Newsletter

ENROLL BY DECEMBER 15 FOR A JANUARY 1 EFFECTIVE DATE

If you’d like your Affordable Care Act plan to be effective January 1, you need to enroll no later than December 15. (Individuals who enroll between December 16 and January 15 will have a February 1 ACA plan effective date.)

Also, if you’re presently enrolled in an ACA plan, you should actively re-enroll by December 15. If we have not been in touch with you, please call us at 786-970-0740 so we can help you update your application to reflect your most accurate projection for 2025 income and to make other changes in your application. If you don’t update your information by December 15, in most cases your present carrier will “passively” re-enroll you on December 15 if you have not otherwise made changes with healthcare.gov. Failure to update your information could cause you to lose your subsidy if your income projection for 2024 is lower than the higher minimum income requirements that apply for 2025 (assuming your projected 2025 income is at least actually equal to the 2025 required minimum).

Also, there is a new carrier available for 2025 and carrier competitiveness differs from 2025. You should ask us to determine if you could receive improved benefits and/or pay lower premiums if you change carriers, and you will lose this opportunity if you passively re-enroll.

For all the reasons outlined in the above two paragraphs you should plan on actively enrolling for 2025 and not simply let your present carrier renew you automatically.



OPEN ENROLLMENT SNAPSHOT

The Centers for Medicare and Medicaid Services (CMS) reports that 496,000 consumers who do not currently have health care coverage through the individual-market Marketplace have signed up for plan year 2025 coverage between November 1 and 16.

During last year’s record-setting Open Enrollment Period, 21.4 million people signed up for coverage, driving the uninsured rate to a historic low, where it remains today. Over 2.5 million existing consumers have already returned to the Marketplace between November 1 and 16 to select a plan for 2025. Building on the historic success of last year, CMS projects there will be a record high number of plan enrollments for this year’s Open Enrollment.

The table below represents activity from November 1 through November 16 for Federally Facilitated Marketplace (FFM) states and through November 9, 2024, for State-based Marketplace (SBM) plans.

For more information, including a state-by-state breakdown of enrollments, please view this fact sheet.

To provide the most meaningful data on consumer activity, CMS will report 2025 Open Enrollment national-level data on a regular basis. The above table reports the most recent available enrollment information as of the date we've scheduled this newsletter for distribution.

ASSOCIATION PPO PLANS AVAILABLE TO INDIVIDUALS AND FAMILIES

These plans are provided by Associations and are written on a group chassis to individuals and families who qualify. Applicants must successfully answer health questions to qualify for enrollment, but there are no pre-existing condition limitations in these plans. Plans are available in all states except Washington.

The plans are administered by MBA Employee Benefits. All these plans use Cigna's largest national provider network. Applicants must become members of the Association for the plan they choose to become eligible to join. Individuals must apply by the 25th of the preceding month to be eligible for enrollment the first of the following month. Payment is processed upon acceptance and starting the second month payments are processed as of the 15th of the month.

Enrollment in these plans is continuous (i.e., enrollees do not have to re-enroll annually).

Major Medical Plans

These four major medical plans are offered through the AFI Association. These are PPO plans that provide both in- and out-of-network benefits.

Here are the questions that must be answered successfully to qualify for membership for any of these plans.

All these plans include a supplemental accident and hospital medical bridge plan through Benefit Logistics that provides payments to beneficiaries. Benefits include a $2500 indemnity payment for hospitalization due to sickness and $3500 for hospitalization due to injury. (This reduces costs for hospitalization by the amount of the supplemental payment.) The other supplemental payments are for items like office visits and diagnostic x-rays and labs and include $20,000 of life insurance provided through Humana.

Both the supplemental accident and hospital medical bridge benefits and the basic plan benefits are described in this brochure. The basic plan benefits are identified by items with white lettering in the left-hand column, whereas the supplemental accident and hospital medical bridge benefits are listed in black lettering in this column.)

Claims for the supplemental accident and hospital medical bridge plan benefits are automatically processed and filed by the plan administrator when a provider submits claims (given the provider submits all information required). Benefits are made payable to the primary insured to help with out-of-pocket costs.

Limited-Day Benefits Plans

These limited-day benefits plans are offered through the BMI Association.

Diabetics are excluded from membership in any of the major medical plans but can be enrolled in any of these plans. Enrollees must successfully answer these questions to qualify. Except for the Value and Advantage plans which have 12-month waiting periods for maternity, these plans do not include maternity coverage and have other limitations and exclusions that do not apply to major medical plans. These plans use the above-referenced Cigna network for in-network benefits, but these plans do not provide out-of-network benefits. Thse plans do not include supplemental accident and hospital medical bridge benefits.

Premiums for both the major medical plans and the limited-day benefits plans are based on the size of the membership group (member only, member and spouse, member and children, and family), are not age-banded, and are the same nationally.

These plans can be offered to people over age 65 and are excellent alternatives for those who can’t qualify for or afford Medicare as well as those who do not have Social Security numbers.

Please contact us at 786-970-0740 (Cell) for more information, pricing, and/or enrollment in any of these plans.

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.