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Illinois Health Agents Inc. has been recognized by the Health Insurance Marketplace® as a member of the 2023 Marketplace Elite Circle of Champions for helping consumers gain qualified health coverage for an 8th consecutive year. 

This Centers for Medicare & Medicaid Services (CMS) award highlights Illinois Health Agents’ success in actively enrolling 100 or more consumers during this Open Enrollment Period and demonstrates their expertise and experience in helping consumers find health coverage.

“Agents and brokers are key partners to CMS in our shared goals of helping expand access to coverage for Americans,” said Ellen Montz, Director of the Center for Consumer Information & Insurance Oversight within CMS, which oversees the Marketplace. “We thank Ryan Kennelly and his agency for their dedication to providing exceptional service and helping access coverage.”

This year’s Open Enrollment Period for applying for Marketplace coverage runs from Nov. 1, 2022, to Jan. 15, 2023. Consumers with questions about their coverage or who would like help enrolling can call/text (312) 726-6565 or email help@ihealthagents.com.

What is the Marketplace Circle of Champions?

CMS created the Marketplace Circle of Champions program to commemorate the hard work and commitment of Marketplace-registered agents and brokers throughout America. This award recognizes agents and brokers who have actively enrolled 100 or more consumers. Each year, thousands of agents and brokers reach the Marketplace Circle of Champions, highlighting their hard work, expertise, and service.

The post 2023 Marketplace Elite Circle of Champions! appeared first on Illinois Health Agents.

What Does the No Surprises Act Mean for Me?

For individuals, this consumer protection act means the following:

• No surprise billing for emergency services. Even if emergency services are provided out-of-network, these services must be covered at an in-network rate without requiring prior authorization.
• No out-of-network cost-sharing and balance billing for emergency and certain non-emergency services. The cost of the service for the individual cannot be higher than if the services are provided by an in-network provider should this situation arise. Also, any deductible or coinsurance must be based on the in-network rate.
• No out-of-network charges and balance billing for ancillary care by out-of-network providers at an in-network facility.
• No additional out-of-network charges and balance billing without advance notice. Providers must provide advance notice (written in plain language) explaining that patient consent is required to get care on an out-of-network basis before the individual can be billed.

While States are primarily responsible for enforcing the No Surprises Act, they can enlist help from the federal government. Consumers can appeal health plan denials, reach out to the enforcement entity, contact their state consumer assistance program or use the national consumer complaints system that will be established should a problem arise.

*Please note: The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE because these programs have other protections against high medical bills.

Contact the IHA Team for Your FREE Plan Comparison

While comparing health coverage plan options can seem overwhelming, take comfort in the fact that you don’t have to do this alone.

IHA offers transparent, free consultations regarding your health insurance options. We’ll discuss what you’re looking for in a plan as well as available options that would suit your specific situation. As brokers, we have access to all private insurance and Marketplace health coverage plans, so you can feel confident that all options will be considered and any questions you have will be answered. We’re here and ready to help you find the best plan for your needs and budget.

The post No Surprises Act Saves Consumers From Unexpected Medical Bills appeared first on Illinois Health Agents.

• If a person’s income does not exceed 150% of the federal poverty level, they might be eligible for a Special Enrollment Period.
• This special enrollment period does not have limitations on how often it can be used, or the type of health plan that can be selected.
• Client has to be eligible for premium tax credits in order to take advantage of this SEP.
  When this article was published, February 9th, 2022, this SEP has not taken effect yet.
• Most people with very low incomes can now enroll in subsidized Marketplace coverage.

In September 2021, the U.S. Department of Health & Human Services finalized a new special enrollment period (SEP) in states that use HealthCare.gov (optional for other states), granting year-round enrollment in ACA-compliant health insurance if an applicant’s household income does not exceed 150% of the federal poverty level (FPL) and if the applicant is eligible for a premium tax credit (subsidy) that will cover the cost of the benchmark plan.

This SEP became available on the HealthCare.gov website (and enhanced direct enrollment entity websites) as of March 21, 2022. It was available prior to that only by calling the HealthCare.gov call center and completing the application over the phone. But it is now available online as well.

Visitors to HealthCare.gov need to select “see if you can enroll” and then select the option that says “Medicaid, CHIP, or a new Special Enrollment Period based on income.” The prescreener tool will then ask questions to determine whether the person/household’s income is in the eligible range. If so, the special enrollment period opportunity will allow them to proceed with the enrollment. Enhanced direct enrollment entities have similar enrollment pathways.

