2021 HEALTH INSURANCE SPECIAL ENROLLMENT PERIOD IS FROM FEBUARY 15, 2021 THROUGH MAY 15, 2021.
With Catherine as your designated agent on your application, you have the same options, same pricing, same eligibility for advanced premium tax subsidy for On the Marketplace, but with her as your designated agent and first contact versus going it alone on a website or randomly-assigned call in a call center.
Schedule your free consultation today with Catherine either by personal appointment or by appointment via phone, Zoom, Skype, or Facetime. You may schedule by submitting your contact information in the "Contact Us" field or by calling Catherine at 940-597-4757 or emailing her at [email protected].
Catherine takes care, with attention to details, to provide you and your family in Texas with high quality Health, Dental, and Supplemental insurance products and services, which are personalized for your unique needs.
Certified Off and On Health Insurance Marketplace, or Healthcare.gov Site
Catherine is certified in the state off and on the Health Insurance Marketplace, or the Healthcare.gov site. She is appointed with the top Health, Dental, and Supplemental insurance companies in Texas.
Offers You Free Consultation, Recommendations, Quotes, Enrollment Assistance, and Servicing
For your Individual and Family Health, Dental, and Supplemental insurance needs, Catherine offers you her extensive knowledge, personalized consultation with recommendations and quotes, enrollment assistance, and servicing for your Health and Dental off or on the Health Insurance Marketplace. She can also offer you assistance with applying for any eligible advanced premium credit for a Health policy on the Marketplace.
Offers You Same Policies and Prices as Direct-Sell Insurance Companies or Health Insurance through the Marketplace
Offers You Same Assistance with Application for Eligible Advanced Premium Tax Credit On the Marketplace
Catherine can offer you the same Health and Dental insurance policies and the same prices as those sold directly by insurance companies off the Marketplace or sold directly on the Marketplace site. She also can offer you the same application assistance for any eligible Advanced Premium Tax Credit on the Marketplace as those provided directly on the Marketplace site. In addition, Catherine can offer you information on the location of links to apply for Medicaid or Children's Health Insurance Program, or CHIP.
Why leave your questions, concerns, and servicing of your Health and Dental insurance needs to Direct-Sell insurance companies or directly on the Health Insurance Marketplace, who both utilize randomly-assigned calls to licensed customer service representatives assigned to your state and on duty at the time of each call? Also, why leave your website or emailed questions, concerns, and servicing for your Health and Dental insurance needs to Direct-Sell insurance companies or directly on the Marketplace, who both utilize randomly-assigned website and email customer service assistance to representatives assigned to your state and on duty at the time?
Summary Information on Health Insurance Open Enrollment, Special Enrollment Period, and Shared Responsibility Fees
Health Insurance Open Enrollment for 2021 coverage starts November 1, 2020 and ends December 15, 2020. 2020 coverage started November 1, 2019 and ended December 15, 2019. Outside of open enrollment, you can still buy a Health insurance plan only if you qualify for a Special Enrollment Period which you must be able to document and to submit with proof. You can apply for Medicaid and CHIP any time, and you can apply for stand-alone Dental Insurance options at any time.
A Special Enrollment Period is a time outside of the Open Enrollment Period during which you and your family have a right to sign up for health coverage. You qualify for a Special Enrollment Period 60 days following certain eligible life events (for example, marriage, birth of a child, or loss of other health coverage.) (Job-based group plans must provide a Special Enrollment Period of 30 days.) For complete information on Special Enrollment Period, please contact Catherine for a consultation.
You’re considered covered for 2021 and also for 2020 if you have Medicare, Medicaid, CHIP, any job-based plan, any Qualified Health plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage.
Starting with the 2020 plan year (for which you’ll file taxes in April 2020), the penalty for no individual coverage no longer applies. (The fee is sometimes called the “Shared Responsibility Payment” or “mandate.”) If you don’t have coverage during 2020, you don’t need an exemption in order to avoid the penalty.
If you are 30 or older and want to buy a Catastrophic health plan, you must apply for a hardship exemption to qualify.
