Choosing between Platinum, Gold, Silver and Bronze health insurance plans

How do I decide which plan is best for me?

You'll have four choices: Platinum, Gold, Silver, and Bronze. If you're younger than 30, you'll also have a fifth choice - a "catastrophic" plan.

How do you decide? The simple answer is it's personal preference. Choose a plan where you're comfortable with the monthly premium and the out-of-pocket costs. Only you know what's best for you.


But here's some information that might help you decide:  
(Note: When we're talking about your "out-of-pocket costs", that includes everything you pay out with insurance that year.... even doctor and prescription copays, too! The only thing that doesn't count toward the total is your monthly premium.)


Platinum: 
The most expensive monthly premium, but you'll pay the least when you use it. Platinum has low copays at the doctor and pharmacy. There's a maximum out-of-pocket of $1,500 per person per year, so that's the most you could pay out each year.

Who buys Platinum? People who use their insurance very often.

Consider: Do you take several prescriptions, especially high-cost brand name drugs? Do you have expensive healthcare procedures coming up like surgeries, scans, or tests? Do you see the doctor very often? Do you have a serious health issue like cancer, diabetes or a heart condition? Are you pregnant or want to have a baby in the next year?

If you answered yes to one or more of those questions, then you might want to consider Platinum. If you use your insurance often, you'll probably save money overall, even though this plan is the most expensive.


Gold: 
Gold includes copays for things like doctor visits and prescriptions. The total out-of-pocket is somewhere between $3,500 and $4,500 on most Gold plans (varies by insurance company). It's generally about 8-10% less expensive than the Platinum plan.

Who buys Gold? Gold is ideal for someone who probably isn't going to have very expensive medical care next year, but still wants a lower out-of-pocket plan, just in case something happens.


Silver: Silver is purchased most often because of it's balance between reasonable price and average benefits. It includes reasonable copays for doctor visits and prescriptions, but you'll have a higher out-of-pocket for the year - usually around $6,350 per person (varies by insurance company).

Silver is generally about 8-10% less expensive than Gold plan. If you qualify for tax subsidies, your discount will be calculated based on the Silver plan, but you can always upgrade or downgrade based on your needs.

Who buys Silver? Someone who wants to keep their monthly premiums low and doesn't think they'll have very expensive medical care next year. If you feel pretty confident that only you'll use your plan for the basics - things like preventive care, doctor visits, and a few low to mid-cost prescriptions -  then Silver might be right for you. In most areas, Silver is the lowest priced plan that still includes copays.


Bronze: 
The lowest monthly premium, but the highest out-of-pocket for the year. It's usually priced about 8-12% less than a Silver plan.

Most Bronze plans don't include any doctor office or prescriptions copays, so you'll pay for those things out-of-pocket and apply them to your deductible. (Although, some insurance companies offer a Bronze plan with a few doctor copays included.) The most you'll pay out is $6,350 per person per year.

With most Bronze plans, you could set up a Health Savings Account (HSA) at your bank where you could get tax savings, which could help off-set those higher costs when you use your plan.

Who buys Bronze? Bronze is purchased most often by people ages 40 to 64. That's because younger families tend to use their plan very often and enjoy having copays at the doctor and pharmacy, which you usually don't get with Bronze.

It's also good for someone who wants the lowest priced option to avoid the penalty for not having health insurance. Bronze plans will be sold for as little as $1 per month based on family size and household income. It's better to take the lowest cost option than not have any insurance at all.

Bronze is also a good financial strategy for some people who have the financial means to pay the $6,350 in case something happened. If so, and especially if you don't think you'll use plan very often, you might see big overall savings with Bronze.

Quick Facts:

• Price Difference, from Top to Bottom: The price difference between Platinum and Bronze is about 30-40% is most areas. There's about an 8-10% difference in price between each plan. 

• Benefit Difference, from Top to Bottom: The benefit difference between Platinum and Bronze is a $1,500 out-of-pocket with copays (Platinum) versus a $6,350 out-of-pocket without copays (Bronze) in most areas. 

• Tax subsidies are calculated based on the second-lowest cost Silver plan in your area. But you can always upgrade or downgrade to suit your needs. 

• Platinum is ideal for somebody who uses there plans often, especially for expensive hospitalizations, testing, treatment, or prescriptions. 

• Bronze is ideal for someone who rarely uses their plan or has the financial resources to pay more out-of-pocket costs when they use their plan. 

• Gold and Silver offer mid-range benefits and pricing. Most people feel most comfortable going with a mid-range plan. 

• Silver is purchased most often, overall. 

If you're still having trouble deciding, just call or email us! We're trained and authorized to walk you through your options.  

The Uninsured's Guide to Health Reform

The Affordable Care Act (ACA) - often called Obamacare - is a new law helping more Americans get health insurance.

Use this guide to learn more about how this law affects people without health insurance.

How ACA impacts the uninsured:

You are required to have health insurance, or pay a penalty. Unless you qualify for an exception, you'll pay a penalty if you don't have qualified health insurance starting in 2014. Qualified health insurance could include job-based coverage, private health insurance, Medicaid, or another government-sponsored insurance plan. 

Do you not have insurance because of a pre-existing condition? Before ACA, private health insurance companies could turn you away because of a pre-existing condition. That left millions of Americans with no access to health insurance because they didn't qualify for any government-sponsored plans or have access to job-based coverage. 

ACA changes that. Now insurance companies cannot decline you because of a pre-existing condition. Insurance companies also cannot charge you extra premium because of a pre-existing condition. 

Do you not have insurance because it's too expensive? For many people, health insurance premiums became completely unaffordable in recent years. Millions of Americans were forced to drop their coverage -  not because they didn't need it -  but because they couldn't afford it. 

Under ACA, you can qualify for tax subsidies based on household income and family size to lower your costs. A tax subsidy is the amount of money paid by the government to your private, brand-name insurance company to lower your monthly insurance premium or your out-of-pocket costs when you use your plan. If your household income is beneath 400% Federal Poverty Level (about $94,000 a year for a family of four), then you'll probably qualify for a tax subsidy.

