Category Archives: F.A.Q

Can Employees Get Marketplace Coverage – ACA Questions

Yes, employees in the United States can get marketplace insurance. Most job-based health insurance plans are designed for your employer to pay a portion of your monthly premium. However, if you enroll in a Marketplace plan instead, the employer won’t contribute to your insurance premium. If you have job-based insurance and want to check out options in the Health Insurance Marketplace, you can do that here. But there are several important things to know first. You can change to a Marketplace plan if you have job-based coverage now, but you probably won’t qualify for a premium tax credit or other savings. As long as the job-based plan is considered affordable and meets minimum standards, you won’t qualify for savings. The Chart below will give you more information.

A new ACA rule fixes the Marketplace “Family Glitch”– Increasing the number of individuals eligible for Marketplace coverage in 2023. Until now under the Patient Protection and Affordable Care Act (ACA), employer offered coverage was considered affordable for all family members to whom an employer’s offer extends if the premium for the employee’s self-only coverage was considered affordable. The premium required to cover family members was not considered in deciding on subsidy. However, beginning plan year 2023, if an employee is offered employer coverage that extends to their family members, the affordability of employer coverage will be based on the family premium cost, not the Employee only premium cost. Family members will be eligible for financial assistance on the Marketplace if the employee’s family premium cost is considered unaffordable.

● Split Coverage (Employer and Marketplace): Employee could enroll in the affordable employer coverage, while
their family members enroll in a Marketplace plan with APTC/CSRs if otherwise eligible.
● Employer Coverage Only: Whole family could enroll in the employee’s offer of employer-sponsored coverage.
While someone is enrolled in employer coverage, they aren’t eligible for financial assistance on a Marketplace plan.
● Marketplace Coverage Only: Employee could decline the affordable employer coverage, and the whole family could
enroll in a Marketplace plan. They will pay full price for the employee’s portion of the Marketplace plan premium, while
other family members’ portions would be lowered by using APTC and/or CSRs if they are otherwise eligible.

Obamacare vs Private Insurance

Here are some examples of when a Short Term Health Insurance Policy may be of use. Short Term Medical is not part of Obamacare and it is offered by private health insurance companies.

An individual was laid off and lost their coverage right before open enrollment began and now they don’t have any income or insurance.

Getting laid off and losing health coverage counts as a qualifying life event which means their open enrollment goes for 60 days from the date their old policy ended However, if they cannot afford an Obamacare plan, then a private short term medical insurance might be a good fit for them to carry them through until they can become covered under their next major medical plan.

An individual did not apply for health insurance through open enrollment, and makes too much money to qualify for Medicaid.

Fortunately, the government realized that the coverage gap is a major problem for individuals who make too much to apply for Medicaid but can’t afford Obamacare plans. Consequently, they are unable to purchase discounted coverage through the exchange. Short Term Medical can bridge the gap until coverage is purchased during the next open enrollment.

An individual is in between jobs and cannot afford Obamacare.

Short term medical insurance is not regulated by the ACA, so there is still underwriting, they don’t cover pre-existing conditions, benefits are capped, and preventive care is not covered. However, STM does cover injuries and illness that can occur after the effective date. Keep in mind the private STM does not meet the individual mandate, but many conditions and injuries are covered under the policy.

Interested? Click here to get a quote on Short Term Health Insurance.


Health Insurance Marketplace

Our Health Insurance Marketplace will help you collect Federal subsidy and enroll in an Affordable Care Act (Obamacare) Plan. We also help people renew their coverage.

Our expertise in the Marketplace begins with our licensed enrollment specialists that are highly knowledgeable in individual and family health products. All our agents are Federally Facilitated Marketplace Agents. This means it is no cost for their advice and guidance. The “Obamacare agents” are both certified with the federal government and with the state in which they assist you. We help clients in the enrollment process for both on and off exchange products for both state and Federal exchanges.

We are also certified to assist with any over 65 who need help with Medicare enrollment.

As an added bonus we manage customer service issues for all active enrollments and assist with future renewals, plan changes, and Special Enrollments.

Added Benefits for Marketplace Health Insurance

  • Introductory Overview of ACA
  • Marketplace Phone Calls
  • Subsidy Estimation
  • Subsidy Application
  • Policy Overview
  • Marketplace Conference call Capabilities
  • Income verification assistance
  • Income change assistance
  • Online Marketplace Enrollment Assistance
  • Customer Service
  • Doctor Search / Provider Search / Hospital Network Search
  • Renewal Assistance
  • Special Enrollment Guidance

If you need help please schedule a phone call with a Marketplace representative.

Remember it is best to shop for coverage during Open Enrollment as no extra information is needed to trigger a Special Enrollment.