Summary Information on Essential Health Benefits
Most Private Health insurance plans off the Health Insurance Marketplace and all Health insurance plans on the Marketplace cover Essential Health Benefits, Pre-existing Conditions, and Preventive Care. Health insurance plans that cover all these benefits are called Qualified Health Plans.
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)
•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 *Beginning with plan year 2021, when consistent with state law, the issuer or plan may, but is not required to, count direct support offered by drug manufacturers for specific prescription drugs towards the consumer’s annual cost-sharing limit.
•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)
•Preventive and wellness services and chronic disease management
Some Health insurance plans may offer additional coverage.
Some Health insurance plans include dental coverage. In other cases, free-standing Dental plans are available.
Summary Information on Coverage for Pre-Existing Health Conditions
Health insurance companies can't refuse to cover you or charge you more just because you have a pre-existing health or medical condition, for example asthma, back pain, diabetes, or cancer. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition. They also can’t charge women more than men.
Medicaid and the Children's Health Insurance Program (CHIP) also can't refuse to cover you or charge you more because of your pre-existing condition.
When you get care for a pre-existing condition, you’ll still need to pay any deductibles, copayments, and coinsurance your plan requires. It doesn’t matter whether you’re being treated for a pre-existing or new health condition.
Summary Information on One Exception: Existing Grandfathered Plans Sold Off the Marketplace
The only exception to the pre-existing coverage rule is for grandfathered individual health insurance plans - the kind you buy yourself, not through an employer. Grandfathered plans don’t have to cover pre-existing conditions.
If you have one of these plans you can switch to an on or off the Marketplace plan that covers pre-existing conditions.
•You can do this during open enrollment, but be sure to contact your insurance company first to learn about how and when you can cancel your current plan.
•You can also buy an on or off the Marketplace plan outside open enrollment when your grandfathered plan year ends. Your plan ending gives you a Special Enrollment Period to enroll in different coverage.
Summary Information on Free Preventive Services
Qualified Health Plans on and off the Marketplace must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.
This applies only when these services are delivered by a network provider.
1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counseling
3. Aspirin use to prevent cardiovascular disease for men and women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for everyone ages 15 to 65, and other ages at increased risk
11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
◦Influenza (Flu Shot)
◦Measles, Mumps, Rubella
◦Tetanus, Diphtheria, Pertussis
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
14. Syphilis screening for all adults at higher risk
15. Tobacco Use screening for all adults and cessation interventions for tobacco users
Summary Information Concerning On the Marketplace Health Insurance Plans
If you have Medicare coverage, you’re not eligible to use the Marketplace to buy a health or dental plan.
You can also buy a plan outside the Marketplace and still be considered covered. If you buy outside the Marketplace, you won’t be eligible for Premium Tax Credit or for lower out-of-pocket costs based on your income, called Advanced Premium Tax Credit.
If you’re eligible for job-based insurance, you may consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance isn't considered affordable or doesn’t meet minimum requirements.
For 2021, employer coverage is considered affordable - as it relates to the Advanced Premium Tax Credit or the Premium Tax Credit - if the lowest-cost self-only coverage option available to employees does not exceed to 9.83% for 2021 plans of an employee's household income. People offered employer-sponsored coverage that’s affordable per these guidelines and that provides minimum value aren't eligible for an Advanced Premium Tax Credit or a Premium Tax Credit. Minimum requirements for health plan means it’s designed to pay at least 60% of the total cost of medical services for a standard population.
For 2020, employer coverage is considered affordable - as it relates to the Advanced Premium Tax Credit or the Premium Tax Credit - if the lowest-cost self-only coverage option available to employees does not exceed to 9.78% for 2020 plans of an employee's household income. People offered employer-sponsored coverage that’s affordable per these guidelines and that provides minimum value aren't eligible for an Advanced Premium Tax Credit or a Premium Tax Credit. Minimum requirements for health plan means it’s designed to pay at least 60% of the total cost of medical services for a standard population.
Summary Information Concerning What On the Marketplace Health Plans Can Offer
•Lower costs based on your household size and income. Most people who apply will qualify for lower costs through an Advanced Premium Tax Credit or a Premium Tax Credit.
