Health Insurance with Tax Credits
Health Insurance Plans for You and Your Family, with Tax Credits to Help Lower the Cost
Do you need to purchase your own health insurance plan? (COBRA running out? Moving to self-employment? Or to a new employer that does not offer health insurance? You have many health insurance plan choices.
If you can answer “yes” to the 2 below questions, choosing an ACA (Affordable Care Act) health insurance plan with instant tax credits to lower the premium costs through the Marketplace is usually your best choice:
Q1
Will your family’s annual income this current year (you will have to estimate) fall under these income thresholds corresponding to the number of people in your family?
Note: Other information being equal, the income thresholds vary by your current age (the older your age the higher the threshold, the younger you are, the lower the threshold). Here we show an average age of 45 for the adult family members (Contact Chip below and he will calculate the income threshold specific to your family).
-approximately $76,000 for a family of 1
-approximately $153,000 for a family of 2
-approximately $204,000 for a family of 3
-approximately $245,000 for a family of 4
-approximately $280,000 for a family of 5
-approximately $290,000 for a family of 6
Q2
DURING the time period you need this individual health insurance coverage…
Will you NOT have access to an employer-sponsored health insurance plan through work?
And…
Will your spouse (if married) NOT have access to an employer-sponsored health insurance plan through work?
If you have answered “yes” to both questions, you are on the right page. Continue below.
If you answered “no” to either question, the better information page for you is “Individual Health Insurance Options.”
Two details to understand about the benefits of a Marketplace health insurance plan…
When your income is under the threshold, and you don’t have available employer-sponsored coverage, you will receive one or both of two big benefits of a Marketplace health insurance plan:
Advanced Premium Tax Credits (APTCs)
In “plain speak” you may receive instant tax credits to help lower the monthly premium cost.
The Affordable Care Act provides APTCs to individuals and families that help lower the monthly cost of health insurance. APTC's or "tax credits" are figured in a formula that analyzes the covered person(s) ages, family size, zip code, and income.
The tax credit is calculated at time of enrollment or renewal, and reported to the health insurer. The insurer will only charge you the remaining premium cost. Just to be clear, here is an example:
-Family of 4, Calculated Tax Credit: $575.00
-Monthly Premium Cost of Chosen Plan: $875.00
-Family Pays $300.00 Monthly to Insurer (875 - 575)
We can easily determine your tax credit based on these factors, so you can compare based on cost.
Cost Sharing Reductions (CSRs)
In “plan speak” you may receive an enhanced Silver Level plan with much lower copays and deductible.
The A.C.A. also provides for Cost Sharing Reductions for some individuals and families who receive the Advanced Premium Tax Credit.
Cost sharing reductions, or "CSR's" are a something much simpler than the confusing name implies. If you receive the CSR then the policy you choose (it must be a Silver level benefit plan) is "enhanced." By enhanced… the policy's copays, deductible and out of pocket maximum are lowered! That means you pay less out of your pocket when you use medical services. Here’s a quick example:
-Doctor's Office Copay: $5 instead $20
-Deductible: $700 instead of the usual $4,500
-Out of Pocket Max.: $2,100 instead of $8,700
We Help Individuals and Families With These Health Insurance Plans (And More)
You can enroll in ACA health insurance through the Marketplace throughout the year.
Many people mistakenly think you can only enroll in your own health insurance plan at the beginning of each year, the annual enrollment period (AEP). Not true! Read below to understand the two enrollment periods.
Annual Enrollment Period (AEP)
Between November 1st and December 15th anyone can enroll in an individual or family health insurance plan, to begin on January 1st of the new year.
This open enrollment period is open to everyone, and you do not need a set reason to enroll.
Special Enrollment Periods (SEPs)
You may also enroll yourself and your family in a health insurance plan at any time throughout the year, if you qualify with a SEP, or special enrollment period.
Because of your SEP eligibility you are able to choose health insurance on a next first of the month within the year (March 1st, April 1st, May 1st, etc.) to accommodate a life change.
Here are the SEPs we see most often:
1. Losing employer-sponsored health insurance: The most often utilized SEP…losing your employer offered health insurance because you left the employer, were fired, laid off, furloughed, or moved to part-time hours. We can enroll you in a health insurance plan you choose the first of the month after your employer-sponsored coverage ends (which is usually the end of a month).
