Obama Care Insurance for People without a Job

March 28, 2014 @ 00:12 Filed under: health care reform,ObamaCare — Alston


The Affordable Care Act can make the cost of health insurance low enough to be within the reach of an individual who is out of work. Although Obamacare benefits people with jobs, it can also benefit workers who have left their employer.

Former employees who have lost medical coverage because they lost their jobs, or had their hours cut, do not have to wait for the next open enrollment period. The law allows them to apply for coverage outside of the open enrollment period, but there are limits. You must apply within 60 days of separating from your employer.

If a person or family has an income below the federal poverty limit whether they work full time, part time or not at all, they will probably be eligible for a state sponsored Medicaid health plan. These plans are free or extremely inexpensive. In some states, the income limit is higher. It may also be higher for those with children and for women who are pregnant.

If you qualify for Medicaid (or Medicare), you will not qualify for an ACA subsidy. However, before the ACA healthcare subsidies were available, many Americans who lost their jobs but were not eligible for Medicaid had no other option for affordable coverage.

Unemployment compensation, or the income from a spouse was often enough to make one ineligible for the Medicaid program. At this time, the government offers either Medicaid or a subsidy for most people who make up to four times the federal poverty level.

The Affordable Care Act has the potential to reduce the number of people who lose their jobs and thereby cannot get medical services. Some of the people who would not have been able to afford the money to pay for health insurance in the past may have died or suffered a permanent disability due to a lack of care. Now many of them will get care, get well, and get back to contributing to a business. They will be able to provide for their families and pay taxes again which helps us all out. Maybe some will start companies that earn millions.

The mandate keeps insurers from denying coverage due to preexisting conditions. This means no one is asked about their health history before they sign and buy.

If you have lost your job and want to check your eligibility for health insurance at a good price, please call us. We will ask you a few questions about your yearly income and family size. We may be able to show you policies that cover doctors and prescription drugs with only a small copay and low premiums that fit your budget.

We are certified brokers for the health insurance exchange (the access health Connecticut marketplace) and can answer your questions and provide assistance by phone when you decide to enroll in an off or on exchange policy.

Obama Care and Health Insurance for Persons Over 65

March 27, 2014 @ 00:09 Filed under: health care reform,Medicare or Medicare Advantage — Alston


Most Americans have Medicare available to them after they reach age 65. However, for some this isn’t viable option. If you have not worked in the United States for 10 or more years, you will have to pay the full cost of Medicare parts A and B. This is often cost prohibitive.

If you are eligible for Medicare Part A without a premium, you can certainly call us for help choosing a health insurance policy that coordinates with Medicare. We can help you select a Medicare Supplement, Medicare Advantage policy (Part C) or a Prescription Drug plan (Part D).

This blog post, however, is written for those for whom Medicare isn’t an affordable option.

Those who immigrated to the United States later in life or who for whatever reason never worked here can take advantage of the Affordable Care Act so long as they are “lawfully present.” This includes, but isn’t limited to, those who are naturalized citizens and permanent residents.

Seniors with low to moderate incomes who apply for health insurance through the Connecticut health insurance exchange, can be eligible for subsidies that can dramatically lower their costs. The policies can cover doctors, hospitals and prescriptions.

Let us know if you would like price quotes or other information for yourself or your loved ones.

If I have Medicare do I need Obamacare?

March 25, 2014 @ 03:15 Filed under: Medicare or Medicare Advantage — Alston


If you are insured by Medicare, you do not need Obamacare.  You have a plan that meets the minimum standards and that can help you avoid a tax penalty.

If you are looking for insurance that coordinates with Medicare, please give us a call or request quotes online.  We can help you explore several different options for Medicare Advantage plans many of which include prescription benefits.

Deadline for Obamacare Insurance

March 22, 2014 @ 21:56 Filed under: ObamaCare — Alston


The first Affordable Care Act open enrollment period that started in October of 2013 ends on March 31, 2014. Unless you qualify for a special enrollment period, you will not be able to enroll in coverage until the next open enrollment period. The next open enrollment period starts on November 15, 2014 and ends on Valentine’s Day 2015.

