Round 1: Signing up for TrumpCare

Round 1: Signing up for TrumpCare
Eileen St. Pierre, The Everyday Financial Planner

More than twice as many people signed up on the first day of this year’s open enrollment period for individual health insurance policies on the Marketplace than last year. That’s after the Trump administration drastically cut the advertising and support budget. Looks like the word got out anyway.

Remember, the open enrollment period has been shortened to just 45 days – ending on December 15. I had no problems signing up this year. I could have completed the process in about 20 minutes but I wanted to spend a few days thinking about how my husband and I planned to use our health insurance in 2018. Hopefully others will follow our example.

sign-to-good-health-road-83363452We do not expect any major health care expenses.

After having major surgery in December 2016 and January 2017, along with all the follow-up visits, I’ve seen enough of hospitals. I even got my first colonoscopy in this year since I had already met my out-of-pocket limit. So we decided to choose a plan with the lowest premium, not necessarily the lowest out-of-pocket maximum.

We picked a plan that has fewer doctors in network.

This was a big change for us. We wanted to spend a few days mulling this over. We had always chosen a Blue Preferred plan because our local hospital and doctors were in that network. But next year we are opting for a Blue Advantage plan – most of our local providers do not belong to this network. Here is our rationale:

  • With our advanced premium tax credit (APTC), our monthly premiums would be $0. We’d have to spend over $5,000 on health care at these providers for this strategy not to pay off.
  • We did not have to use all of our APTC. Since we plan on making more money in 2018 than we did in 2016 (on which the APTC is based), we expect to have to pay back some of the APTC. By using less of the APTC, there is less to pay back.
  • We travel a lot, and we know some of the places we plan on travelling to in 2018 have providers in the Blue Advantage network.

For those who qualify, monthly subsidies have risen dramatically.

Because the Trump administration cut off cost-sharing reduction payments to insurers, insurers raised monthly premiums on Silver plans to offset this. The Affordable Care Act requires the APTC (subsidies) to rise accordingly. Most who qualify for these subsidies will be able to find policies that have very low or $0 monthly premiums.

Those who make too much money to qualify for subsidies are the ones who will pay much higher premiums next year. Weren’t these the people the president promised to protect?

Open Enrollment for TrumpCare Begins Wednesday – 6 Things to Know

Open Enrollment for TrumpCare Begins Wednesday – 6 Things to Know
Eileen St. Pierre, The Everyday Financial Planner

I, like many other Americans, wait with bated breath to see how much I will be paying for health insurance next year. Being self-employed, my husband and I have purchased our individual policies in the Marketplace (the federal health insurance exchange) for the past four years. Open enrollment begins this Wednesday, November 1.

Here are 6 things to know:

  1. The open enrollment period will be cut in half – just 45 days. After December 15, you’re out of luck.
  2. Funding has been drastically cut for advertising (over 90%) and help (the budget for Navigators was cut 41%). The website will even shut down on Sundays (except December 10) during open enrollment from midnight to noon.
  3. It took a while, but you can now preview prices at
  4. There has been a lot of publicity surrounding the tax credit and cost sharing payments. If you get a tax credit to offset your premiums, the monthly amount you have to pay may not go up at all. That’s because the tax credit rises when insurers raise premiums. You will still get the tax credit – that’s written in the law. However, those who do not qualify for the tax credit will have to pay higher premiums.
  5. The cost sharing reductions that the president has stopped paying help offset out-of-pocket payments for some consumers. Those who qualified for these reductions are in silver plans. Insurers still have to provide these reductions to those who qualify – they just won’t be reimbursed by the federal government. Insurers have increased the cost of silver plans in 2018 in anticipation of this. Those who are not eligible for cost-sharing may even find that the gold plans in their areas are comparable in price to silver plans.
  6. The IRS has publicly stated that it is still enforcing the penalty for not having health insurance. The cost of going without health insurance in 2018 is the same as 2017 – the greater of 2.5% of AGI or a flat rate of $695 per adult, up to $2,085 for a family.

As I have been doing every year, I’ll let you know how everything goes for us during open enrollment.

Have health insurance quetions?

Round 4: Signing up for Obamacare

Round 4: Signing up for Obamacare
Eileen St. Pierre, The Everyday Financial Planner

health-care-reform-pictureIt’s that time of year again. Open enrollment for those individuals and families wanting to purchase health insurance in the Marketplace started on November 1. I had to wait about 15 minutes to enter the enrollment site, but had no problems signing up this year. You need to sign up for a plan by December 15 if you want coverage to start on January 1, 2017.