In finalizing this SEP, HHS noted it’s beneficial for low-income consumers to have additional enrollment opportunities, and that this is in keeping with the executive order to strengthen Medicaid and the ACA, signed by President Biden in January.

What does this new special enrollment period allow eligible applicants to do?

Under the new special enrollment period, eligible applicants can enroll in an ACA-compliant health plan through the marketplace at any time during the year. Coverage will take effect the first of the following month. (If a state-run exchange chooses to offer this SEP, they can use that same approach or choose to have a deadline of the 15th of the month for coverage to start the first of the following month. As of 2022, HealthCare.gov allows all SEP enrollments to have coverage effective the first of the following month, regardless of the application date.)

This special enrollment period does not have limitations on how often it can be used, or the type of health plan that can be selected. But people with income up to 150% of the poverty level are strongly encouraged to select a Silver plan.

At that income level, Silver plans have built-in cost-sharing reductions that make the coverage better than a Platinum plan. And for as long as the American Rescue Plan’s subsidy enhancements are in effect — at least through the end of 2022 — the two lowest-cost Silver plans are premium-free (in most states) for applicants with income up to 150% of the poverty level.

A person with an eligible household income who is already enrolled in an exchange plan can use this SEP to pick a different plan, although deductible and out-of-pocket spending would reset to $0 for the year when the new plan starts.

However, the new rules do clarify that if a current enrollee is adding a dependent to their plan, they can either add the dependent to the existing plan, or switch to a Silver level plan and enroll the new dependent in that plan. But the SEP cannot be used to switch the current enrollee to a non-Silver plan together with the new dependent.

Who is eligible for this special enrollment period?

To be eligible for this SEP, an applicant’s household income cannot exceed 150% of the federal poverty level. For a single person enrolling in coverage for 2022 in the continental U.S., 150% of the poverty level amounts to an income of no more than $19,320. For a household of five, it’s $46,560. (Note that the prior year’s poverty level guidelines are used, and that the poverty levels are higher in Alaska and Hawaii).

You have to be eligible for premium tax credits in order to take advantage of this SEP. So regardless of income, the SEP is not available to a person who is eligible for Medicaid, premium-free Medicare Part A, or an employer-sponsored health plan that provides minimum value and is considered affordable. The SEP is also not available to people in the coverage gap (which exists in 11 states as of 2022), because they are not eligible for premium tax credits.

This SEP is only available on-exchange, since premium tax credits aren’t available outside the exchange.

(Note that to get on-exchange coverage, you can enroll directly through the exchange, or through an enhanced direct enrollment website, or with the help of an agent or broker. If you have questions, you can call (312) 726-7266 to speak with one of our licensed agents.)

This special enrollment period may or may not be permanent

This special enrollment period is fairly unique in that it may or may not be permanent. HHS has clarified that the new SEP is only available for as long as people at this income level are eligible for premium-free benchmark plans. The American Rescue Plan (ARP) enhanced premium tax credits (subsidies) for 2021 and 2022. The result is that people with income up to 150% of the poverty level do not have to pay premiums for the benchmark plan. (In some states, these plans still cost a dollar or two, due to additional state-mandated benefits.

Although the American Rescue Plan only provides these enhanced subsidies through the end of 2022, the version of the Build Back Better Act that passed the House in November 2021 called for them to be extended through 2025 (that’s for the increase in subsidy amounts and the elimination of the income cap for subsidy eligibility; it calls for the unemployment-based subsidies to be extended through 2022). But that legislation stalled in the Senate.

There is optimism that some parts of the Build Back Better Act, including the enhanced premium subsidies, could be enacted on a piecemeal basis before the end of 2022, but this is still very much up in the air. So the new SEP may only be available through 2022, or it may end up being available in future years; it all depends on whether Congress extends the ARP’s enhanced subsidies.

How do I prove my eligibility for this SEP?

To gain access to this SEP in the federally run marketplace (HealthCare.gov), you just have to attest to the fact that your income is in the eligible range.
If the income information the government has on file doesn’t match the income the applicant has projected, the exchange may request proof of the projected income to ensure that it is actually no more than 150% of the poverty level.

If an applicant does not provide proof, the federally run marketplace can terminate the premium tax credit that’s being paid on the enrollee’s behalf, meaning that the person would then be paying full-price for their coverage (or will simply find coverage terminated when they fail to pay the full premium in the first month it’s required).

Does the SEP for individuals with income under 150% FPL apply in every state?