•You may qualify for Medicaid and the Children’s Health Insurance Program (CHIP). These programs cover millions of families with limited income. If it looks like you qualify, Catherine can share information with you about applying with your state agency.
Summary Information on Eligibility Concerning On the Marketplace Health Plans
Most people are eligible to use the Marketplace.
To be eligible for health coverage through the Marketplace, you:
A. must live in the United States
B. must be a U.S. citizen or national (or be lawfully present).
C. On February 24, 2020, new U.S. Citizenship and Immigration Services (USCIS) regulations apply to the definition and factors for “public charge” status. These regulations outline how USCIS will determine whether applications for admission to the United States or applications for adjustment to immigration status will be denied because the applicant is likely at any time to become a public charge.
Use of public benefits could be considered a negative factor in a public charge inadmissibility determination. This means it could affect a consumer’s chances of admission or adjustment of status.
•Enrollment in a Marketplace plan (with or without the premium tax credit) is not a public benefit under the public charge final rule. •For children under age 21 and pregnant women, enrollment in Medicaid or CHIP will not be considered to be a public benefit under the public charge rule.
However, for some foreign national adults, enrollment in Medicaid may be considered a negative factor in a public charge inadmissibility determination.
Consumers may visit the USCIS website or contact USCIS directly before continuing with his or her Marketplace application. For more information on what it means to be a public charge, visit USCIS’s website: https://www.uscis.gov or call U.S. Citizenship and Immigration Services at: 1-800-375-5283.
U.S. citizens living in a foreign country for at least 330 days of a 12-month period are not required to get health insurance coverage under the Affordable Care Act for that 12-month period. If you're uninsured and living abroad under this definition, you don't have to pay the fee that other uninsured U.S. citizens may have to pay.
Generally, health insurance coverage in the Marketplace covers health care provided by doctors, hospitals, and medical services within the United States. If you're living abroad, it's important to know this before you consider buying Marketplace insurance.
Summary Information for Expatriates Concerning Off the Marketplace Global Health Insurance Options
For Expatriates who are living and working in a country other than your nation of citizenship, Catherine can offer you off the Marketplace Global Health insurance policies and services.
Continued Summary Information on Eligibility Concerning On the Marketplace Health Plans
B. must be a U.S. citizen or national (or be lawfully present).
The term “lawfully present” includes immigrants who have:
•“Qualified non-citizen” immigration status without a waiting period (see the definition below)
•Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
•Valid non-immigrant visas
•Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals)
Following is a list of immigration statuses that qualify for Marketplace coverage.
•Lawful Permanent Resident (LPR/Green Card holder)
•Paroled into the U.S.
•Conditional Entrant Granted before 1980
•Battered Spouse, Child and Parent
•Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
•Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
•Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
•Temporary Protected Status (TPS)
•Deferred Enforced Departure (DED)
•Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
•Lawful Temporary Resident
•Administrative order staying removal issued by the Department of Homeland Security
•Member of a federally-recognized Indian tribe or American Indian Born in Canada
•Resident of American Samoa
Applicant for any of these statuses:
•Temporary Protected Status with Employment Authorization
•Special Immigrant Juvenile Status
•Victim of Trafficking Visa
•Adjustment to LPR Status
•Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)*
*Only those who have been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days are eligible
With Employment Authorization:
•Order of Supervision
•Applicant for Cancellation of Removal or Suspension of Deportation
•Applicant for Legalization under IRCA
•Legalization under the LIFE Act
Immigration Status Documentation
To support Marketplace applications, the following documents may be required or used, depending on the individual situation:
•Permanent Resident Card, “Green Card” (I-551)
•Reentry Permit (I-327)
•Refugee Travel Document (I-571)
•Employment Authorization Card (I-766)
•Machine Readable Immigrant Visa (with temporary I-551 language)
•Temporary I-551 Stamp (on passport or I-94/I-94A)
•Arrival/Departure Record (I-94/I-94A)
•Arrival/Departure Record in foreign passport (I-94)
•Certificate of Eligibility for Nonimmigrant Student Status (I-20)
•Certificate of Eligibility for Exchange Visitor Status (DS2019)
•Notice of Action (I-797)
•Document indicating membership in a federally recognized Indian tribe or American Indian born in Canada
•Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
•Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
•Document indicating withholding of removal
•Administrative order staying removal issued by the Department of Homeland Security
•Alien number (also called alien registration number or USCIS number) or 1-94 number
C. can't be currently incarcerated. For purposes of the Marketplace, “incarcerated” means serving a term in prison or jail. Incarceration doesn’t mean living at home or in a residential facility under supervision of the criminal justice system, or living there voluntarily. In other words, incarceration doesn’t include being on probation, parole, or home confinement. You’re not considered incarcerated if you’re in jail or prison pending disposition of charges—in other words, being held but not convicted of a crime.