I braced myself for sticker shock when I started previewing plans in late October. There were two reasons why our insurance was going to be more expensive in 2017:

First, we made more money in 2015 than in 2014.

In computing the amount of the advanced premium tax credit, the Marketplace uses the last filed tax return to verify income. So when considering our 2017 insurance application, they will use information from our 2015 tax return. As I mentioned in last year’s column, 2014 was the first full year of self-employment income for us so we got a good size tax credit plus very low cost sharing in 2016.

The big difference this year was not the amount of the tax credit – it actually increased. It was that we now have to pay much higher deductibles and have larger out-of-pocket maximums. This is what a lot of people don’t realize with Obamacare.

  • If your income is below a certain threshold, you have very low deductibles and out-of-pocket expenses in addition to the tax credit.
  • Cross that income threshold, and that extra help disappears.

We got real spoiled in 2016. Like many consumers, we’ve tried to fit in as many doctor visits and prescription refills as we can before the end of this year. In a way, it helped to compensate us for starting our own business. That’s how I like to look at it.

Second, health insurance costs have really skyrocketed.

We kept hearing that our home state of Oklahoma was going to experience really high premium increases. Indeed, if we were to keep the same policy we had in 2016, our monthly premiums would have gone up by almost $900. To make things worse, our individual in-network deductible and out-of-pocket maximum went up by $3,250 and $5,750, respectively. Ouch!

We decided to go with a cheaper Bronze plan.

We’ve had a Silver plan since the Marketplace began. But it made sense to switch after considering how we expect to use our insurance next year. By going with the Bronze plan, our monthly premium costs will only go up about $40 a month over last year. Even though our in-network deductible and out-of-pocket maximum will be higher, we’ll save about $5,000 a year by switching plans. We expect our extra out-of-pocket expenses to be less than that.

The bottom line is that I am grateful for this insurance. I will be having surgery over the next few months to correct a pre-existing condition. Without the passage of the Affordable Care Act, I would be uninsured for this condition – or I would have had to stay at a job that did not make me happy just to be covered under an employer plan.

Round 3: Signing Up for Obamacare

Round 3: Signing Up for Obamacare
Eileen St. Pierre, The Everyday Financial Planner

health insurance1Open enrollment for those individuals and families wanting to purchase health insurance in the Marketplace started on November 1. The deadlines are a little different from last year. You need to sign up for a plan by December 15 if you want coverage to start on January 1, 2016.

It did not take long to sign my husband and me up this year. The website worked really well. As promised, here is a highlight of my experience – the good, the bad, and the ugly.

The Good – Our tax credit doubled.

It is always a good idea to get your tax credit recalculated. The Marketplace uses income data from your 2014 return to determine the amount of your advance premium tax credit for 2016. It just so happened that 2014 was our first full year of self-employment.

  • We do expect to earn more than our income in 2014 but we do not know how much. This means we expect to have to pay back some of the tax credit.
  • To be on the safe side, we will put the full value of the tax credit in savings to handle the increase in income taxes.
  • Based on last year’s experience, I knew the IRS would not accept any of our 2016 income projections. They would end up using the last available tax return. That’s what makes this system tough for sole proprietors like us.

The Bad – Our previous plan is being discontinued.

We had the same plan for the last two years and liked it. But we had to choose a new one. We wanted to keep the same insurer. After going through the application process, there were only four Silver plans from this insurer. Only one of these plans listed our local hospitals and doctors in their network. So the decision was pretty simple. This was also the plan the insurer was going to put us in automatically. But there are going to be some trade-offs:

  • Our total costs should be lower if we use in-network providers. We both get three free visits to our primary care doctor during the year.
  • There are only three pharmacies that are now considered in-network. Luckily Walmart is on the list.
  • We are going to pay through the nose if we have to use out-of-network providers. There are no out-of-pocket maximums anymore. Our cost for using out-of-network providers is unlimited.

The Ugly – Premiums have really gone up.

That’s probably not a surprise to many of you. For us, here is how our costs have changed:

  • Last year’s monthly premium was $683.76 for the two of us.
  • Next year we will have to pay $1,051.61 per month for the new plan.
  • Luckily, the doubling of our tax credit will end up lowering our monthly cost by almost $20 a month. That’s $240 we can put towards dental care.

I always opt out of letting the Marketplace use tax and income data for the next five years to help determine our advance premium tax credit in the future. I prefer to enter the information myself. In the back of my mind, I keep hoping Congress will reform the system. There are some good sides of Obamacare, but there are also some parts of it that are very divisive. I know – it’s just wishful thinking on my part.

