On-Marketplace Health Insurance Policies
ObamaCare
I’m sure you’ve heard that term tossed around before in conversation. It’s a slang term for the Health Insurance Marketplace.
Fun Fact!
We weren’t legally allowed to say that term when the Affordable Care Act was first implemented. But since no-one understood what that meant, the Government allowed us to start using ObamaCare when referring to the Health Insurance Marketplace because that’s what everyone thought it was called.
“Well, you may think that, but you’re wrong.”
Edward Scissorhands
Is Florida Blue not available in your county?
We also own Florida Health Care Plans (FHCP)! Those plans are available to purchase in Brevard, Flagler, Seminole, St. Johns, & Volusia counties.
If you’re a current FHCP Policy Holder, please click the button below to visit our FHCP Member Page to explore the Benefit Guides available to you!
Currently on a Health Insurance Marketplace Policy and turning 65 soon or are about to receive Original Medicare due to collecting 2 years of Disability?
When the Government passed the Affordable Care Act (ACA) implementing it in 2014, it changed some of the rules for enrolling into any type of Medicare Plan.
Normally you have the 3 months before your 65th Birthday (Or when your Original Medicare Parts A&B start if you’re receiving it due to Disability), the month of your Birthday, and the 3 months following your Birthday month to sign up for some type of Medicare Plan. This is called your Initial Enrollment Period (IEP).
As long as you paid 10 years of Medicare Taxes (Or 40 Quarters), you’re eligible for Premium Free Original Medicare Part A. Your Original Medicare Card will come in the mail about 4 months before your 65th Birthday with your Part A Effective Date. If you’re currently drawing your Social Security Checks, then your Original Medicare Part B Effective Date will be on there as well. They’ll both be effective for the 1st of your Birth Month. Unless your Birthday is on the 1st, then Parts A&B will be effective on the 1st of the month before your Birth Month.
If you’re not drawing your Social Security Checks, then Part B is NOT automatic, and you should visit our Medicare Part B Page or our Medicare Info Page to learn about how to sign up Manually.
YOU MUST HAVE MEDICARE PARTS A & B TO SIGN UP FOR A MEDICARE ADVANTAGE PLAN OR SUPPLEMENT PLAN!
Here’s the Kicker!
If you’re currently enrolled in a Health Insurance Marketplace policy, you MUST come off that plan by the end of the month before your Medicare Parts A&B start.
Even though your Initial Enrollment Period is 7 months long, per ACA Laws, since the Marketplace and Medicare are both Government funded programs, you cannot have a Marketplace Policy when you’re eligible for Medicare.
This means your new Medicare Plan must start the same day your Medicare Parts A&B are effective to be compliant with the ACA laws.
If you fail to do this by the end of your 7th-Month IEP, once you do sign up for your Medicare, you will incur a Lifetime Part B Late Enrollment Penalty (LEP).
The Marketplace will also automatically terminate your Marketplace Policy once that 7-Month IEP Period ends. Which will be 3 months after your 65th Birthday. Then you will NOT be able to sign up for Medicare Part B till the next General Enrollment Period.
This means NO Outpatient Provider Visit Coverage. (Medicare Part B)
It could potentially mean NO Prescription Drug Coverage as well. (Medicare Part D)
Depending on when your IEP ends, you may be able to sign up for a Stand-Alone Prescription Drug Plan (PDP) if another Enrollment Period is available. You only need Medicare Part A to sign up for Part D Coverage.
However, if you go longer than 63 Days without Creditable Prescription Drug Coverage, you will incur a Lifetime Part D LEP once you do sign up for Coverage.
It is HIGHLY advised to sign up for some type of Medicare Plan to be effective for the same month your Medicare Parts A&B are effective to avoid any Lifetime LEPs!!
You can learn more about all the different types of Medicare Enrollment Periods, by clicking HERE.
What is the Health Insurance Marketplace?
What the Health Insurance Marketplace does is offer you a monthly Advancement of the Premium Tax Credit (APTC/Subsidy) based on your estimated Household Adjusted Gross Income for the current plan year (2024), family size, geographic location, age, and tobacco use.
Important Fact - The Health Insurance Marketplace bases the subsidy (APTC) amounts on the family size that is included on your taxes. If you’re unsure of who to include on your Marketplace Application, CLICK HERE.
The Monthly Subsidy is what has saved millions of Americans money on their health insurance premiums.
Anyone making under 400% of the Federal Poverty Level is eligible for a subsidy.
If you click on the image to your right, you can view the 2024 Qualifying Amounts. You will see that it doesn’t go all the way to 400%. When the Government passed the American Rescue Plan back in 2021, it made the 400% cutoff different in every county.
To receive a proper quote, please visit our Contact Page.
Running a Quote is your BEST option!
If your income is over the qualifying amounts listed in the Federal Poverty Chart above, we HIGHLY suggest visiting our Contact Page to receive a quote.
