depending how long you go without coverage, you may have to pay a penalty.

How will the government really know whether I have insurance?

Great question. When you submit your federal taxes in 2015, the forms will have a new question about health insurance coverage. Health insurance companies, like Health Alliance, will also have to send the IRS info about who has a coverage with us.

You still have time to enroll in a plan.  And we’re here to help you find one that fits your needs (yes, even if it’s in the last 10 minutes!)

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