2016 Open Enrollment for Obamacare Begins November 1

2016 Open Enrollment for Obamacare Begins November 1
Eileen St. Pierre, The Everyday Financial Planner

Open enrollment for those individuals and families wanting to purchase health insurance in the Marketplace starts November 1, 2015. Although the enrollment period runs through January 31, you need to enroll by December 15 for your policy to become effective on January 1, 2016. These dates are a little different from last year.

The penalty for not having health insurance goes up in 2016.

If you do not have health insurance and do not qualify for an exemption, you will have to pay the higher of:

  • 2.5% of yearly household income
  • $695 per person ($347.50 per child under 18)

Despite all the bickering in Congress over the penalty, neither the House nor Senate has passed any legislation as of yet to lift the penalty. This penalty will be assessed when you file your 2016 tax return.

Plans and prices will be available for preview during the third week of October.

Keep checking for the release. Don’t worry – when the plans and prices are released, it will be front and center on their home page and in the news. The Kaiser Family Foundation has done an early analysis of 2016 premium changes for the cost of the lowest and second-lowest silver plans in 13 states and the District of Columbia.

  • The average premium is expected to rise 4.4%.
  • Premiums are expected to rise the highest in Minneapolis (28.7%) and Portland (22.8%).
  • Premiums are expected to fall by 10.4% in Seattle and 5% in Los Angeles.

Re-examine your insurance options.

It’s always a good idea to look at all your options. Some insurers may drop out of the Marketplace. Some states will have new insurers join. Your insurance needs may have changed.

My husband and I plan on re-enrolling again for next year – I will keep you posted on our experience using

Year 2 under Obamacare: Our tax credit was just lowered because we could not prove our income

Year 2 under Obamacare: Our tax credit was just lowered because we could not prove our income

Eileen St. Pierre, The Everyday Financial Planner

Being sole proprietors, my husband and I are grateful for being able to purchase individual health insurance in the Marketplace with the help of a tax credit.  Last year we were asked to provide documentation to prove our income.  We did our best to estimate what we would earn in 2014 – and the government accepted it.  We were not that lucky this year.

What more information do you want?

frustrated woman.jpgWhen we re-enrolled for this year, we told the Marketplace to use the same income information as last year.  We are expecting to earn more this year, but we have no idea how much.  We figured we would just pay back any tax credit we were not entitled to when we file our 2015 taxes.  It was just easier to keep the same policy since we were happy with it.

Starting in December 2014, we started getting messages from the Marketplace asking us to provide information to prove our income.  I uploaded the same types of information as last year.  Then on March 17, we were told the information we provided was not sufficient.

Our tax credit was lowered by $48 per month starting in April 2015. 

A series of emails followed.  Our current policy was cancelled and we were enrolled in a new policy starting April 1.  Everything was the same except the deductible.  It went from $1,500 to $5,000 (individual, in-network).  So in addition to having to pay $48 more per month, we lost most of our cost-sharing.

Kudos to Leo at the Marketplace Call Center.

The information being provided by my health insurance provider only added to my confusion.  So I called the Marketplace Call Center just to make sure I knew what our new policy was covering and what it would now cost us.  I went through my whole story, which took several minutes to explain.   The representative named Leo repeated everything back to me word-for-word.  Never have I talked to a customer-service representative who did that!  You always have to repeat something.

But not this time – Wow, what a difference 18 months makes!  Leo was on the ball and explained everything to me.  I guess they have finally worked out all the bugs with

In the end, we ended up with the policy we probably should have had from the start.

We were told that the Marketplace used current income data on file to determine our eligibility for a tax credit and any cost-sharing reductions.  Turns out that was income from our 2013 tax return.  This was the year I left my university position and we launched our business.  After looking at what we “officially” earned in 2013, the amount was similar to what I thought we would earn this year.

I guess in a weird way everything worked out.  If all goes as expected, we will not have to pay back that much of the tax credit.  But if we have to pay more, this just means our business was a lot more successful.  I’ll take that.

Round 2: Signing Up for Obamacare

Round 2: Signing Up for Obamacare
Eileen St. Pierre, The Everyday Financial Planner



Open enrollment for those individuals and families wanting to purchase health insurance in the Marketplace started on November 15. Although the enrollment period runs through February 15, you need to enroll by December 15 for your policy to become effective on January 1, 2015.

Boy, what a difference a year makes! I had no problems re-enrolling through

Re-calculate your tax credit.