Use our Subsidy Calculator to see how much discount you might qualify for. Or, contact us - we're trained and authorized to walk you through the process. 

ACA cuts DSH funding. Many of us are used to the idea of going to the hospital to get treatment if we don't have insurance, but that might change. Disproportionate share hospital (DSH) payment cuts are included in the new law. DSH payments help provide money to hospitals to treat people without health insurance. 

The assumption behind the cuts was that when Medicaid was expanded to cover more people, less DSH funding would be needed because more uninsureds would be covered under Medicaid. However, many states did not expand Medicaid, so they will see deep DSH cuts. The law requires $18.1 billion in total reductions between 2014 and 2020, which cuts the uninsured's safety net in almost half. 

If you're younger than age 26, you can be covered on your parent's insurance plan. ACA allows young adults to stay on their parent's health insurance plan longer. And it doesn't matter if you're married, a full-time student, or if your parent claims you as a dependent. You can be covered under a parent up until your 26th birthday - no questions asked.  

Get covered to avoid the penalty 

Consider the lowest cost option. Since you're not used to having a health insurance premium, you might want to consider the lowest cost option. That way, you'll avoid the penalty for not having insurance, avoid bankruptcy if you get back sick, and get great benefits like free preventive care. 

For most people, the Bronze plan will be the lowest cost option. But if you're under 30 years old, it will be the "catastrophic" plan. These plans have higher out-of-pocket costs when you use your insurance, but they have the lowest monthly premiums. 

You get the power of choice. Even if you qualify for a tax subsidy to reduce your costs, you can still choose your plan and your brand-name insurance company from all the ones available in your area. Be sure to consider whether or not your doctor accepts that insurance plan, too.

Be sure to check out our GUIDE to help you choose between the Platinum, Gold, Silver, or Bronze plans.

And if you're overwhelmed, don't worry, we're here to help. We are tried and authorized to walk you through your options.

Young Adult's (age 19-30) Guide to Health Reform

The Affordable Care Act (ACA) - often called Obamacare - is a new law helping more Americans get health insurance.

Once you're 19 years old, you can enroll in a health insurance policy on your own, without a parent. Use this guide to learn how the law impacts young adults under the age of 30.

Costs are going up, but your's might be going down

• Changes to how plans are priced for younger people. Before ACA, insurance companies charged very little monthly premium for young, healthy adults. They might have charged older adults five times more than you for the same coverage just based on age. 

The new law changes that. Now, insurance companies can only charge older adults three times more than younger adults. Many younger adults might see big premium increases under ACA because of the new rating system. 

• Qualify for discounts on your health insurance. Even though retail costs for your health insurance is going up in most areas, you might qualify for lower rates based on family size and household income. 

If your household income is beneath 400% Federal Poverty Level (FPL) - which is about $45,000 a year for a family of one or about $94,000 a year for a family of four - you'll qualify for a tax subsidy. A tax subsidy is the amount paid by the government directly to your brand-name, private insurance company to lower your monthly insurance premium or healthcare costs. 

• Medicaid is expanding. ACA expanded Medicaid to include more people - before the household income cut-off was 100% FPL, but now it is 138% FPL. Medicaid varies state-by-state, so not all states went forward with the expansion. 

If your state did not expand Medicaid, you can enroll in a private plan for as little as $1 per month with a brand-name insurance company of your choice based on household income and family size instead.

• If you're under 30 years old, you'll have a "catastrophic" plan option. In addition to the four basic plan choices (Platinum, Gold, Silver, Bronze), you'll have a fifth choice - a "catastrophic" plan - which has a much lower monthly premium but much higher out-of-pocket costs when you use your plan. 

• If your under 26 years old, you can be covered on your parent's health insurance plan. ACA has lengthen the amount of time that young adults can be covered on their parent's health insurance plan. Until your 26th birthday, you can be covered under your parent. You do not have to be a full-time student, you can married, and your parents do not have to claim you as a dependent. 

• Don't forget: You're required to have health insurance, or pay a penalty. Unless you qualify for an exception, you're required to have health insurance or pay a penalty starting in 2014. Qualified insurance could be job-based coverage (your's, your spouse's, or your parent's), private health insurance, Medicaid or another government-sponsored insurance plan. You might decide it's better to go with the low-cost catastrophic plan to avoid the penalty and the potential for bankruptcy if you got bad sick.

Improved Benefits

• You can't be turned down for pre-existing conditions anymore. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or if you use your health plan very often. And no insurance company can drop you just because you get sick. 

• You can't be charged extra premium for pre-existing conditions, gender, profession, or how often you use your plan. Also, premiums are changing so that older individuals cannot pay more than three times what a younger person pays for health insurance.  

• All plans cover Essential Health Benefits with no yearly or lifetime limits. All plans must include coverage for a set of benefits with no yearly or lifetime limits, so you can never run out of insurance for core care. Essential Health Benefits includes doctor office visits, hospitalization, prescriptions, preventive care, and more. 

• Is your family growing? All new plans must include coverage for maternity. If you're pregnant now, you cannot be turned down by any insurance company. And when the baby arrives, you'll get free well checkups and immunizations for your baby. 

• Dental and vision care for children under age 19. Is your child overdue for a dental cleaning? Is she squinting to see the board at school? Good news! Dental and vision care for children is included in all new health plans. 

• Children up to age 26 can be covered on a parent's health insurance. ACA allows for children up to age 26 to be covered under a parent's health insurance plan. It does not matter if your child is married, a student, or if you claim them as a dependent, or not. They can be covered with under your plan until they turn 26 - no questions asked. 

• Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. Preventive care for children is included, too. 

You still have the power of choice

• Choose your insurance company. Even if you accept a tax subsidy -  where the government helps pay your health insurance costs so your plan stays affordable - you still have the power of choice. 