Online Obamacare Enrollment Was Easy For Me

Obamacare is very easy to sign up with, and you simply head over to their main site and fill out an application with all of your personal data and information. They will look at your application and determine if you qualify for a federal subsidy or not, which if you are not making a great deal of money, you are probably going to get. The way that this works in Georgia is that you will get a certain allotment, which will be taken off of a regular plan that the various health insurance companies offer. In essence, you apply with Obamacare, which will set you up in the system and award you your monthly subsidy, as well as the subsidies that are impacting on all of your medical costs.

At this point, you have the option of going through the various health insurance companies, as well as the individual policies that they offer within their systems and you pick your policy. Each month you will get a bill in the mail that shows the overall costs of the plan, minus your subsidies and you end up paying that amount. There are various coverage options that you can choose when you receive these subsidies, which all involve different amounts of coverage for things like if you need to have a surgery, or if you end up in the hospital for several days or more. This really comes down to an individual decision on your part, based on your overall health situation at the meantime and what you think it will be in the foreseeable future.

I’ve had a few plans in the past, but based on my research and advice from friends and family who also have Georgia Obamacare, I decided to go with Ambetter, where I got a very good plan that has worked out spectacularly. My subsidy was fairly large and I worked my payments out so that they are just under forty five dollars per month. Once you get your subsidy, you can click into the various health insurance companies’ pages and you will have usually three or four options for your coverage and the one I selected just happened to have the figures that I currently pay. The overall costs of going to see the doctor are anywhere from three to five dollars per month and if I have to go see a specialist, it is typically free.

I have used my coverage so far to see the doctor on more than a handful of occasions, spanning across multiple departments and perhaps the best thing about Ambetter is that they are all in one location. You can also purchase your medication at any Ambetter hospital or doctor’s office, meaning if you go in for any appointment you do not have to go to an outside pharmacy and can pick it up in the building. I pay several dollars for my medication and the pickup time is very short. Ambetter is made up of the utmost professionals and if you are looking for an Obamacare plan, you should definitely consider them.

Obamacare Dental Insurance

Many people think Dental Insurance is automatically included in your Obamacare Plan. This is not the case, 99% of the plans offer have NO adult dental insurance. If you want dental insurance it is best to buy private dental insurance.

Can I get dental coverage through the Obamacare Marketplace? 

In the Obamacare, dental coverage is included in a select few health plans. You can also get a stand-alone plan and pay a separate premium.

How do I add dental coverage to my Obamacare plan?

You can buy a dental plan through the Obamacare site ONLY when you enroll in a health plan at the same time. If you’re already enrolled in a Obamacare plan, you can’t add on dental coverage. If YOU do try and add dental coverage at this time, you will have to start and entirely new medical policy, which would mean a new policy number and a new deductible.

How can I see what dental plans and benefits are available?

After you complete your Obamacare application and get your results, you can view health plans that include dental coverage. If you decide you want a stand-alone dental plan, you can choose one after you select your health plan.

Do I have to get dental coverage for my child?

No. Dental coverage for children is an essential health benefit. This means if you’re getting health coverage for someone 18 or under, dental coverage must be available for them either as part of a health plan or as a stand-alone plan.

Can I cancel my dental coverage at any time and still keep my health coverage? It depends on what type of dental coverage you have. If you have a separate, stand-alone dental plan, you can cancel your dental coverage any time during the year by not making payments on the dental plan premium.

Remember your oral health is important. Every year millions of Americans suffer pain, abscess, disease, and even death from poor dental hygiene. The best way to have quality dental is to shop online for a quality dental plan.

How much is the Obamacare Penalty for 2016


The Obamacare Tax Penalty for 2016 will be $695 per a person, or 2.5% of your income, whichever is higher.

Example 1:  A family of 3 who make $50,000.

2016 Obama Tax Penalty:  $2085.00

Example 2: A self employed individual making $150,000.

2016 Obama Tax Penalty:  $3,750 (2.5%)

Example 3: Apply for 2016 Health Insurance.

2016 Obama TaxPenalty:  $0.00

More examples of how to avoid Health Insurance Penalty and Save Money

An individual would pay $695 a year or $58 a month tax penalty. SO if they buy a 2016 Obamacare plan under $58 a month, they are saving money (by avoiding penalty) AND getting health insurance.

A family of 2 would pay $1390 a year or $116 a month penalty. SO if they buy a 2016 Obamacare plan under $116 a month, they are saving money (by avoiding penalty) AND getting health insurance. 

A family of 3 would pay $2085 a year or $174 a month penalty. SO if they buy a 2016 Obamacare plan under $174 a month, they are saving money (by avoiding penalty) AND getting health insurance.

