What does “off the exchange” and “on the exchange” mean?

"Off the exchange" refers to buying coverage through the private market without a premium subsidy.  If you are buying "off the exchange," your income is over the 400% Federal Poverty Level or you have access to affordable group coverage through an employer or through a spouse's employer.  You will not qualify for a subsidy. The term "on the exchange" refers to buying coverage that will be subsidized through premiums credits and/or cost sharing reductions.  If you are buying "on the exchange," you are in the 100-400% of the Federal Poverty Limit and have do not have access to group coverage through an employer or a spouse's employer.

Will any coverage be free under Obamacare?

In some cases, premiums can be reduced to the point of no premium owed.  This often happens with high deductible plans with a large subsidy. Premiums can be reduced based on your subsidy or cost sharing reductions, but each person will have to pay some premium for their coverage.  Some premiums could be as low as $19 per month for plans with very low co-pays and out of pocket maximums.

What are cost sharing reductions?

In addition to subsidies, those who fall under the 250% Federal Poverty Level will qualify for cost sharing reductions.  This will allow you to upgrade your plan for no costs.  It will mean lower co-pays, deductibles, and total out of pocket expenses.

What if I have a pre-existing health condition?

The law requires health insurance companies to offer coverage to you regardless of any health conditions or pre-existing conditions.  Premiums will no longer be tied to your health or gender at application, but will be based on the following factors:
  • Household income and size (determines subsidy)
  • Smoker/Non Smoker
  • Geographical location
There will be no waiting periods or pre-existing conditions for coverage effective 1/1/2014 under the new law.

What are navigators?

Navigators are people who will be paid by the government to educate people on Obamacare (PPACA).  So far in North Carolina, few groups have come forward to operate as navigators.  Navigators cannot recommend a plan, they can simply help you review your options.  The law only allows licensed and trained insurance professionals to make plan recommendations.

What is the exchange?

The exchange is simply a place where different insurance companies will offer their various subsidized plans for consumers to compare.  The exchange is technically not a place, but a website.  If you qualify for a Obamacare subsidy, you will purchase your plan on the exchange.  If you do not qualify for a subsidy, you will purchase your plan off the exchange.  Only plans with subsidies will be shown on the exchange.  Since each subsidy will be different for each person/family, each plan premium and plan details will be different.  We expect there to be over 35 different plans available on the exchange in North Carolina.

What is Modified Adjusted Gross Income (MAGI)?

Your Modified Adjusted Gross Income (MAGI) is used to determine the level of subsidy you will receive with Obamacare.  The MAGI for Obamacare takes into account all household incomes (adults and children).  You MAGI is calculated by totaling your household income, subtracting certain deductions allowable by the IRS.  It can be found by:  
  • Form 1040:  Totaling Line 37 + Line 8b on your prior year Tax Return (Form 1040)
  • Form 1040 EZ: Line 4
  • Form 1040A: Line 21
  This will help you determine your MAGI, however the final calculation of the MAGI will be determined by the Federal Exchange.   Not sure how this will impact your subsidy?  Still confused about which carrier will make the most sense for you?  We are here to help you.  Our enrollment process is lightning fast (5 minutes)!  We use software that ties into the back end of Healthcare.gov.  What does that mean for you?  It means you don't have to:  
  • Spend 45-60 minutes enrolling on Healthcare.gov
  • Verify your account via email
  • Avoid waiting "in line" when there is lots of traffic
  If you want our help, it's no additional cost to you.  We can help you avoid the pitfalls of choosing the wrong plan.  Networks, subsidies, cost share reductions are VERY important factors to review before selecting the plan you will have for all of next year.  Just click below to allow us to assist you!  

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What do I need to do for Obamacare?

On October 1, the North Carolina exchange will be open.  On that date, you can start comparing the various plan options available to you.  Enrolling before December 15th, will guarantee a January 1, 2014 effective date.  Why get coverage?  Because the law will limit when you can purchase insurance.  You can not purchase car insurance after you have had a wreck; the same will apply to health insurance after 2014.  We believe it's in people's best interest to choose a plan.  Depending on the subsidy level, the plan premium could be very affordable.

What is the Affordable Care Act in just a few words?

The Affordable Care Act (Obamacare) allows any individual the ability to purchase health insurance regardless of health conditions or pre-existing conditions.  For some North Carolinians, coverage could be lower than it has been in the past; however, there will be others who will pay more for coverage.

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