These plans are not issued by the government, but instead, they are issued by private, brand-name insurance companies like BlueCross BlueShield, United Healthcare, Humana, Kaiser Permanente, and more. 

Like a particular insurance company? Don't like a different one? No problem! You choose where you want to use your tax subsidy from the participating insurance companies in your area. 

• Choose your benefits. Whether you qualify for a tax subsidy or not, you'll be choosing from four categories of plans: Platinum, Gold, Silver, or Bronze. 

If you are less than 30 years old (or none of the other plans are affordable), you'll have a fifth plan choice - a "catastrophic plan" - where you'll pay more when you use your plan but pay less each month for the premium.

Keep in mind that subsidies are calculated based on the second lowest cost Silver plan in your area. So if you want to pay less monthly premium, you could enroll in a Bronze plan instead. You'll pay more when you use your plan, but you'll pay much less each month for insurance. 

Be sure to check out our GUIDE to help you choose between the Platinum, Gold, Silver, or Bronze plans.

And if you're overwhelmed, don't worry, we're here to help. We are tried and authorized to walk you through your options.

Early Retiree's (Under age 65) Guide to Health Reform

The Affordable Care Act (ACA) - often called Obamacare - is a new law helping more Americans get health insurance.

You are eligible for Medicare when you turn 65, but many Americans retire before that time. Before ACA, many early retirees found themselves stuck without many good insurance options. But now, the law is making it easier for you to enroll in quality, affordable coverage.

Learn more about how it will affect early retirees.


What health insurance options do you have when you retire before age 65?

1. COBRA or another continuation option. Workers and families who lose job-based heath insurance can choose to continue group health benefits for a limited period of time - usually 18 months, sometimes 36 months. You can be charged up to 102% of the monthly insurance premium. This option is generally only available for businesses with 20 or more employees on the group plan during the prior year.

• If your business is too small to offer COBRA, you might have a different continuation option. This will vary by state.

• Your employer might offer a special retiree health plan. If so, you could consider this option, too. 

2. Be added to your spouse's health insurance plan. If your spouse has job based coverage through his or her employer, you can be added to that health insurance plan when you retiree. Loss of coverage is one of the triggering events that allows you to be added to a group health insurance plan outside of the Open Enrollment election period.

3. Enroll in a private individual health insurance policy. The Affordable Care Act has made changes to private health insurance policies that will make it easier for you to enroll in quality, low-cost coverage.

Health Insurance benefits have improved

You can't be turned down for pre-existing conditions. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or if you use your health plan very often. And no insurance company can drop you just because you get sick. All plans cover Essential Health Benefits. All plans must include coverage for Essential Health Benefits, which includes doctor visits, hospitalization, tests, screenings, prescriptions, and more. 

Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. 

No benefit limits. New insurance policies have no yearly or lifetime benefit limits, so you can never run out of insurance. 

Plans are becoming more affordable

• You cannot be charged extra premium because of pre-existing conditions, gender, or how often you use your plan. Before ACA, people with pre-existing conditions like diabetes, cancer, heart problems, or high blood pressure might be charged very high premiums, if they were approved at all. But now, health insurance companies can no longer penalize you.

• Changes in pricing for older adults. In the past, insurance companies could charge older adults much more than younger adults - sometimes up to six times higher. ACA says that insurance companies can't charge you more than three times more than they would charge a younger adult.  

• Qualify for discounts on your health insurance. The new law has made it possible for about 26 million Americans to qualify for tax subsidies to lower their healthcare costs, and you might be one of them. Your tax subsidy is paid directly to your insurance company to lower the monthly premium or out-of-pocket costs on your private health insurance policy. 

The amount of subsidy you get is based on family size and household income. The income maximum for one person is about $45,000 per year. Use our calculator to see if you qualify for reduced costs - or contact us - we're trained and authorized to help you through the enrollment process. 

You still have the power of choice

• Choose your insurance company. Even if you accept a tax subsidy -  where the government helps pay your health insurance costs so your plan stays affordable - you still have the power of choice. 

These plans are not issued by the government, but instead, they are issued by private, brand-name insurance companies like BlueCross BlueShield, United Healthcare, Humana, Kaiser Permanente, and more. 

Like a particular insurance company? Don't like a different one? No problem! You choose where you want to use your tax subsidy from the participating insurance companies in your area. 

• Choose your benefits. Whether you qualify for a tax subsidy or not, you'll be choosing from four categories of plans: Platinum, Gold, Silver, or Bronze. 

Keep in mind that subsidies are calculated based on the second lowest cost Silver plan in your area. But you can upgrade or downgrade plans to best suit your needs.  

A couple of things to consider when choosing a plan

• Provider network. We know that insurance plans have a network - or a list of doctors and other healthcare providers that accept that insurance. When you use a doctor on the list, you pay less. When you use a doctor not on the list, you pay more. It's important to know if your favorite doctors take the insurance plan you're interested in before you decide. 

• You'll probably notice fewer doctor choices under ACA.  Networks are getting smaller, so if there's a doctor you love, you might want to ask them what insurance plans they accept. If your doctor doesn't take the insurance plan you want, see if there are other doctors close-by that you'd like to try instead.   

• Don't forget about your prescriptions. Most of us have no idea how much our prescriptions actually cost because we've been paying copays at the pharmacy for years. If you take prescriptions - especially more expensive brand name drugs -  you'll want to make sure your plan covers your particular prescriptions before enrolling. Remember: All new plans must cover prescriptions but not every prescription has to be covered - only one drug per class must be included. 

Be sure to check out our GUIDE to help you choose between the Platinum, Gold, Silver, or Bronze plans.

And if you're overwhelmed, don't worry, we're here to help. We are tried and authorized to walk you through your options.

A Single or Expectant Parent's Guide to Health Reform

The Affordable Care Act (ACA) - often called Obamacare - is a new law helping more Americans get health insurance.

Learn more about how the law will affect single or expectant parents.