Community Health Alliance Closes

A sad day in Tennessee. Community Health Alliance due to huge internal problems Com TN will no longer offer insurance coverage next year. This will be forcing about 27,000 enrollees to find new TN health insurance plans.

The Tennessee Obamacare insurance cooperative, created under the Affordable Care Act, will continue to pay out existing claims but will wind down its coverage by not taking on new customers, which it has not done since January 2015 .

The decision was based on the co-op’s financial condition, according to the Tennessee Department of Commerce and Insurance, and ends months of uncertainty about its future. The alliance had stopped selling its plans on the federal exchange in January after its low-cost plans attracted more enrollees than expected, and their ability to handle the high volume came into question.

“This was not a decision that the Department took lightly, but it was the right decision,” Julie Mix McPeak, commerce and insurance commissioner, said in a statement. “With thousands of Tennesseans’ coverage hanging in the balance, Community Health Tenn financial success could not be guaranteed. The risk of CHA’s potential failure in 2016 was too great and would have caused substantial detrimental effects on the market as a whole if it were to collapse.”

TN active members will keep their insurance coverage through 2015 as long as premiums are paid. However, they must enroll again during the Open Enrollment period, which begins Nov. 1, 2015. To shop health plans in 2016, consumers must enroll by Dec. 15, 2015 for a Jan 1 start date, and have until 01.31.2016 until Open Enrollment closes. They will be able to choose from four remaining carriers on the federal marketplace, which they can shop for on

Nevada Health Coop Closes Door for Open Enrollment

As Open Enrollment of Obamacare begins, Nevada Health Coop is packing its bags. Essentially, it’s broke. NV Health Coop is one of the many nonprofit organizations formed and funded by the Affordable Care Act to “keep insurance companies honest”. One cannot help but scratch their head and marvel at the huge loss of money from this poorly executed idea. Now the Commissioner of Insurance has filed a suit against the delinquent domestic insurer.

It should be stated that Nevada Health Coop is not the only organization like this to close its doors. New York, Nebraska, and a slew of other states also had to close their doors as well. It is interesting that carriers like Anthem BSBS of NV, Sierra Health and Health Plans of Nevada will all continue doing business in Nevada.

Below is a document.
Nevada Health Coop Sued

Obamacare 2016 Renewal Dates

Here are some key Obamacare dates Americans need to keep in mind.

  • November 1, 2015 – 2016 Open Enrollment begins
    This is the first day your to shop and enroll in a 2016 Obamacare health insurance plans or Private Health Insurance. It’s also important that consumers make sure their account information is up to date to reflect any changes to their income or family.
  •  December 15, 2015 – Last day to renew or choose a plan to avoid a coverage gap. This is the last day to renew or choose a plan to make sure coverage will start on January 1, 2016.
  •  January 1, 2016 – First date health insurance coverage begins
    This is the plan effective date if applicants renewed or choose a plan by December 15, 2015.
  • January 31, 2016 – 2016 Open Enrollment ends
    This is the last day Americans can make changes or enroll in a new 2016 Obamacare health insurance plan, without potential penalty for being uninsured.

Nevada Health Co-op Goes Belly Up

The Board of the Nevada Health CO-OP decided NHC will not offer health insurance policies after December 31, 2015 and will voluntarily cease operations beginning January 1, 2016.  The health policies are to remain in effect, and members may continue to see providers under the terms of their policies.

The goal is for the members to have a positive experience through this transition. Nevada Health Co-Op will be notifying all individual members that they will need to select a new health insurance plan for 2016 during the upcoming open enrollment beginning November 1, 2015.

Nevada Health Co-op Notice to Providers

“…continue to treat our members in the same manner you have been doing under the terms of your provider agreement. Claims continue to be processed in the same manner and we will accept claims for dates of service through December 31st, 2015.” If you have any questions, please call us at 702-823-2667, Monday through Friday, 8:00 a.m. to 6:00 p.m.

Nevada Health Co-op Notice to Agents

“…our goal is for all brokers and members to have a positive experience through this transition. We are committed to satisfying broker commissions that have been and continue to be earned through 2015. We appreciate the opportunity brokers gave the CO-OP to help improve health care in Nevada.”

Nevada Health Co-op Phone Number

3900 Meadows Lane
Las Vegas, NV 89107

Nevada Health Co-op closes as of 12/31/2015.

Nevada Obamacare Options

Currently the state of Nevada still has many Obamacare options. This Open Enrollment residents can apply for Nevada Obamacare coverage with Anthem Blue Cross Blue Shield of Nevada, Sierra Health, Health Plan of Nevada (HPN). Consumers can also shop off Exchange with some additional carriers.