Once I finally realized that I had written down the wrong username, I had no problem accessing my account. Recalculating our advanced premium tax credit was straightforward. Even though our estimated income is the same as last year, our tax credit is going up $13 per month. So I would encourage those of you currently getting a tax credit to have it re-calculated even if you expect the same income and plan on keeping your current health insurance plan. Remember these things:

  • You are supposed to let the Marketplace know if you have changes in income.
  • If you end up understating your income, you will have to pay some of the tax credit back when you file your taxes in the following year.
  • If you end up overstating your income, you will get a larger tax refund when you file your taxes in the following year.

Re-examine your insurance options.

We actually ended up being happy with our health insurance provider last year. We had some issues with the bills from my husband’s surgery, but they eventually worked out in our favor. Read my column V is for Victory over Medical Bills for our story.

In my state of Oklahoma, the only provider with policies on the Marketplace is Blue Cross Blue Shield. That’s ok with us because that’s who we would have picked anyway. But it does highlight that options may be limited for some consumers.

There were seven Bronze plans, seven Silver plans, and eight Gold plans available to us. No Platinum plans were available. We decided to stay with the same policy. Cheaper ones were available, but our local medical center where we go for most of our medical care is not in their network.

Be prepared to pay more – and watch out for rising deductibles.

You may be in for quite a shock if your income goes up.

  • If you had been eligible for cost-sharing in 2014, this meant that you had a lower deductible and lower out-of-pocket maximum than others in the same plan.
  • If your estimated income in 2015 goes up, it may bump you into the next income bracket, reducing or even eliminating your cost-sharing. The result is a much higher deductible and out-of-pocket maximum.
  • The bottom line – Losing some or all of your cost-sharing will not result in higher premiums, but it will raise your health insurance costs overall.

The premium for our policy is going up by $93.26 per month. Factoring in our tax credit, we will have to pay $80.26 more per month for health insurance in 2015. It’s still less than what we paid when I had health insurance from my former employer. But it would be hard for us to pay this without the tax credit.

The future of tax credits is still unknown.

Knowing these tax credits were available made it possible for us to have health insurance coverage while launching our own business. The Supreme Court will decide by June 2015 if tax credits offered to those purchasing health insurance on federal exchanges are allowed.

For me personally, I’m reasonably confident that my health insurance policy and tax credit will not be changed during 2015. Despite all the opposition to Obamacare, it would be too difficult politically to completely overhaul ACA right away. But for 2016, all bets are off. I’ve got a year to get ready.

Open Enrollment for the Health Insurance Marketplace Begins November 15

Open Enrollment for the Health Insurance Marketplace Begins November 15
Eileen St. Pierre, The Everyday Financial Planner

Happy-first-birthdayThe Health Insurance Marketplace is now a year old. Open enrollment for those needing an individual health insurance policy for 2015 begins November 15. If you want your coverage to start on January 1, then you need to make your selections by December 15. Like last year, you can sign up at (hopefully the website will work better this time around) or by calling the Marketplace Call Center at 1-800-318-2596.

Automatic Re-Enrollment

For those of you who signed up for an individual policy on the Marketplace last year, you will be automatically re-enrolled in the policy if your insurance company is still offering the plan, and your income and household size have not changed. So if you are happy with your coverage, you don’t have to do anything.

  • If the plan is no longer offered, you are supposed to be automatically enrolled in a similar plan. However, if this happens to you, it’s a good idea to look at your new options and make your own decision for next year.
  • Remember that your coverage is based on where you live, not where you work.
  • You should always report changes in income and household size to the Marketplace right away.

Recalculate Your Tax Credit

All of the confusion surrounding open enrollment is going to focus on the advanced premium tax credits. First of all, the fate of these tax credits could be decided by November mid-term elections or the Supreme Court (see my column T means Tax Subsidies for Obamacare Up in the Air). For now, let’s assume these tax credits will be available to offset premiums in 2015.

  • The rules governing how the tax credits will be redetermined for 2015 were just approved in early September 2014. [Side note: Redetermination means the same thing as recalculation. It just sounds a lot more confusing but it’s the term the government will use.]
  • If you currently receive the premium tax credit, you will receive a letter explaining this process. There are three different groups of people who will receive letters.
  • Please read this letter! For some groups, your premium tax credit may end at the end of 2014 if you do not contact the Marketplace and have your tax credit recalculated for next year.
  • For other groups, your premium tax credit will stay the same for next year if you do not contact the Marketplace with updated income information. Even if your income is not expected to change, it’s a good idea to ask the Marketplace to recalculate your tax credit. That’s because it will use updated numbers, which may result in a higher tax credit. But you will not automatically get this if you don’t ask for a redetermination.

Penalty Rises in 2015

If you go without health insurance coverage for more than 90 days, then you will have to pay a penalty – what the federal government calls a shared responsibility fee.