Explore different options for your children

There are lots of ways that you can provide health insurance to your children at little to no cost. ACA has made some changes that make it easier for children to gain access to quality health insurance.

• Tax Subsidies. You might qualify for a tax subsidy, which is kind of like a discount on a new health insurance plan. Your subsidy can used to lower how much you pay each month for insurance or reduce how much you pay when you use your plan. The subsidy will be paid by the government directly to your brand-name insurance company.  

• Medicaid Expansion. Under the new law, Medicaid has been expanded to include more people. The income cut-off used to be 100% FPL, but it has been raised to 138% FPL starting in 2014. 

• Children's Health Insurance Program (CHIP). Since 1997, each state has offered a program to help cover children whose families make too much money for Medicaid but still require some financial assistance toward health insurance. See if your children qualify for CHIP in your state. 

If your household income is below 400% Federal Poverty Level (FPL) - that's about $94,000/ year for a family of four - you'll probably qualify for a subsidy. The less you make, the bigger your subsidy. A bronze plan can be sold for as little as $1 per month by using tax subsidies. Go to www.Healthcare.gov for more information. Or, contact us! We are authorized to help you qualify for subsidies and enroll in your plan. 

Medicaid can vary state-by-state, and not all states choose to go forward with the expansion. Qualifying for Medicaid also varies by state, so your children might qualify for Medicaid even if you don't. www.Medicaid.gov

Benefit changes that are helping children 

• No child can be turned down for health insurance because of pre-existing conditions or health history. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or use your health plan often. And no insurance company can drop you just because you get sick. 

• You can't be charged extra premium for pre-existing conditions. All pre-existing conditions are covered. Insurance companies can longer penalize your child for having pre-existing conditions.  

• All plans cover Essential Health Benefits with no yearly or lifetime limits. All plans must include coverage for certain benefits with no limits so you can never run out of insurance for core care. Essential Health Benefits includes doctor office visits, hospitalization, prescriptions, and more. 

• Dental and vision care for children under age 19. Is your child overdue for a dental cleaning? Is he squinting to see the board at school? Dental and vision care for children is included in all new health plans. 

• Children up to age 26 can be covered on a parent's health insurance.  It does not married if your child is married, a student or not, or if you claim him/her as a dependent. Up to age 26, they can be covered with you - no questions asked. 

• Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include free preventive care for your kids for things like checkups and immunizations. 

Changes in maternity coverage 

• Pregnancy is longer a pre-existing condition. Remember how insurance companies used to ask, "Are you pregnant?" on an application for private health insurance, and then they would usually decline you? Or not cover the pregnancy? Not anymore. Now insurance companies cannot turn you away just because you are pregnant. But you must enroll during Open Enrollment: October 1, 2013 - March 31, 2014.

• Maternity care is always covered. On all new health plans, all your maternity visits and delivery are covered. And when you're baby arrives, you can add him or her to your plan.

• Your new baby might actually lower your health insurance costs. Remember that tax subsidies are based on household income and family size, and your family size is growing. A tax subsidy is the amount the government pays directly to your insurance company to keep your health insurance affordable. 

• What if the baby is born after Open Enrollment ends? No problem. Birth is a qualifying event, which allows you to enroll in a new health plan at an odd time of the year. It's good to plan ahead, so you can make your plan choice right after the baby is born. 

The power of choice 

• Choose your insurance company. Whether you qualify for a tax subsidy or not, you can still choose your insurance company from the ones offered in your area. A tax subsidy is the amount paid by the government directly to your private insurance company to help make your health insurance more affordable. 

• You'll have four plan choices: Platinum, Gold, Bronze, and Silver. See the guide at the bottom to help you compare the plan choices. If you're under 30 years old (or all other plans are still unaffordable for you), you'll have a fifth "catastrophic plan" choice, which has a lower monthly premium but you'll pay much more when you use your plan.  

Something to think about 

Before choosing your plan, consider the network of healthcare providers that you can use.

• Provider network. Most health insurance plans have a list of doctors, hospitals, and other providers that are in the network. When you use doctors on that list, you'll pay less. When you use doctors who are not on the list, you'll pay more. And sometimes there's no coverage at all for providers who aren't on the list. Doctor and hospital choice is especially important to parents and expectant parents.  

• You'll probably notice fewer doctor choices under ACA. And some plans might not cover your care at all if you don't use a provider on the list. So if there's a doctor you love, ask them if they take the insurance plan you're considering before you enroll. Or, you can always go online to the insurance company's website and look at their provider directory.  

• Questions to ask yourself: "Will my child's pediatrician take this insurance plan?" And if you're pregnant, "Is my OB-GYN on the list? What about my delivering hospital?" It's a good idea to figure that out before you make a final decision about your insurance. 

• If you're pregnant, you might want to consider a better benefit plan. You already know that you're going to have a lot of doctor visits and probably a hospital stay, so it might be a good idea to consider a lower out-of-pocket plan - like Platinum or Gold - as long as the premium is affordable for you. Use the guide below to help you decide. 

Be sure to check out our GUIDE to help you choose between the Platinum, Gold, Silver, or Bronze plans.

And if you're overwhelmed, don't worry, we're here to help. We are tried and authorized to walk you through your options.

Individual & Family Guide to Health Reform

The Patient Protection and Affordable Care Act - often called Affordable Care Act (ACA) or Obamacare - is a new law helping more Americans get health insurance.

Learn about how the law is affecting Individual & Family policies.

Qualify for Lower Costs 

• Get discounted health insurance. You can qualify for a tax subsidy to help pay for your monthly premium and out-of-pocket costs when you use your plan. A tax subsidy is money that the government will pay directly to your brand-name insurance company to make your insurance more affordable. 

•  Medicaid Expansion. Under ACA, Medicaid has expanded to include more people. The income cut-off used to be 100% FPL, but it was raised 138% FPL. Medicaid can vary state-by-state, and not every state choose to go forward with the expansion. 