Not necessarily. State-run exchanges (there are 18 as of the 2022 plan year) are not required to offer this SEP. But as of early 2022, several state-run exchanges (Colorado, Maine, Pennsylvania, New Jersey, California, and Rhode Island) had already debuted the new SEP.
Several other state-run exchanges have no need for this SEP, because they have other programs with year-round availability. This includes:

• New York and Minnesota, both of which have Basic Health Programs that cover people with income up to 200% of FPL
• Massachusetts, which offers Connector Care to people with income up to 300% of FPL (enrollment is open year-round to people who are newly eligible or who have not been covered under the program in the past)
• DC, which offers Medicaid to adults with income up to 215% of the poverty level

Some of the remaining state-run exchanges may decide to allow this SEP as of 2022, and others may choose not to offer it at all. Some state-run exchanges may find that it’s too operationally challenging to make this SEP available for 2022, and may postpone it until 2023 (assuming that the ARP’s subsidy enhancements are extended).

State-run exchanges have flexibility in terms of how they implement this SEP. As noted above, some may choose not to offer this SEP at all. For those that do offer it, proof of income might be required in order to trigger the SEP, or they may follow the federal government’s lead and allow the SEP eligibility to be based on the income attested by the consumer.

But HealthCare.gov is the exchange used in the majority of the states, and this SEP is available in all of those states for as long as the ARP-style subsidy enhancements are in effect.

What else do you need to know about eligibility for the SEP?
Although access to this SEP is largely based on income, there are several points to keep in mind:

In most states, there is a fairly narrow income window for eligibility for this SEP, since Medicaid is available to adults in most of the country with income up to 138% of the poverty level. So this SEP would only be available to applicants with income between 139% and 150% of the poverty level (note that Medicaid enrollment, for both adults and children, is always available year-round).

In the dozen states where Medicaid has not been expanded, this SEP is available to households with income between 100% and 150% of the poverty level. (There’s a coverage gap in those states for many adults with income below the poverty level, and this SEP does not change that.)

Recent immigrants (who aren’t eligible for Medicaid due to their new immigrant status) can qualify for this SEP with income between 0% and 150% of the poverty level.

People receiving unemployment compensation may be able to qualify for this SEP in 2022 and future years, if additional legislation is enacted. In 2021, income was determined to be 133% of the federal poverty level for people receiving unemployment compensation, regardless of how much it actually was. The Build Back Better Act called for this to be extended through 2022, with income above 150% of FPL disregarded for people receiving unemployment compensation. This would continue to allow these applicants to be eligible for this SEP, as eligibility is based on having an income of no more than 150% of the poverty level. But as of early 2022, the Build Back Better Act has stalled and its future is very uncertain. Some aspects of it may be enacted piecemeal or as part of other legislation.

The post New for 2022: an ongoing Special Enrollment Period (SEP) for eligible individuals whose income falls at or below 150% of the Federal Poverty Level (FPL). appeared first on Illinois Health Agents.

Those with incomes less than 150% of the federal poverty level — $19,320 for an individual and $39,750 for a family of four — can select policies on healthcare.gov through a special enrollment period, the Centers for Medicare and Medicaid Services told CNN exclusively on Monday. Most people will be able to select plans with no premiums, while others may have to pay a few dollars.

The agency is launching advertising and outreach campaigns to spread the word about the new special enrollment period, which lasts for the rest of the year. The effort will also target those experiencing certain life changes, such as losing job-based coverage, getting divorced or aging out of a parent’s policy, which have always allowed them to sign up for Obamacare policies during the year.

“We’re doing year-round outreach on marketplace coverage to make sure that people know that it’s available to them and really get the word out to new communities,” CMS Administrator Chiquita Brooks-LaSure told CNN.
The Biden administration has beefed up enrollment assistance, funneling more funds to navigator programs that help people select policies. It is aiming to enroll more of the uninsured in coverage, as well as aid those who lose Medicaid coverage to maintain health insurance after the public health emergency ends.

“We know this has been a tough time for a lot of people and want to make sure the door is always open for them to sign up for coverage,” said Health and Human Services Secretary Xavier Becerra.
The 17 states (and Washington, DC) that run their own marketplaces can also opt to run special enrollment periods for their low-income residents. Most, including Maine, Pennsylvania and Rhode Island, have already started doing so.

The expanded enrollment opportunity stems from the Democrats’ $1.9 trillion Covid-19 relief package, which was enacted last year. In addition to temporarily providing more generous subsidies that reduce premiums to $0 or close to it for low-income folks, the law allows them to sign up outside of the traditional open enrollment season, which ended in mid-January.