2. Turning age 26 and losing health insurance as your parents’ dependent. When you turn 26 you can no longer remain on a parent’s employer based or individually chosen coverage. This SEP allows you to choose your own plan.
3. Losing your health insurance based on a separation agreement or finalized divorce. When either of these two decrees are issued and you lose your coverage as a dependent, you can enroll in a new plan you choose.
4. Having a baby or adopting a child. This is the one SEP where we can begin coverage other than the first of the month…rather the start date is the date of the baby’s birth or the adoption date.
5. Moving. If you move to a new county, new state or move back from abroad, you can choose a plan and enroll for coverage beginning the first of the next month.
6. Losing student coverage. If you graduate and lose access to health insurance offered by a college or university, you can choose a new health insurance plan to begin the next first of the month.
And many others, including getting married, losing Medicaid eligibility, the death of a family member, becoming a U.S. citizen, leaving incarceration, gaining access to a HRA or QSEHRA, and unique SEPs announced after major events such as a hurricane.
Two important notes to understand:
-You must enroll in a plan within 60 days of the date of your SEP.
-You may have to prove the SEP…For example, if you lost employer-sponsored health insurance, the Marketplace may ask for a COBRA letter or other proof.
If you are feeling overwhelmed already, no worries! Chip can help.
We know….selecting your own health insurance plan is kind of a confusing mess! We can help! See below how Chip can help you through the process, doing most of the work along the way:
You Request a Free Quote
Begin the free process of working with Chip by requesting a quote (see the bottom of this page for a quote request form).
Chip will receive your information, calculate your tax credit, and research plans for you. He’ll then send you an initial email ASAP. The email will have specific plan designs, cost information, and recommendations.
Recommendations, and Questions Answered
You can review all the information in your own time, then follow up with Chip with your questions. You can have a conversation via email, phone, text, Zoom, Google Meet or an in-person meeting at his office.
You can schedule time here if you like, calendly.com/chipmillard
Enrollment in the ACA Marketplace
The healthcare dot gov Marketplace site can feel like a puzzle to solve. Chip can enroll you in the plan you choose with the Marketplace, locking in the tax credits, then work to follow up with any requested items, such as proof or prior coverage or income. He’ll then work to ensure your ID cards and policy arrive quickly.
Chip Millard is a member of Healthcare.gov's "Champions Circle."
A distinction awarded by Healthcare.gov to health insurance agents and brokers who go above and beyond to increase access to health insurance (helping local people understand their benefits and costs options, and helping them enroll) in their communities.
Three Recent Marketplace Health Insurance Plans We Helped Clients With:
Below are 3 recent success stories we found in helping our customers obtain their own health insurance with tax credits through the Marketplace:
Newlyweds Need Their Own Health Insurance Plan
Brooke and Alan, both 30, have had a lot of recent changes, getting married and moving to Chapel Hill so Brooke can attend a graduate school program.
Their family’s income is Alan’s work as a sous chef at a local fine dining restaurant.
Their family income qualified for a substantial tax credit, which allowed the couple to choose a Gold level plan with low copays (which helps with some expensive prescriptions they take) for $233.47 monthly.
Family Moves Off of Work-Based Health Insurance
A family of 5 in Pittsboro experienced a SEP recently, as one spouse was laid off, and realized he could do the same work as a self-employed consultant. His spouse works part-time to be at home with the couple’s 3 young children, so has no access to an employer-sponsored health insurance plan.
We determined the tax credit (as the couple’s income was well under the threshold for a family of 5), and found they could choose a copay style plan for the family, all at $350.23 total premium cost per month.
A Retired Couple Needs a Plan Before Medicare
A couple in their early 60’s recently moved to Durham to live close to their adult children (and their grandchildren!), after retiring from jobs in Utah. They have two SEPs, moving to a new state, and ending work coverage.
They are currently at a lower income bracket between full-time work and taking a larger retirement income at age 65, so the tax credit they are eligible for pays the entire monthly premium cost! They will pay $0.00 for a health savings account (H.S.A.) type plan.
Free Personalized Quote and Information
Complete the form below and Chip will send you an email with recommended quotes of insurance (including detailed ideas of premium costs and benefits). All in a conversational, “plain speak” explanation of the details Chip is known for (see our reviews on the home page). You can review the information, then follow up with your questions via email, phone call, text, Zoom, Google Meet, or an in-person meeting.
Note: Privacy is something we take seriously. The minimum of information is shared with an insurance company to put together a detailed free quote and illustration for you.