• Children's Health Insurance Program (CHIP). Since 1997, each state has offered a program to help cover children whose families make too much money for Medicaid but still require some financial assistance toward health insurance. 

• Medicare. If someone in your household is 65 years old or older, they qualify for Medicare. You get Part A (hospitalization) at no cost and pay a monthly premium for Part B (medical). Medicare is considered qualified coverage, so you don't need to make any changes to be compliant with the law. ACA made almost no changes to Medicare, except for shrinking the "donut hole" in Part D prescriptions plans over the next several years

Improved Benefits

• You can't be turned down for pre-existing conditions anymore. On all new plans, you are guaranteed acceptance no matter if you have a pre-existing condition or if you use your health plan very often. And no insurance company can drop you just because you get sick. 

• You can't be charged extra premium for pre-existing conditions, gender, profession, or how often you use your plan. Also, premiums are changing so that older individuals cannot pay more than three times what a younger person pays for health insurance.  

• All plans cover Essential Health Benefits with no yearly or lifetime limits. All plans must include coverage for a set of benefits with no yearly or lifetime limits, so you can never run out of insurance for core care. Essential Health Benefits includes doctor office visits, hospitalization, prescriptions, preventive care, and more. 

• Is your family growing? All new plans must include coverage for maternity. If you're pregnant now, you cannot be turned down by any insurance company. And when the baby arrives, you'll get free well checkups and immunizations for your baby. 

• Dental and vision care for children under age 19. Is your child overdue for a dental cleaning? Is she squinting to see the board at school? Good news! Dental and vision care for children is included in all new health plans. 

• Children up to age 26 can be covered on a parent's health insurance. ACA allows for children up to age 26 to be covered under a parent's health insurance plan. It does not matter if your child is married, a student, or if you claim them as a dependent, or not. They can be covered with under your plan until they turn 26 - no questions asked. 

• Free preventive care. Health insurance isn't just for when you get sick - it's also for keeping you well so you don't get sick. All new plans include 100% coverage for preventive care - things like physicals, labs, screenings, pap smears, mammograms, PSA tests, colonoscopies, and more. Preventive care for children is included, too. 

You still have the power of choice

• Choose your insurance company. Even if you accept a tax subsidy -  where the government helps pay your health insurance costs so your plan stays affordable - you still have the power of choice. 

These plans are not issued by the government, but instead, they are issued by private, brand-name insurance companies like BlueCross BlueShield, United Healthcare, Humana, Kaiser Permanente, and more. 

Like a particular insurance company? Don't like a different one? No problem! You choose where you want to use your tax subsidy from the participating insurance companies in your area. 

• Choose your benefits. Whether you qualify for a tax subsidy or not, you'll be choosing from four categories of plans: Platinum, Gold, Silver, or Bronze. 

If you are less than 30 years old (or none of the other plans are affordable), you'll have a fifth plan choice - a "catastrophic plan" - where you'll pay more when you use your plan but pay less each month for the premium.

Keep in mind that subsidies are calculated based on the second lowest cost Silver plan in your area. So if you want to pay less monthly premium, you could enroll in a Bronze plan instead. You'll pay more when you use your plan, but you'll pay much less each month for insurance. 

Be sure to check out our GUIDE to help you choose between the Platinum, Gold, Silver, or Bronze plans.

And if you're overwhelmed, don't worry, we're here to help. We are tried and authorized to walk you through your options.

How are private exchanges helping Small Businesses?

The two biggest problems facing Small Business health plans today are cost and administration. And let's don't even get started about how Health Reform complicates things! A private exchange takes care of everything benefits so you can take care of your business.

Lowering your costs 

You'll get the buying power of our nationwide network, so you'll be choosing from lower priced plans. We'll develop a personalized financial strategy to save your business even more money. Our advice goes way beyond quotes on a spreadsheet. We'll develop a personalized financial strategy just for your business.

Small Business is not subject to any penalties for not offering insurance to their employees, so you have more options. You can select from low-cost business plans offered through the private exchange, or you can give your employees access to our Individual and Family private exchange instead. If your employees qualify for tax subsidies based on their family size and household income, they can only use it toward individual and family policies. We'll present all your options to you in everyday language so it makes sense. We'll be able to show you, down to the penny, which option saves you the most money.

By using a private exchange, you pick a fixed dollar amount to give to each employee to spend in the store. So you don't have to worry about renewal increases anymore. Employees login to the secure store that we'll build just for your business, and go shopping. Employees love building personalized benefit packages that are unique and perfect for them.

Administration Ease

We'll give you a custom benefit management system built just for your business. It will be branded for your business and we can load it full of whatever company information you'd like - maybe an events calendar, or employee handbook, or even a video message from you.

Employees login, set up a profile, and make their benefit selections from your store. As they are adding benefits to their shopping cart, they are enrolling online in those benefits. Each employee can download a benefit app to their smartphone to have 24/7 access to benefits or to make changes. Now Open Enrollment is a snap! Your benefit management system can also be linked to your payroll system, so employees can have access to payroll information and compensation statements. Get access to other private exchange technology and services such as Section 125, COBRA, FSA, HSA, or HRA administration.

Health Reform

It seems like everytime we turn on the television, we are hearing something about the Health Reform law, but it's still hard to know how it will affect personally or affect our business. And that's why you have the experts at our private exchange! You know that all the plans that you enroll in through the private exchange are 100% compliant with the new law. Our experts will handle any calculations, reporting, or employee notifications required under the Affordable Care Act for your business.

How are pregnancy and birth control covered by new health plans?

Pregnancy will be covered on new individual and family health plans 

New plans must include coverage for pregnancy as part of the Essential Health Benefits coverage. You must enroll in an Affordable Care Act compliant plan with an effective date of January 1, 2014 or after.

If you are planning on keeping your current coverage and are interested in maternity coverage, it's a good idea to check your plan before making a final decision on new plan options.  

Covered contraceptive methods

New plans must also offer cover contraceptive methods and counseling for all women, as prescribed by a health care provider.