  • In 2014, this fee is the greater of 1% of your annual income or $95 per adult (and $47.50 per child). This fee will be assessed when you file your 2014 tax return. So if you are owed a refund, expect the IRS to deduct the penalty from the refund.
  • In 2015, you will pay the greater of 2% of your income or $325 per adult (and $162.50 per child) if you choose to go without health insurance.

The IRS has not released tax filing forms for 2014 yet. Once it does, we will be able to see how all this will be documented when you go to file your taxes. I’ll do my best to keep you posted.

H is Happy with Health Insurance Six Months into Obamacare

H is Happy with Health Insurance Six Months into Obamacare
Personal Finance from A to Z
Eileen St. Pierre, The Everyday Financial Planner

So far, so good – We’ve had no major issues with our Marketplace insurance policy. In a prior blog post, I commented on how customer service was a mess and paying wasn’t so easy anymore.

  • We still have to wait over an hour to speak to customer service.
  • But it has gotten easier to pay our monthly premium – We can use our credit card with no extra charges.
  • It took a bit of persistence on our part, but we now have paperless billing – They still keep sending our bill in the mail as well.

There really hasn’t been any difference on our end when it comes to getting prescriptions (RX) filled and paying for routine doctor visits.

  • One of our RX is now free, and the other went from $4 to $10 per month.
  • We have the same co-pay for in-network specialists.

I do have issues with the quality of health care in my community, but these issues were in place long before Obamacare was implemented. Living in a small town, it’s hard to find specialized care. We can get basic preventative care, but we have few specialists.

  • For many medical specialties, we have just 1 or 2 doctors (if we are lucky). Most of them are over the age of 55.
  • The medical center has been buying up many of the local practices, creating a monopoly for medical services. You pay what they tell you to pay.

As I write this column, my husband is preparing for outpatient surgery at a major hospital 90 minutes from our home. The hospital is out-of-network, but it does not bother me to pay a little more ($3,000 maximum out-of-pocket vs. $1,500 for in-network). To be honest, I’m relieved he is having the surgery there.  There wasn’t a specialist in my community qualified to do the surgery.

As the bills for his surgery start coming in, I will get a better sense of how well our Marketplace insurance policy is meeting our needs. I’ll keep you posted.

First Person: One Month into Obamacare

First Person: One Month into Obamacare
Eileen St. Pierre, The Everyday Financial Planner

My husband and I have been enrolled in a health insurance policy on the federal exchange for a month now. Factoring in our tax credit, we are saving almost $600 a month on premiums. No real problems so far, just a few annoyances:

We gave up trying to call customer service.

My husband needed to cancel his old policy with the same insurer. Every time he called, he was put on hold for so long that he eventually just hung up. The insurer posted a notice on its website in mid-January acknowledging the long delays and apologizing. It listed some FAQs and luckily the company addressed what to do about old policies (just don’t pay them – they will eventually be closed). But we would have appreciated it if the company would have mailed or emailed us this notice.

The company refers you to its website if you don’t want to wait for a representative.

The company website is still a mess.

We were told about the amazing features of the website. We’re still waiting for them.

  • The website only lists my husband as a covered person on the policy (although I have had no problems filing a claim).
  • No claim information for 2014 is up yet.
  • We haven’t been able to email the company.

The website suggests you call customer service if you have any problems or questions.

The payment deadline for January and February was extended.

We were given until the end of the month to pay both our January and February bills. That was kind of them. However,

Paying is not so easy anymore.

Since we never switched insurance companies, we figured we would be able to pay our bill the same we had always done – on our credit card. Now the insurer charges a fee for credit card payments. We wanted to pay our bill with a one-time electronic transfer from our bank, but the website is only set up for monthly automatic payments. Don’t want to do that – if something goes wrong it takes forever to straighten it out.  So we ended up just mailing in our premium payment.

It’s hard to get too mad at the insurance company. It is going to take some time to get all the kinks worked out. So far we are happy with our insurance plan. I’ll let you know how we feel at the end of the year.

New Tool to Preview Marketplace Plans and Prices Released

New Tool to Preview Marketplace Plans and Prices Released
Eileen St. Pierre, The Everyday Financial Planner

Like many of you, I’ve wasted a lot of time this month trying to log into so I can see what plans are available for me and my husband on the new health insurance exchanges. I had even set up an account before the Marketplace opened on October 1 but I still could not log in. Many people, even those covered by their employers’ plans, simply want to know what the plans will cost them.