Summary Information Concerning Eligibility for Advanced Premium Tax Credit for On the Marketplace Health Plans
Only when you buy health insurance coverage on the Marketplace, you may be able to get an Advanced Premium Tax Credit, if you qualify, that lowers what you pay in monthly premiums.
Catherine can assist you with your Marketplace application in which you’ll report your household size and income.
•Any eligible Advanced Premium Tax Credit depends on your household income and family size.
•If your income falls between the amounts shown in the chart below, you’ll qualify for an Advanced Premium Tax Credit that you can apply directly to your monthly premiums. This means you’ll pay less money to your insurance company each month.
If your income falls within the following ranges generally you may qualify for an Advanced Premium Tax Credit. Generally, the lower your income within these ranges, the larger Advanced Premium Tax Credit for which you may qualify. The Health Insurance Marketplace® will use the 2020 FPL guidelines when making calculations for APTC and income-based CSRs for coverage year 2021 starting November 1, 2020.
Note that Medicaid and CHIP assessments/determinations are currently based on the 2020 FPL from the HHS 2020 Poverty Guidelines until January or February 2021 when HHS releases the new guidelines for 2021.
The 2021 guidelines have not been released as of the date of publication of this training, but will be available on the HHS Assistant Secretary for Planning and Evaluation (ASPE) website.
•$12,760 to $51,040 for individual
•$17,240 to $68,960 for a family of 2
•$21,720 to $86,880 for a family of 3
•$26,200 to $104,800 for a family of 4
•$30,680 to $122,720 for a family of 5
•$35,160 to $140,640 for a family of 6
•$39,640 to $158,560 for a family of 7
•$44,120 to $176,480 for a family of 8
*Chart is for 48 contiguous states and the District of Columbia; for Hawaii and Alaska, please visit the HHS ASPE website: https://aspe.hhs.gov/poverty-guidelines.
The 2020 guidelines are available on the HHS Assistant Secretary for Planning and Evaluation (ASPE) website (http://aspe.hhs.gov/poverty-research).
If your income falls below the amounts shown on the chart, you may qualify for coverage under your state’s Medicaid program.
But if your income falls below the amounts shown on the chart, your state is not expanding Medicaid, and you don't qualify for Medicaid under your state's rules, you can’t get Premium Tax Credits that reduce what you pay for a private insurance plan.
Summary Information on Exemptions from the Shared Responsibility Tax Fee
Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies. If you don’t have coverage during 2019 or later, you don’t need an exemption in order to avoid the penalty.
Summary Information for Off the Marketplace Health Plans
You can also buy a Qualified Health plan outside the Marketplace and still be considered covered. If you buy outside the Marketplace, you won’t be eligible for Premium Tax Credit or for lower out-of-pocket costs based on your income, called Advanced Premium Tax Credit.
Most Off the Marketplace Health Plans are Qualified Health Plans which mean they cover the same Essential Health Benefits and Preventive Services that on the Marketplace Health Plans cover.
Summary Information On Supplemental Insurance
Supplemental Insurance is not major medical insurance and therefore not a Qualified Health Plan. Supplemental Insurance is low-cost insurance that, at covered claim, pays you direct benefits by check in the mail and pays you above, beyond, and regardless of any other types of insurance you may have.
Catherine can offer you supplemental Life, Accident, Hospital, Critical Care, Cancer, and Dental insurance in Texas.