These plans must cover the services without charging a copayment, coinsurance, or deductible when they are provided by an in-network provider.

All Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

• Barrier methods (used during intercourse), like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Sterilization procedures
• Patient education and counseling

Plans aren’t required to cover:

• Drugs to induce abortions
• Services related to a man’s reproductive capacity, like vasectomies

The Exchange App is included in all our business plans

There's no doubt about it: we all live busy lives. There's so many personal and professional obligations that sometimes it's nearly impossible to manage.

So for many of us, a smartphone is our lifeline. We use them to manage our time and responsibilities, to receive information on-the-go, and stay connected to others.

We understand the importance of having quick and easy access to information, especially when it comes to benefits. It seems like the only time we really need the information is when it's hard to access it - like, when we're driving a sick child to the Emergency Room, standing in line at the pharmacy, or sitting in the doctor's office waiting room.

That's why we developed the smartphone Exchange App, which is included in all our business plans. Employees can enjoy 24/7 access to their benefits, claims, or check provider networks. They can enroll in benefits or make changes right there on their phone.

Employees can also use the app to access any of the information included in the company's custom benefit management system: payroll information, Human Resource policies and procedures, company announcements, update profile information, make changes to dependent status, get quotes on voluntary insurance products, and more.  

The Exchange App is just one more way that we're making employee benefits simple.

What happens if a Large Business doesn't offer health insurance to it's employees?

You are subject to penalties starting in 2015.

What is the penalty?

If you are a Large Business (50 or more employees), then you are required to offer health insurance or pay a penalty in 2015. The penalty for not offering health insurance is $2,000 per employee per year. You get a waiver for the first 30 employees.

So, for example, let's say that your business employees 72 full-time equivalents and you don't offer qualified health insurance.

You get a waiver on the first 30, so that leaves 42 employees to pay penalty for.
42 x $2,000 = $84,000 annual penalty.

Is it better to pay or play?

Many Large Businesses are asking if they should pay or play? Is it better to not offer health insurance and pay the annual penalty or is it better offer affordable health insurance to their employees?

Our Pay or Play Calculator will show you, down to the penny, the cost for both options. And we'll advise you on the pros and cons of each.

What if my plan is not affordable?

A Large Business plan has to pass an Affordability Test for each and every employee. What the employee pays toward the employee-only premium cannot exceed 9.5% of his/her Modified Adjusted Gross Income.

If your plan is unaffordable, and at least one employee tries to use a tax subsidy to get lower costs on Individual or Family Insurance plans, then the penalty is $3,000 per employee per year.

For example, if there was a business with 72 employees:

72 employees x $3,000 = $216,000 annual penalty

What about the plan I have now for Large Businesses?

You can keep it. You shouldn't see any changes in benefits or pricing until you next plan renewal.

How the Affordable Care Act changes Large Business Plans 

Under ACA, a Large Business is one with 50 or more full-time equivalent employees.

The Affordable Care Act had very little effect on  how Large Business health plans are underwritten, priced or the benefits they will provide. However, there were significant changes to Individual, Family, and Small Business plans under the new law.

The law affects Large Business plans by penalizing employers who do not offer health coverage to employees. A Large Business is also penalized if the plan offered doesn't pass the Affordability Test for each employee.

Penalties have been delayed until 2015 to give Large Businesses time to make sure that their plan is compliant with the law. Our experts will conduct a review of your plan and show you all your options. When you work with a Private Exchange, you know that your plan is 100% compliant. And the exchange takes care of all the required reporting, calculations, and employee notifications for you.

You can keep your current group plan and still use the Private Exchange technology and services such as a smartphone benefit App, custom benefit management system, intra-office communication, payroll services, outsourced Human Resources, COBRA, FSA, HSA Administration, and more.

How do I know if our health plan is affordable under the Health Reform Law?

The employee portion of the monthly premium cannot exceed 9.5% of his or her Modified Adjusted Gross Income.

What is considered in the Affordability Testing?

For the Affordability Testing, you'll look at 1) what the employee pays toward employee-only coverage (not family coverage) 2) the employee's annual income (not the household income).

Originally, the intent of the law was to ask employers to gather income from the employee's entire family and calculate affordability of the family premium, but it was determined that it would be too difficult on the employer and leave too much room for error. The unintended consequence of this change was that many families who would have qualified for subsidy will not be able to use it if the employee passes the Affordability Test.

How do we handle the testing?

You don't have to because we will. Our experts will determine if your plan is affordable for each employee. And if it's not, we will show you several different strategies and advise you on which option is best for your business.

What is considered a full-time equivalent employee under the Health Reform law?

A full-time equivalent employee (FTE) is one who is a true employee of your business, generally receiving a W-2 at the end of the year, who works 30 or more hours per week.

Why is it important to know how many FTEs work for my business?

It's important because you need to know if you are considered a "Small" or "Large" Business under the Affordable Care Act. A Small Business is defined as one with less than 50 FTEs (2-49). A Large Business has 50 or more FTEs employed. If you are Self-Employed (business of one), then you are considered a business but not an employer, so you will shop for Individual and Family policies instead. 

The pricing, benefits, and how plans are issued by the insurance company will be different for Small and Large Businesses. 

Do I count part-time or seasonal employees?

You do not have to offer benefits to part-time or seasonal employees, but they can partially count toward your total number of FTEs.

For every 30 hours worked by different part-time employees, it counts as one FTE. For example, if you have two part-timers who work 15 hours per week, together they work 30 hours per week and count as one FTE. 

Seasonal employees only count toward your total number of FTEs if they work 120 or more days in the year. 

How to calculate your Modified Adjusted Gross Income (MAGI)

Generally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income and any tax-except interest income you may have (amounts on lines 37 and 8b from IRS Form 1040).

How to calculate your Gross Income (GI)

Your gross income is the total money you earn through wages, interests, dividends, rental income, royalty income, capital gains, business income, farm income, unemployment, and alimony. It includes your salary, interest, income from investments, and any income you made through business, trade, or investments.