The open enrollment period for the Affordable Care Applies to both on exchange and off exchange policies. The rules for boh on and off exchange policies are virtually the same with the exception of the fact that only on exchange (marketplace) policies can be subsidized. This post goes over some of the rules that apply to individuals and families that purchase their own insurance as opposed to those who get insurance through their employers or businesses.

If you do not have a health insurance policy that meets the minimum standards by March 31, 2014, you may pay a penalty when you file your taxes next year. HUSKY (Medicaid) and Medicare meet the minimum standards. Employer-sponsored coverage and individual/family plans typically do as well.

How do you qualify for a special enrollment period?

You can enroll or make changes to your health insurance policy at other times of the year if certain life events occur. If you qualify for a special enrollment period, you will have a limited time to take advantage of it. 60 days is the limit.

Qualifying life events include:

  • Having a child
  • Getting married
  • Losing your coverage involuntarily due to:
    • Divorce
    • Job loss
    • A move
    • Not being able to renew your present plan

If you have a blessed event, whether it involves medical professionals (birth) or legal ones (adoption) you can add your child to your policy or enroll in a new policy. However, be sure to do so as soon as is practical. If you wait more than 30 days to add your newborn to your policy the coverage may not be effective retroactive to the date of your child’s birth.

Please check your policy to see what the deadlines are.  The first month of life often involves costly medical intervention.

You have 60 days after the date of your marriage to enroll in coverage.

If you lose coverage due to a divorce, job loss, a move or due to your insurer refusing to renew your present policy you will be able to enroll in coverage without waiting for the next open enrollment period. Losing your coverage voluntarily because, for example, you failed to pay the monthly premiums will not create a special enrollment period.

If you move to another state or if you move to a new area within your state where new insurance options are available, you will likely qualify for a special enrollment period.

If you purchased a policy in 2012 or 2013, you will probably not be able to renew it again. If renewal is not an option, you will have 60 days to enroll in a new plan.

Do you questions about the new Federal law and how it applies to you?

If you live in Connecticut, we can probably answer your questions. Please feel free to call us at 203-374-3645 if you have a question, would like to sign up or would otherwise like to take advantage of our services.

If you are from another state, you may want to visit Healthcare.gov or irs.gov for answers.

Bill Payment Deadline Extended for Access Health CT

January 7, 2014 @ 23:09 Filed under: ObamaCare — Tags: , — Alston


For policies with a January 1, 2014 effective date

Our clients and anyone else who purchased through accesshealthct.com have until January 15, 2014 to pay their first bill if they purchased policies from Connecticare or HealthyCT.  The deadline to pay the first bill for Anthem policies is January 31, 2014.  Coverage will be in effect retroactively to January 1, 2014 so long as other requirements are met.

Anthem allows their new members to pay Anthem online so long as they have their application ID.  This is not the application ID you will see on accesshealthct.com documentation.  This is Anthem Blue Cross’ application ID that you should be receiving in the mail soon if you haven’t received it already.

Call Anthem at to get your application ID number at 1-855-738-6644.

If you are a client of ours, we can get your application ID for you but please try the number above first. If you have had to pay for prescriptions or medical care because you haven’t received a bill yet we can help you get reimbursed once you have your policy number. Please give us a call about either issue.

Once you have your application ID, you can pay Anthem online.

Should I Get Dental Insurance?

December 13, 2013 @ 05:32 Filed under: Medical and Dental Insurance — Alston


Over the years, many of our clients have asked about dental insurance. I have been hesitant to offer it without fully informing my clients about the limitations. I will try to do that in this blog post.

Dental Insurance Plans We Represent:

The following is a NOT insurance. It is a dental discount plan:

Health vs Dental Insurances

Medical insurance policies, especially in the Affordable Care Act era, are often just as comprehensive as options one might be offered through their employer. This is not true for dental coverage.

The products offered directly to individuals and families will invariably have significant limitations. This may mean that you are better off paying your dentists out of the money that you might otherwise pay in monthly premiums.