For the past few weeks, those eligible could enroll only using the federal exchange’s call center.
The special enrollment period could run beyond 2022 if Congress extends the enhanced premium assistance, which expires after this year.

Increased interest in Affordable Care Act coverage

The beefed-up subsidies, which also make Obamacare policies more affordable for those with higher incomes, helped draw a record 14.5 million Americans to 2022 coverage on the health insurance exchanges during open enrollment.

Sign-ups were particularly strong in several states that have not expanded Medicaid to low-income adults. And it’s been popular among those with lower incomes nationwide: Some 4.6 million consumers who earned up to 150% of the poverty line enrolled in 2022 coverage, a 21% increase from the prior year.
Giving low-income Americans more opportunity to sign up is important because the economy has not fully recovered, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

“We’re still dealing with a lot of disruption in people’s lives,” said Corlette, noting some are still contending with changes in their jobs or residences.

And it’s important to have health insurance since Covid-19 continues to plague the nation, she said.

Shortly after taking office in January 2021, President Joe Biden opened a six-month special enrollment period to allow Americans to sign up for health care coverage and to take advantage of the enhanced subsidies during the pandemic. Some 2.8 million people selected policies during that time.

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As a reminder, Medicare is composed of two programs. Part A, Hospital Insurance (HI), which covers inpatient hospital services, skilled nursing facilities, home healthcare, and hospice care. HI is financed primarily by a 2.9% payroll tax, shared equally by employers and employees. The second and larger program is Supplementary Medical Insurance (SMI), which consists of two separate accounts: Part B, which covers physician and outpatient hospital services, and Part D, which covers prescription drugs. SMI is financed by a combination of general revenues and participant premiums. The Part B premium is set at 25% of projected program costs.

Read: Seniors get the biggest Social Security raise in years — and it’s already eaten up by inflation

With a 14.5% increase, the Part B premium for a single individual — with income less than $91,000 — is slated to rise from $148.50 in 2021 to $170.10 in 2022. And since Medicare premiums increase with income, individuals with income of $170,000 to $500,000 will see their premium increase from $475.20 to $544.30. (See Table 1 for 2022 premiums.)

How did this happen when healthcare costs grew by only 0.4% in the past year (see Figure 1)? And the announced increase was also significantly higher than the 6.7% predicted by the CMS Trustees in August. 

Apparently, the increase was due to three factors, two fairly routine and one horrifying. The routine factors include: 1) projected rising prices and increases in intensity of care; and 2) making up for a cap in Part B premium increases in 2020.Visit our

Read: Premiums, deductibles, and copays will be higher — Medicare changes for 2022

The horrifying source of the increase relates to Aduhelm, the new Alzheimer’s drug estimated to cost $56,000 a year. While the process is still under way to determine whether and how Medicare will cover Aduhelm, CMS decided to increase “contingency reserves” to cover possible significantly higher expenditures in the future.

As an aside, the reason that Aduhelm falls under Part B instead of Part D is that it is administered in physicians’ offices rather than purchased at a pharmacy. One implication of being under Part B is that traditional enrollees have to pick up 20% of the cost of most Part B medications, which would translate into about $11,200 in out-of-pocket costs for those prescribed Aduhelm.  

So where does this enormous increase in premiums leave Social Security beneficiaries after they pay the higher premium? An individual currently receiving $1,600 a month (the approximate average retiree benefit) will see benefits go up by $94 from the COLA, but pay $22 more in Medicare premiums, resulting in a net increase of $72 or 4.5% of the original benefit amount. Thus, while the Part B increase does not eliminate the COLA, it seriously erodes its inflation protection.    

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The American Rescue Plan broadens the subsidies available under the Affordable Care Act for comprehensive health insurance — increasing them for people who are already eligible, and providing new assistance for people with incomes previously too high to qualify. The top set of maps, drawn from calculations made by the Kaiser Family Foundation, show how much the changes will reduce what people pay for health insurance around the country, depending on their location and age.

The changes mean small adjustments for some Americans and very substantial ones for others. For anyone earning around $19,000, subsidies will now be generous enough to sign up for a typical plan with no monthly payment. For someone earning over $51,000, new subsidies could lower premiums by as much as $1,000 a month in the country’s most expensive markets.