How to calculate your Adjusted Gross Income (AGI)

This is your GI minus your IRS deductions: things like IRA contributions, moving expenses, alimony paid, self-employment taxes, and student loan interest.

GI - Deductions = AGI

How to calculate your Modified Adjusted Gross Income (MAGI) and why it's important to healthcare

The MAGI is the magic number that determines if you qualify for a tax subsidy to lower the premium or out-of-pocket expenses through an Individual or Family health policy through the exchange.

Your MAGI is your ADJ with some items added back and counted again.

AGI + IRA Contribution Deductions + Student Loan or Interest Deductions + Excluded Foreign Income + Employee Savings Bonds used to pay higher education + Employer-paid adoption expenses = MAGI

It's simpler than it seems

For most people, the AGI is the same as their MAGI. .

What if I lose health coverage through my job?

If you lose your health coverage at your job, you have 2 main options for health insurance: 1) Enroll in an individual or family plan through the private exchange or 2) Continuing your group coverage through COBRA.

Get the Facts

If you lose your job and/or your job-issued health insurance, you may want to buy an individual or family plan through the private exchange. 

If you qualify for a tax subsidy based on your family size and household income, you can enroll in the government-sponsored plans through the private exchange. Your plan will be issued by a brand-name insurance company. 

If you do not qualify or don't want to use a subsidy, you can enroll in a private plan offered through the private exchange instead. We offer both public and private plans options. 

Or, you may have the option of continuing your coverage for a period of time through COBRA. COBRA is generally for employers with 20 or more employees on the plan, so if your employer is too small for COBRA, you might have a different continuation option in your state. 

• 1) Get an individual or family plan in the exchange If you lose your health insurance through your job for any reason, you can enroll in a private plan through the exchange. This is true even if you leave your job outside the Open Enrollment period (first year is October 1, 2013 to March 31, 2014). By using the exchange, you could qualify for lower costs based on your household income to keep the plans affordable for you. You can't be turned away or charged more because of pre-existing conditions, how often you use your plan, gender, or profession. Pre-existing conditions and pregnancy are always covered. All plans must include Essential Health Benefits (things like hospitalizations  ER, Rx, etc) with no yearly or lifetime limits so you can never run out of insurance for core care.   
• 2) Use a continuation option for smaller businesses (varies by state) COBRA might not be available to you if your employer is too small to qualify for COBRA (generally speaking, "too small" means employers with less than 20 employees on the health plan for more than half of the previous plan year). If COBRA isn't an option, there might be a different continuation option for small employers in your state. COBRA is a federal law that may let you pay to keep you and your family on your employee health insurance for a limited time (usually 18 months) after your employment ends or you lose coverage through your job.

If you decide on COBRA continuation coverage, you won't be able to get any of the lower costs on premiums or out-of-pocket expenses when you use your plan. You can only qualify for reduced costs through individual or family private plans in the exchange. 

Individual Requirement to have health insurance

If you do not have coverage that is considered minimum essential coverage (this could be a private plan, coverage through your job, or a government-sponsored health plan like Medicaid, Medicare, CHIP, Tri-Care, etc.) starting in January 2014, you have to pay a penalty if you don't qualify for an exception. You will also have to pay all of the costs for your health care and will have no financial protection if you get sick. 

What if I have insurance through my job?

You can keep it. You're considered covered under the new Health Reform law. 

But you may be able to change to enroll in new coverage through the exchange if you want to.

Any job-based health plan you currently have qualifies as "minimum essential coverage" under the law. You don't need to change to a new plan in order to avoid the fee that uninsured people may have to pay for 2014.

Comparing job-based and Exchange plans

With most job-based health insurance plans, your employer pays a portion of your premiums (usually about 50% of your portion of the monthly premium). If you choose a private exchange plan instead for you (as individual or as family), your employer will not likely pay any toward the premium. 

Qualifying for exchange savings in 2014

If you decide to shop for new plans in the exchange, you can. You'll still be entitled to all the new benefits and underwriting. You won't be turned down or charged more premium for pre-existing conditions  claims, gender or profession. Pre-existing conditions and pregnancy are always covered. All new plans must include a of Essential Health Benefits with no yearly or lifetime benefit limits so you can never run out of insurance for core care. 

But be aware that you may not qualify for lower costs on your monthly premiums and out-of-pocket costs (things like deductibles, copays, etc), even if your income qualifies you for it.

Whether you qualify for lower costs in the exchange based on income will depend on what kind of coverage your employer offers. 

If your job-based coverage is considered affordable and meets minimum value, you won't be able to get lower costs in the exchange. This is true no matter what your income and family size are.

Your employer can tell you whether the insurance plan it offers meets minimum value and can provide you with information to determine if the plan is considered affordable to you.

If you do not qualify for lower costs in the exchange, and your employer does not pay part of your premiums on new plans in the exchange, be sure you take these things into account before you consider choosing a plan other than your employer’s.

What if I have PCIP coverage?

Coverage through the federal Pre-Existing Condition Insurance Plan (PCIP) ends on December 31, 2013. You must take action by December 15 to avoid a coverage gap.

Why is PCIP coverage ending?

PCIP will not pay for services you get after December 31, 2013. If you don’t sign up for new coverage by December 15, you won’t have health insurance coverage on January 1, 2014.

When the health care law was signed in 2010, it created PCIP as a temporary program. PCIP made health coverage available to uninsured people with pre-existing conditions until key parts of the law took effect.

PCIP enrollees have new options

Starting in 2014, health insurance companies can no longer deny you coverage or charge you more because of your health condition. Pre-existing condtions must be covered and you can't be penalized for having them. You might qualify for lower monthly premiums or lower out-of-pocket costs (things like deductibles, copays, etc) based on household income. New plans through the exchange are based on a sliding scale to keep them affordable for you while offering you comprehensive coverage for your your health conditions. 