I have looked at several companies offering dental insurance over the years. I find that have similar shortcomings. These include:

Network Limits – Your dentist may not be on the list of network providers. You may have accept a lower level of reimbursement or receive no reimbursement if you get treatment from an out-of-network dentist.

Waiting Periods – Although preventive care is generally covered without a waiting period, other services are not. On one plan, if you need a filling or an X-ray, the service must be performed at least six months after your policy is effective or it will not be covered. On the same plan, oral surgery must be performed at least eighteen months after the effective date for it to be covered.

Dollar and Percentage Limits – You will have an annual dollar limit for covered services. You will need to pay a percentage of the cost of many services. The percentage may vary depending on the type of service.

Many families believe that they will be better off saving the money and paying their dental costs out of pocket. This is often the better choice, especially since the expenses covered by these plans have so many limitations.


Most if not all dental insurance policies do a good job of covering preventive care including cleanings.

Having coverage may have the benefit of helping you maintain a regular teeth cleaning schedule. You In essence, prepay for your exams and cleanings. You may rightly feel that if you don’t have your twice-yearly cleanings, you get no benefit out of what you paid for.

Who Qualifies For Obamacare?

November 24, 2013 @ 18:54 Filed under: health care reform,ObamaCare — Tags: , — Alston


If you are a US citizen or are “lawfully present,” and do not qualify for Medicaid or Medicare, you probably qualify for the federal program known as “Obamacare.”

(Being lawfully present includes having a green card and having a valid non-immigrant visa. You can find a more comprehensive list of immigration statuses that meet the requirements here.)

Qualifying for “Obamacare” does not mean that you are also eligible for a subsidy. (A subsidy is also known as a tax credit.)

Eligibility for “Obamacare” means that you cannot be denied coverage for an insurance policy due to your medical history. However, you won’t find anything in the program that ensures that what you pay will be affordable.

The main requirements to get an Affordable Care Act subsidy include qualifying for “Obamacare” and having a Modified Adjusted Gross Income within certain limits. For most people, their adjusted gross income will equal their MAGI. If you receive non-taxable Social Security income or interest that is exempt from taxes, it may be different.

See table below:

Medicaid and ACA subsidy chart
“Obama Care” Limit
1 $15,856.20 $45,960.00
2 $21,403.80 $62,040.00
3 $26,951.40 $78,120.00
4 $32,499.00 $94,200.00
5 $38,046.60 $110,280.00


About Obama Care Insurance Rates

The net cost of your premiums may be greatly affected by whether or not you qualify for a subsidy. For many Americans, the higher cost of the 2014 policies will be more than balanced by the subsidy they will receive. If you qualify for a subsidy, you should look at the exchange policies first. (Call us. We are authorized to help you on the State of Connecticut’s health exchange, which is also known as the marketplace.)

If you do not qualify for a subsidy, you should consider buying a policy off the exchange. There may be an off exchange policy that is less expensive or is better for your family in some other way. We can help you choose between various on exchange and off exchange options. And help you enroll in coverage. Please call us if you would like to take advantage of our services.

Qualifying for Obama Care Subsidies

If health insurance benefits are available to you from an employer, or a family member’s employer your family will likely be unable to qualify for a subsidy. However, if the group insurance policy from work is deemed unaffordable or if it does not meet the minimum standards, you may still qualify for a subsidy.

If the cost of insuring the employee on the least expensive plan the business offers and that meets the minimum is less 9.5% of the household income, it is deemed affordable. And yes, you read that right they compare the cost of insuring only the individual employee with the income of the entire household. (Hopefully they will fix that for next year, but that is the way the regulations read currently.)

Obamacare Facts and Myths

We have heard many half-truths about how this program will affect Connecticut residents. Some if it is probably politically motivated. Some is simply the result of people misunderstanding a complex law.

One myth we would like to dispel is that you have to do your enrollment by yourself or use a navigator or assistor. Although a navigator or assistor can help you determine whether you qualify for a subsidy, they cannot help you choose a policy. They cannot answer questions about deductibles, copays or provider networks.