The government is listening to the complaints. A new tool to preview Marketplace plans and prices in your area has been released. The web address is

  • After answering a few questions, you will get a list of plans and prices, but you will not be able to find out the details about the plans just yet.
  • This list may not be all the plans available to you – but at least it’s a start.

For a married couple with no kids living in Payne County, Oklahoma, there were 23 plans available for us to choose from:

  • Only 2 insurance companies, Coventry Health Care and BCBS of OK, had plans listed.
  • The cheapest is a Catastrophic Plan from Coventry at $256.42 per month but we are too old (over 30) to qualify.
  • The cheapest Bronze Plan is $287.88 per month from BCBS of OK.
  • The most expensive plan listed is a Gold Plan from BCBS of OK at $672.80 per month.

These monthly premiums do not reflect any advanced tax credits we might receive. The Kaiser Family Foundation has an interactive calculator you can use to estimate any premium subsidies.

If you want to find out more about a particular plan and still cannot log into, you have several options:

  • You can try calling the Marketplace call center at 1-800-318-2596 and see if they can help you.
  • You could also try contacting the insurance company offering the plan for more details.
  • There is now a search tool you can use to find local help in your area.  Go to and just type in your zip code.

I’ll do my best to keep you informed on my progress towards signing up for coverage.

This column was updated on 10/22/13.

Premium Rates for Oklahoma Health Insurance Marketplace Plans

Premium Rates for Oklahoma Health Insurance Marketplace Plans

Eileen St. Pierre, The Everyday Financial Planner

This posted was updated on 9/26/13.

Open enrollment in the Oklahoma Marketplace (i.e., the Oklahoma health insurance exchange) begins October 1.  Five insurance companies will be offering plans.  Three of these companies are Preferred Provider Organizations (PP0s):  BCBS of Oklahoma, Aetna, and Coventry Health – now owned by Aetna but offering separate plans.  The other two companies, Global Health and Community Care, are Health Maintenance Organizations (HMOs).

According to Oklahoma Watch, all five companies have posted their rate information with the Oklahoma Insurance Department (OID).  The OID has released the information for the PPOs – it is not allowed under state law to release rate information for HMOs.  The information does not appear to be publicly posted.  You need to request a copy of the insurance company filings by emailing the OID – read this news release for contact information.

That’s just as well.  By the time you read everything, the Marketplace will be open for business.  Oklahoma Watch states that BCBS’s filing is 207 pages long, and Aetna’s is 151 pages.

Rates will vary based on three factors:  where you live, how old you are, and if you smoke.  Remember, in 2014 insurance companies will not be able to charge women higher rates.  Here’s a summary of PPO rate information listed in the Oklahoma Watch story:

  • The Oklahoma figures appear to be in line with rates published by other states.
  • Most Marketplace customers will pay between $200 and $700 per month.  Advanced tax credits may be available to individuals and families, reducing this monthly cost.
  • The biggest variable appears to be age – the Affordable Care Act allows insurers to charge a 64-year old three times as much as a 21-year old.  All three PPOs appear to be doing just that.
  • Smokers should expect to pay 10% to 30% more.
  • Oklahoma has been divided into 5 regions – insurers are allowed to charge different rates in different regions based on their claims history and projected costs.  Aetna’s rates are lowest for the 7-county Oklahoma City metro area and highest for Comanche County (Lawton).  On the other hand, Coventry charges its lowest rates in ComancheCounty.
  • A 40-year old, non-smoker in the Oklahoma City metro area will pay $302 per month for a Silver plan from Aetna with a $5,000 deductible.

On September 25, the the Department of Health and Human Services released an Issue Brief outlining premiums on the Federal Exchanges for 2014. The brief provides average cost information for the state and the Oklahoma City (OKC) metro area.  Oklahomans will have 53 qualified health plans to choose from – same as the national average.  In the OKC metro area, you will have 61 plans.

For a family of four with an income of $50,000:

  • On average, they will pay $634 a month for the second lowest cost Silver plan before tax credits, $282 after tax credits. In the OKC metro area, this family will pay $597 before tax credits ($282 after credits).
  • The average premium for the cheapest plan of all, the lowest cost Bronze plan, will be just $63 ($66 in OKC) after applying tax credits.

For a 27-year old no longer eligible to remain on his/her parent’s plan, the lowest cost plans before tax credits will be on average:

  • $105 per month for a Catastrophic plan ($107 in OKC)
  • $114 per month for a Bronze plan ($105 in OKC)
  • $169 per month for a Silver plan ($158 in OKC)
  • $203 per month for a Gold plan ($204 in OKC)

Remember, these premium rates are averages – your actual cost will vary based on your age, where you live, and if you smoke.