As stated before, the cut off for 400% of the Poverty Level is different in every county.
If you receive a subsidy (APTC) through the Health Insurance Marketplace, you MUST file your taxes with the 1095A Tax Form to receive your refund.
If your income ends up being more than 400% of the Federal Poverty Level for that health plan year, then you MUST pay back EVERY dollar of subsidy (APTC) received that year.
Example: Received $1,500/month in subsidy. Multiply that by 12 months. You would owe the IRS $18,000 in taxes!
Good News is that ONLY happens if you file over 400% of the Poverty Level for your county. As long as your Household Adjusted Gross Income is below that mark, then there’s capped repayment amounts depending on what level your income falls under.
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If you enroll into a Health Plan directly with the Marketplace, you will not have an agent to contact when you have customer service issues throughout the year. This is not recommended as the Navigators with the Marketplace are not legally allowed to discuss health plan benefit details with consumers. However, during the next Open Enrollment Period, we can take over your Health Policy and you’ll finally have your own personal Agent to contact whenever you have any questions or concerns.
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If you enroll into a Health Plan directly with Florida Blue, then their Corporate Office will be your Agent of Record and that can NEVER be changed unless you have a lapse in coverage, which is not advised!
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If you enroll into a Health Plan directly with FHCP, then their Corporate Office will be your Agent of Record and that can NEVER be changed unless you have a lapse in coverage, which is not advised!
Is your Employer Coverage unaffordable to add your family?
Good News!! In 2023, there was an Amendment to the American Rescue Plan where they removed the “Family Glitch.”
The Family Glitch was a part of the Affordable Care Act law that made health coverage for Americans who had access to Group Insurance through their spouse’s employer unaffordable. If you’ve never had Group Insurance before, adding a dependent is VERY expensive. The Family Glitch made these individuals ineligible for a subsidy (APTC) through the Health Insurance Marketplace.
Those individuals were not eligible for a subsidy (APTC) unless the annual premium on the cheapest Group Plan for just the employee was more than 9.5% of ONLY their income. NOT the Household.
Thanks to this Amendment, the percentage to qualify for a subsidy was lowered. Your family may now qualify to receive a subsidy (APTC) through the Health Insurance Marketplace.
Please click on the image to your left to learn more. You can also visit our Contact Page to reach out to us for more details.
Important Facts!!
You MUST file your taxes every year to qualify for a subsidy (APTC) through the Health Insurance Marketplace. Even if your only income is Social Security which is non-taxable, per the Affordable Care Act, Social Security Benefits qualify as income.
Unsure of what income to include on your Marketplace Application? CLICK HERE
Since the Health Insurance Marketplace bases your monthly subsidy (APTC) on an ESTIMATION of your Household Adjusted Gross Income for the current health plan year (2024), you are required to file a 1095A Tax Form from the following year to continue to have coverage through the Health Insurance Marketplace.
If you fail to file your taxes with the 1095A when you had health coverage through the Health Insurance Marketplace the previous year, the IRS will hold your Refund till you amend your taxes by filing the 1095A into the 8962 Form on your taxes.
You would also be at risk of losing your current subsidy halfway through the year if you fail to file your taxes with the 1095A Tax Form from the previous year when you were enrolled in a health plan through the Health Insurance Marketplace.
Sounds Confusing, eh?
The Health Insurance Marketplace is required to mail out everyone’s 1095A Tax Forms by January 31st, so they usually arrive in the mail at the beginning of February every year. DO NOT THROW AWAY ANY MAIL DURING THIS TIME FROM THE HEALTH INSURANCE MARKETPLACE!!!
The Tax Form arrives in the same type of envelope as the Eligibility Notices do, but it should say IMPORTANT TAX DOCUMENTS INSIDE. There’s about 6 pages of this letter, but all you need is the chart that lists the subsidy amount (APTC) for every month you were enrolled in coverage. It’s usually located on Page 5.
If you do your own Taxes, you just need to scan that chart into your computer and save it as a JPEG or PDF file. Then you’ll be asked if you had health coverage for that Tax Year and you will upload the chart into the 8962 Tax Form. Please CLICK HERE for instructions on how to file your Marketplace Insurance Tax Forms correctly!
Don’t have a scanner? You can also do this by taking a picture of the chart on your smartphone and emailing it to yourself.
Can’t afford a Tax Preparer, but would like one? Google “United Way Tax Service” near me, and there are locations all over the state of Florida that help lower income individuals file their taxes for FREE.
For more information on the different kinds of 1095 Tax Forms, CLICK HERE.
To see examples of ALL the different kinds of notices you could receive from the Health Insurance Marketplace, CLICK HERE.
If you are viewing any PDF documents downloaded from our site on your laptop or computer, you can click “Ctrl” & “F” at the same time to populate a search box in the document. In that search box, you can type whatever you’re looking for and it will take you to every word pertaining to your search in that document.