Joel and I are authorized to help you enroll on the exchange. We are also appointed with several companies that sell off the exchange. We can answer your questions about the Affordable Care Act, the enrollment process and the policies themselves.

And… your price each month will be the same as if you did it without the help of a broker.

We can save you time and can give you the information you need to shop and to select the best plan for your family. I hope you will give us the opportunity to serve you now and in the coming years.

Buying or Keeping a pre “Obama Care” policy – CT Buying Option 3

November 23, 2013 @ 18:32 Filed under: ObamaCare — Tags: , — Alston


For some, keeping an existing policy will be best option. For some others purchasing a new policy that is effective in 2013 will be the best option. I will try to outline the advantages and disadvantages of these options and contrast them with the other options discussed on my previous two blog posts.

The posts in the series are:

Policies purchased in 2011, 2012 or 2013 will not be considered grandfathered plans. Your insurance company may let you keep those plans for one more year at the most. Many of these policies cannot be kept past December 31, 2013. Check with your agent or the company to see how long you can keep your present policy.

Obamacare and Grandfathered Plans

Plans purchased in 2009 and before as well as some policies purchased in 2010 are likely to be considered grandfathered. This means that your insurance company may allow you to keep the plan for 2014 and beyond. However, some companies are not allowing policyholders to keep these older policies.

However, keeping such a plan may not be the best option for you. All grandfathered plans are at least three years old as of this writing and have probably experienced several rate increases since their inception. If you qualify for a subsidy, it is unlikely that keeping a policy this old will be your best option. If you do not qualify for a subsidy, it may or may not be.

You cannot get a subsidy for a grandfathered policy or any policy purchased outside of the health insurance exchange (or marketplace). This means that if you qualify for a subsidy, you should get price quotes for on-exchange plans. (Call us. We can answer your questions about purchasing on the health insurance exchange and help you enroll if you choose. We can calculate your subsidy and give you on-exchange and off exchange quotes over the phone in just a couple of minutes.)

Purchasing a 2013 Policy

If you can pass the health screening, do not have a grandfathered policy and do not qualify for a subsidy, you will probably do best by purchasing a policy with a 2013 effective date. Why? The rates for 2014 will be higher than the current rates. Without a subsidy, your net cost will almost certainly be higher if you purchase a 2014 policy.

Even if you already have an existing policy, purchasing a new policy that is effective in 2013 may be to your advantage. Unless your policy is grandfathered, you will lose the coverage on the anniversary date. Purchasing a new policy that is effective in December of 2013 may be the best way to avoid paying the higher rates for as long as possible.

You will only be able to keep a newly purchased policy that is effective in 2013 for one year. However, you may save $200 or more each month during that year.

After the year is up, you can shop for other options. We hope that you will give us the opportunity to answer your questions about the Affordable Care Act, grandfathered plans and plans available for 2013 effective dates. As well as plans available for 2014, 2015 and beyound.

How Can We Help?

Please call us with your questions. One or both of us should be available seven days a week from 9:00 in the morning until 9:00 in the evening six or seven days a week until the end of the year.

Buying Off Exchange Health Insurance – CT Buying Option 2

October 19, 2013 @ 00:38 Filed under: health care reform — Tags: , , — Alston


This post will focus on purchasing a 2014 health insurance policy off the health insurance exchange. This will be a short post. Why? So far, I haven’t found significant advantage associated with using this option.

Most Connecticut residents who do not get their insurance coverage through Medicare, Medicaid or their employer will have three options for health insurance:

(We can help you purchase with any of the options above. Just call us at 203-374-3645 or 1-800-467-8726.)

I’ve compared the off exchange policies with the plans offered on the exchange. The premiums are about the same off the exchange for similar coverage.

If your income and other factors qualify you for a tax credit or subsidy, it is important that you purchase an on exchange policy unless you do not want the tax subsidy. You cannot get a subsidy unless you buy on the exchange.