Now you have more choices for health coverage. You can get coverage in the individual market, through your employer, or from public programs like Medicaid and the Children’s Health Insurance Program (CHIP).

Enroll by December 15 for coverage that starts January 1

You must enroll in a new health plan by December 15, 2013 in order to have coverage that starts January 1, 2014. If you enroll after December 15, your coverage can start no earlier than February 1, 2014.

Open enrollment for the exchange ends March 31, 2014.

You must take action to get new coverage because PCIP coverage does not automatically convert to an exchange plan.

What dates should I mark on my calendar?

For shopping in the exchange for new coverage:

There are 3 key dates to remember: 

• October 1, 2013: Open enrollment starts
• January 1, 2014: Health coverage can start
• March 31, 2014: Open enrollment ends

If you want to secure new coverage and try to lower your costs based on your household income, you'll need to make a plan selection during Open Enrollment. If you miss it, you'll have to wait until the next year's Open Enrollment to qualify for lower costs (October 1, 2014-December 31, 2014)

You can apply for Medicaid and CHIP any time

Medicaid provides low-cost or no-cost insurance to low-income individuals or families. Children’s Health Insurance Program (CHIP) provides insurance to children whose family's incomes are too high for Medicaid but they still need some financial assistance. These are both administered by your state and can vary depending on where you live. If you qualify for Medicaid or CHIP, your coverage can begin immediately. You can also apply for coverage at any time. 

Self-Employed will use the Individual and Family Exchange to secure coverage

Under the law, if you are Self-Employed (business of one), then you are not considered an "employer" under the Affordable Care Act. Therefore, you'll be able to use the exchange to qualify for lower monthly premiums or out-of-pocket expenses based on your household income on new plans... if you don't have access to an affordable job-based plan through your spouse's employer or other government-sponsored coverage. Be sure to mark those 3 dates at the top of this post on your calendar  Open Enrollment rules will apply to you.

Small employers can start coverage any time

A small employer has less than 50 full-time equivalent employees. Small employers generally may start offering health insurance coverage to their employees through the exchange at any time during the year.

Large employers can start coverage any time

A large employer has 50 or more full-time equivalent employees. Small employers generally may start offering health insurance coverage to their employees through the exchange at any time during the year.

What if I'm a part-time employee and my employer doesn't offer coverage?

If you’re a part-time worker and you don't have access to coverage through work, you may be able to buy health insurance in the exchange and qualify for lower costs based on your household income.

If your employer doesn’t offer health insurance to part-timers

You may be able to get lower costs on your monthly premiums and out-of-pocket costs based on your household size and income.

You may also qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

If your employer does offer coverage to part-timers

If you’re offered coverage through an employer, you may buy insurance through the exchange instead, but in most cases, have access to affordable coverage through work means you can't qualify for lower costs for private plans based on income. 

You would be eligible for lower costs only if the coverage your employer offers isn’t considered affordable to you or doesn’t meet certain minimum standards.

How are exchanges helping individuals and families?

If you need coverage, you can use the exchange to enroll. If you have coverage, you gain new rights and protections through the exchange. 

But if you don’t have any qualified coverage (individual or family coverage, plan through your job or your spouse's, or a government-sponsored plan), you may have to pay a fee.

Exchanges and what’s changing in 2014

Whether you’ve been uninsured, you’ve been turned down for health insurance in the past, or you just want to see if you can save money and get better coverage under the new law, the exchange will give you more choices. And, you'll have more control over your benefits. No matter where you live in the United States, you'll have access to the new health plans. 

By using a private exchange, you can compare coverage options based on price, benefits, quality, and more. You can compare private and government-sponsored plans side-by-side. You can choose the combination of price and benefits that fits your budget and meets your needs.

• You can get lower costs on coverage: Many will qualify for lower monthly premiums or out-of-pocket costs (like deductibles, copays, etc) on private insurance through the exchange. Subsidies are on a sliding scale to keep insurance affordable for you based on your household income.
• Essential health benefits are covered in the exchange: All plans must offer Essential Health Benefits including doctor visits, preventive care, hospitalization, prescriptions, and more - with no yearly or lifetime benefit limits, so you can never run out of insurance on core care. 
• Pre-existing conditions will be covered: Plans won’t be able to deny you coverage or charge you more due to pre-existing health conditions, including a pregnancy or disability.
• An exchange can help you make decisions:  Find out if you qualify for lower premiums, check doctor networks, compare plans side-by-side, calculators for tax subsidies or Small Business Tax Credits, watch videos to help you make choices: these are just some of the helpful tools you can use through the exchange. And you'll have access to a nationwide team of benefit specialists and Health Reform experts if you need personalized assistance. 
• Fees begin: Beginning 2014, most people are required to have health coverage. Coverage could be a plan you purchase yourself, coverage through your job or your spouse's job, or a government-sponsored plan. Without qualified coverage, most people will be charged a fee starting in 2014. 

Open enrollment for exchange plans begins October 1, 2013 and runs through March 31, 2014. Coverage begins as early as January 1, 2014.

What are Essential Health Benefits?

All new individual and family plans issued January 1, 2014 or after must include coverage for Essential Health Benefits. No insurance company can put a yearly or lifetime maximum on Essential Health Benefits so you'll never run out of insurance for core care.

The essential health benefits include at least the following items and services:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (such as surgery)
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

Essential health benefits are minimum requirements for all plans in the exchange. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the exchange.

Can I keep my own doctor?

You may be able to keep your doctor and use one of the new plans, depending on the plan you choose.

Different plans have different doctor choices

A network is a list of hospitals, doctors, specialists, pharmacies, and other health care providers that participate in your plan. The health care providers have contracts to take care of the plan's members (that's you!). Depending on the type of policy you buy, care may be covered only when you get it from a network provider.

When comparing plans in the exchange, you will see a link to a list of providers in each plan’s network. If staying with your current doctors is important to you, check to see if they are included before choosing a plan.