Go to to enroll in the Marketplace starting October 1. 

The New Health Insurance Exchanges: Tax Credits and Cost-Sharing Reductions

The New Health Insurance Exchanges:  Tax Credits and Cost-Sharing Reductions

Eileen St. Pierre, The Everyday Financial Planner

It’s been a constant message from the advocates of the new health insurance exchanges – there will be help for many of us to help pay for mandated individual health insurance coverage starting in 2014.  But what kind of help will be available?  It will come in two forms:  advanced premium tax credits and cost-sharing reductions.

Advanced Premium Tax Credits

With most tax credits, you have to wait until you file your taxes to get the credit.  But the new Advanced Premium Tax Credit available through the Marketplace lets you reduce your monthly insurance premiums right away.  The monthly estimated amount of your tax credit will be sent directly to your insurance company.  So you just have to pay the net premium amount each month.

  • You do have the option to wait to receive the credit when you file your income taxes but why would anyone want to do that?
  • This tax credit will be available to individuals and families with incomes between 100% and 400% of the Federal Poverty Level (FPL) – $23,550 to $94,200 for a family of four in 2013 – who do not have access to certain other types of minimum essential coverage.

Here’s where it gets a little confusing.  This credit is just an estimate, based on your projected 2014 income that you put on your application.  When you file your 2014 taxes in early 2015, you will compute the exact amount of your credit.  The actual credit will depend on:

  • Your actual household income in 2014, and
  • The cost of the Silver plan, adjusted for your age.

You do not need to sign up for the Silver plan, though.  You can choose whatever type plan you want.  If you choose the cheaper Bronze plan, you could end up paying little to no monthly premium.  Just remember that you are not eligible for the tax credit if you sign up for the Catastrophic plan.  (Click here to read my column on the types of plans offered by the Marketplace.)

Depending on what happens throughout 2014, you may end up with a higher credit (and a refund) or a lower credit (and have to pay up) when you file your taxes.  This is why it is very important to notify the Marketplace (online at or call the Toll-Free Call Center at 1-800-318-2596) of changes in income and family size.

It sounds like filing our 2014 tax returns is going to get a lot more complicated.  Just a reminder for those of you who decide not to purchase health insurance, you will have to pay a penalty at tax time.

Cost-Sharing Reductions

In addition to your monthly premiums, you will also have out-of-pocket expenses such as co-pays and deductibles.  This is what the government refers to as cost-sharing.  Your share of the costs will be about

  • 40% for the Bronze plan,
  • 30% for the Silver plan,
  • 20% for the Gold plan, and
  • 10% for the Platinum plan.

Cost‐sharing reductions are available to help reduce these out‐of‐pocket expenses.  To be eligible, you must

  • have a household income that is less than or equal to 250% of the FPL ($58,875 annually for a family of four in 2013),
  • meet the requirements to enroll in a health plan through the Marketplace and receive the tax credit (described above),
  • and enroll in a Silver plan.

You will be notified when you apply if you are eligible.  Certain American Indians and Alaska Natives who purchase health insurance through the Marketplace do not have to pay co‐pays or other cost sharing if their income is under 300% of the FPL – $70,650 for a family of four in 2013 ($88,320 in Alaska).

The New Health Insurance Exchanges: Types of Plans and Covered Services

The New Health Insurance Exchanges: Types of Plans and Covered Services

Eileen St. Pierre, The Everyday Financial Planner

Individual health insurance plans in the new health insurance exchanges (the Marketplace) will be sold and run by private companies.  If you decide to enroll, you will have guaranteed coverage and renewability, regardless of pre‐existing conditions, your sex, or age.  According to the Center for Medicare & Medicaid Services, 129 million people have pre-existing conditions.

Covered Services

Every qualified health plan offered in the Marketplace will cover a core set of benefits called Essential Health Benefits:

  • Ambulatory services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Pediatric services, including oral and vision care (dental services may be stand-alone plans)
  • Prescription drugs
  • Preventative and wellness services, and chronic disease management
  • Rehabilitative services and devices

Providers are not required to offer adult dental plans.  Some plans may cover additional benefits.  You may have to see certain providers or use certain hospitals.

Types of Plans

Premiums, co-pays, and coinsurance will vary based across plans.  Exact numbers for plans offered on federally-run exchanges will not be released until October 1.  If you live in a state that is running its own exchange, check its website to see if cost figures have been released.