Before I had access the information I needed to compare the two options, I speculated that the off exchange policies would be have a lower cost for people who didn’t qualify for a subsidy. However, now that I have more information, I see that so far that is not the case for most people.

I still believe that at some point in the future, the off exchange policies may be significantly cheaper for an individual who does not qualify for a subsidy (a credit on his or her taxes).

One thing that may make a difference isn’t the monthly premium, but the availability of doctors. Some insurers will have more doctors in their provider list for their off exchange policies.

At some point the premiums or benefits may change. However, so far these plans have similar prices for similar coverage. If your doctor is in the network for both the an on exchange policy and an off exchange policy and the benefits are similar, choose the one with lower premiums.

Obama Care Health Insurance Exchange – CT Buying Option 1

October 10, 2013 @ 01:01 Filed under: health care reform — Tags: , , , — Alston


(If you have already decided that buying through the exchange is the best option for you, go directly to how to buy on the Connecticut health exchange to see plans, prices and to enroll.)

There are currently three ways we can help Connecticut individuals and families purchase health insurance. Each one will be the best for some people, but not for others. The three ways are:

This post will focus on getting coverage through the Connecticut Health Exchange. If you qualify for a subsidy, this will probably be your best option because your net costs are likely to be much lower. If not, one of the other two options may be better for you.

Do You Qualify for A Subsidy (or tax credit)?

The Affordable Care Act has laid out other criteria, but getting a subsidy is primarily based on how much you make. This is based on your household’s Modified Adjusted Gross Income (MAGI), which may be a little lower than your gross income. If your household MAGI is below 400 percent of the Federal Poverty Limit (FPL) for the size of your household, you probably qualify to have your monthly premiums reduced by a subsidy. (Below 138 percent of the FPL, you should probably put in an application for Medicaid.) See the tables below to see if you are likely to qualify for a subsidy or for Medicaid.

Annual Household Income Table
“Obama Care” Limit
1 $15,856.20 $45,960.00
2 $21,403.80 $62,040.00
3 $26,951.40 $78,120.00
4 $32,499.00 $94,200.00
5 $38,046.60 $110,280.00

If your expect that your modified adjusted gross income for next year will be between the Medicaid limit and the “Obama Care” limit, you will probably qualify for a subsidy unless you are eligible for affordable health insurance coverage from an employer.

Most people will have a Modified Adjusted Gross Income that is the same as, or very close to, their adjusted gross income (line 37 of a 1040). Here is more information on how to calculate your MAGI,

If you do get coverage from your employer and it is deemed to be unaffordable or doesn’t meet the minimum standards, you may still qualify for a subsidy.

If you need coverage for 2013, you may want to purchase a separate policy that will cover you for the last part of the year and then switch over to an “ObamaCare“ policy. You can request “pre-ObamaCare” 2013 quotes from us or call us for more information.

Contact the Connecticut Department of Social Services if you believe you are eligible for Medicaid. We cannot provide assistance applying for government programs like Medicaid. (Although we can help with Medicare Part C, Part D and Medicare Supplement plans.)

If your gross pay is below the figures above, you probably qualify for a subsidy (or Medicaid benefits). The Open Enrollment Period started on the first of October 2013 and ends in March. You cannot be denied due to a medical condition so long as you apply during an open enrollment period. Your policy can start as early as January 1, 2014.

Here is how to buy on the Connecticut health exchange.

Health Care reform will make life better for some consumers and worse for others. There are important protections built into the law that will benefit many but they come at a cost. Americans are likely to continue the debate in private, in the news and online. However, one thing is for sure for most of the public. Life is a little more complicated now. If you want assistance sorting through your options we are here.

As always, contact us with any questions at 203-374-3645 or 1800-Insurance or via email. As always, you never pay a broker fee for our services. No matter what option you select your price will be the lowest allowed by law when you use our agency (insurance companies pay us some of the money they would have paid one of their employees, but are required to keep your price the same).

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Blue Cross Blue Shield health insurance questions?  Call me, I specialize in health insurance and can give you quotes from every Connecticut health insurance company.

Alston J. Balkcom
CT Agent since 1985
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