Some groups still won’t qualify for help: undocumented immigrants, and poor Americans in states that have not expanded Medicaid under an option provided by the Affordable Care Act. But a large majority of uninsured Americans can now get financial help buying insurance, according to Cynthia Cox, a vice president at Kaiser.

The maps here show roughly how much Americans who buy such plans will need to pay each month under the new rules. All the eligible plans must cover a standard set of comprehensive benefits, including prenatal care, prescription drugs and mental health services — more coverage than is available in the short-term plans or health-sharing ministries that some middle-income Americans are currently enrolled in.

To qualify for the new benefits, people need to sign up for plans at Healthcare.gov, an approved web-broker or a state exchange website. The changes will be retroactive to Jan. 1, meaning that people who already have Obamacare plans will get money back. Anyone who is uninsured now can qualify for new prices as soon as they sign up. But experts say it may take a little while for the subsidy changes to show up on Healthcare.gov. If you sign up right away, you may have to pay the old price for the first month and wait for a refund.

If you are receiving unemployment insurance, the legislation entitles you to a special discount: Regardless of your income, your premiums will look similar to that of the person earning $19,000 on our maps. And if you lost your coverage at work and want to keep it, the bill will also pay the full cost of your premiums for six months under the federal COBRA program.

Notes: Premiums and subsidies displayed here are for individuals buying a silver plan at the second-lowest price in their market. But subsidies are calculated differently depending on family sizes. A family of four earning around $40,000 would pay the same premium as an individual earning $19,000, for example.

In a handful of states, people earning $19,000 won’t qualify for new subsidies because they already qualify for other low-cost state insurance programs — Medicaid in Alaska, Hawaii and the District of Columbia; and the basic health plan in Minnesota and New York (the basic health plan is Medicaid-like coverage with low premiums for a sliver of low-income Americans in certain states).

If you want to calculate the premium you would pay for your income, household size and location, this online tool may be helpful.

The post American Rescue Plan Lowers Obamacare Costs Immediately appeared first on Illinois Health Agents.

As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed COVID-19‘s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go right to intensive care. Some don’t survive.

“We’re in a bad dream all the time,” she said during a recent day treating coronavirus patients at Mount Sinai Hospital, which was founded in the early 20th century to care for the city’s poorest immigrants. “I can’t wait to wake up from this.”

Prendkowski believes some of the death and suffering could have been avoided if more of these people had regular treatment for the types of chronic conditions — asthma, diabetes, heart disease — that can worsen COVID-19. She now sees a new reason for hope.

Illinois added to States Aging the Fastest

Amid a deadly virus outbreak that has disproportionately stricken Latino communities, Illinois recently became the first state to provide public health insurance to all low-income noncitizen seniors, even if they’re in the country illegally. Advocates for immigrants expect it will inspire other states to do the same, building on efforts to cover undocumented children and young adults. Currently, Democratic legislators in California are pushing to expand coverage to all low-income undocumented immigrants there.

“The fact that we’re going to do this during the pandemic really shows our commitment to expansion and broadening health care access. It’s an amazing first step in the door,” said Graciela Guzmán, campaign director for Healthy Illinois, a group that advocates for universal coverage.

Undocumented immigrants without health insurance often skip care. That was the case for Victoria Hernandez, 68, a house cleaner who lives in West Chicago, a suburb. The Mexico City native said she had avoided going to the doctor because she didn’t have coverage. Eventually, she found a charity program to help her get treatment, including for her prediabetes. She said she intends to enroll in the new state plan.

“I’m very thankful for the new program,” she said through a translator who works for the DuPage Health Coalition, a nonprofit that coordinates charity care for the uninsured in DuPage County, the state’s second-most populous. “I know it will help a lot of people like me.”

Healthy Illinois pushed state lawmakers to offer health benefits to all low-income immigrants. But the legislature opted instead for a smaller program that covers people 65 and older who are undocumented or have been legal permanent residents, also known as green card holders, for less than five years. (These groups don’t typically qualify for government health insurance.) Participants must have an income at or below the federal poverty level, which is $12,670 for an individual or $17,240 for a couple. It covers services like hospital and doctor visits, prescription drugs, and dental and vision care (though not stays in nursing facilities), at no cost to the patient.

The new policy continues a trend of expanding government health coverage to undocumented immigrants.

To read the full article, visit https://www.usnews.com/news/best-states/articles/2021-01-07/illinois-is-first-in-the-nation-to-extend-health-coverage-to-undocumented-seniors .  This article was originally published on 1/7/2021 by Kaiser Health News, written by Giles Bruce.

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