There will be four types of plans:

  1. Bronze – The cheapest plan; you pay 40% of costs on average in addition to the monthly plan premium
  2. Silver – Plan pays 70%, you pay 30% + monthly premium
  3. Gold – Plan pays 80%, you pay 20% + monthly premium
  4. Platinum – The most expensive plan; you pay only 10% of costs on average + monthly premium.

Approved insurance providers are required to offer Silver and Gold plans.  They may offer Bronze and Platinum plans.

A Catastrophic Health Plan will also be available to individuals age 30 or younger, and those individuals who obtain hardship waivers.  This is a high-deductible plan.

  • These plans cover 3 annual primary care visits and preventive services at no cost.  Enrollees pay out-of-pocket for other expenses.
  • After the deductible is met, they cover the same set of Essential Health Benefits that other Marketplace plans offer.
  • These plans are not eligible for tax credits and cost-sharing reductions.
  • Each member of the family must meet eligibility requirements to purchase.

Enrolling in the New Health Insurance Exchanges

Enrolling in the New Health Insurance Exchanges

Eileen St. Pierre, The Everyday Financial Planner

There are a lot of questions we want answered regarding the running of the new health insurance exchanges, especially from partner organizations (like The Everyday Financial Planner) who want to assist the public in understanding this new system.  The Center for Medicare & Medicaid Services (CMS) has started to offer training to these groups.  From my point of view, things are starting to come into focus.

First, let’s define some terms.  The public uses the term “Exchange” to describe this system of purchasing individual health insurance plans.  The government refers to this system as “The Marketplace” since it is designed to be a one-stop shop for health insurance including Medicaid and CHIP (Children’s Health Insurance Program).

Initial Open Enrollment

The initial open enrollment period runs from October 1, 2013 through March 31, 2014.  Timing is important when signing up.  To have coverage start on January 1, you need to enroll by December 23.

  • This includes the 110,000 people currently enrolled in the Pre-Existing Condition Insurance Plan (PCIP).  This program ends at the end of this year.  For those of you in this plan, you will need to sign up for coverage in the Marketplace – there will be no automatic transition.  Don’t worry if you forget.  You will be mailed notices reminding you to do so.

If you enroll between the 1st and 15th day of January – March, your coverage will be effective on the first day of the following month.  If you enroll between the 16th and the last day of January – March, your coverage will be effective on the first day of the second following month.  Sound confusing?  Here are a few examples:

  • If you enroll on December 20, your coverage will begin on January 1, 2014.
  • If you enroll on January 2, your coverage would also start on February 1, 2014.
  • If you wait until the last day of the enrollment period, March 31, your coverage would not start until May 1, 2014.

Your first premium must be received before enrollment begins.  CMS is still working with plan providers on forms of payment.  You do not need a bank account to participate.

Special Enrollment Periods

After the initial enrollment period ends, you will not be able to sign up or change plans unless you experience a qualifying event that triggers a special enrollment period.  Examples of qualifying events include:

  • Moving to a different state
  • Gaining or becoming a dependent
  • Becoming a U.S. citizen
  • Gaining or losing eligibility for premium tax credits (I will discuss tax credits in an upcoming column)

The Affordable Care Act includes the permanent reauthorization of the Indian Health Care Improvement Act, which provides unique provisions for Native Americans.  Native Americans (members of federally-recognized tribes) may enroll or change from one qualified health plan to another one time per month.

Annual Open Enrollment

After the initial open enrollment period ends, the annual open enrollment period will run from October 15 to December 7 (subject to change).  So if you enroll in a plan for 2014 and wish to change plans for 2015, you will have to wait until October 15, 2014 to make the switch.

Ways to Enroll

You can enroll in the Marketplace in 4 ways:

  1. Online at
  2. By mailing in your application (we all know how long that can take)
  3. By calling the Toll-Free Call Center at 1-800-318-2596
  4. By getting in-person help from Navigator organizations (a list of these organizations will be released in mid-August)

Your application will be verified with data from the Social Security Administration, IRS, Department of Defense, Homeland Security, and other approved sources. If you apply online, you are supposed to get results in real time. Questions on the application are not supposed to be too intrusive.

I did find it interesting when a CMS training moderator mentioned that there would be a question regarding foster care.  This question only needs to be answered by those ages 18 to 25 as it relates to a new Medicaid category for people aging out of foster care.

In a Google Hangout held earlier this month, the CMS representative mentioned that they would be partnering with libraries to provide internet access and help with enrollment.  No details of the program were given.

Participating in the Marketplace is not mandatory.  If you receive health insurance through your employer and are happy with the plan, you do not need to worry about this.  If it is too expensive to include your family on your employer’s plan, they can enroll in the Marketplace.

This column was updated on 12/10/13.