Health Insurance Decision Time

Once again it is time to make health insurance decisions. If you are insured through your workplace, your deadlines will be determined by your employer. If you are insured through Medicare (including Medicare Advantage plans), you have between now and December 7 to make changes; your best resource for unbiased assistance in Iowa is the Senior Health Insurance Information Program. Similar resources are available in other states, as well.

If you are not yet eligible for Medicare, and do not have affordable insurance available through an employer, then the Health Care Marketplace is the place to turn for quality health insurance plans* that do not consider pre-existing conditions. The base premium for plans in the Marketplace is affected by your location, your age, and use of tobacco. That is because health care costs vary by location, and are higher for people who are older and who use tobacco. Two other factors also affect your cost:

  • Type of plan (bronze, silver, gold, platinum) you choose. All of these plans are quality* plans, but it is valuable to understand the difference. Bronze plans have the lowest premiums, because they have higher deductibles and co-payments. Premiums increase as you go up in metal value. Platinum plans have the highest premiums, but lower deductibles and co-pays. This post from 2014, when the Health Care Marketplace was new, provides more detail.
  • Your income. That’s right. Two people might pay different premiums even if they are both 30-year-old non-smokers who live in the same county and both chose a silver plan. The Marketplace is designed to provide more help in paying for health insurance to people who need it more. So when you enroll in a Marketplace plan, you will estimate what your household’s income will be for 2022. Based on that estimate, the system determines what your share of the premium for a silver plan should be, and the remaining amount will be covered by an Advance Premium Tax Credit, which is an estimate of how much help you are eligible for. All this is based on a baseline silver plan; you will get the same amount of help toward your premiums regardless of what “metal color” plan you choose. At the end of they year, your tax return will show your actual total income for the year. The actual income will be used to determine your final Premium Tax Credit amount. If you received too much or too little in advance, the difference will be taken care of on your tax return, by either increasing or decreasing your tax refund or the amount of tax you owe when you file. The Kaiser Family Foundation offers a useful tool to give you an idea of how much help you may be able to receive.

Open enrollment for 2022 health plans in the Marketplace continues through January 15, but if you want your coverage to begin as early as possible (January 1) then you need to enroll by December 15. Enrolling between December 16 and January 15 will get you coverage that begins February 1. Enroll online at www.healthcare.gov OR call 800-318-2596. A link is also available to find local help. You have the option to choose (filter) whether you wish to find an agent/broker OR would rather get help only from an assister.

*What do I mean by “quality” plans? The biggest factor is that a quality plan covers all ten essential types of health care. By contrast there are plans (sometimes referred to as “junk plans”) that purport to provide health coverage, but exclude certain categories. I’ve heard of situations where people are excited to get health insurance, but then when need arises they discover it doesn’t cover hospitalization, or it only pays $100/day toward hospital care, or has some other substantial limitation. In addition marketplace do not have annual or lifetime limits on what they will pay for an individual’s care. Another key “quality” factor is that the plans have been actuarially evaluated as providing appropriate coverage for an appropriate cost. In other words, they are not set up to make big profits for the company.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Medicare Open Enrollment – So What?

Medicare’s annual open enrollment period for 2022 coverage began last Friday and continues through December 7. But why does it matter? Most people enroll in Medicare when they turn 65 — doesn’t that take care of it? The answer is: probably not.

NOTE: Even if you are too young for Medicare, this blog post may be worth your attention if there are people you care about who are enrolled in Medicare. I’d encourage you to touch base with them to make sure they understand their options, and the mailings they are receiving, and help them get help if they need it.

During open enrollment each year, consumers have options to make changes. They also may receive a small deluge of marketing mail, email, and perhaps even phone calls. It’s important that they understand what their options are, and that they pay attention to mailings — especially those from Medicare itself (CMS – The Center for Medicare and Medicaid Services) AND from their current insurance company(ies). There are generally three types of choices consumers make during Open Enrollment:

  • Prescription Drug (Part D) Plan. This may be the most common decision people make during open enrollment. Most Medicare participants also enroll in a separate insurance plan to help cover prescription costs. These plans are offered by CMS in partnership with private insurance companies, and you may literally have dozens of plans to choose from. Some people make the mistake of assuming that if they like their current plan, they should just stay with it. The reason that’s a mistake is that plans can change substantially from one year to the next. Maybe this year, your plan covered your medications nicely, with low co-pays; but next year, they could choose to drop one of your medications or attach a much higher co-pay. So even if your own medications haven’t changed, it is smart to use the Medicare on-line tool to see which plans offered in your area will cover your medications at the lowest cost to you. (SHIIP can help with this — see below)
  • Medicare Advantage Plan. Some consumers choose Medicare Part C (Advantage) plans instead of traditional Medicate Part A and B. These are managed care plans operated by private insurance companies in partnership with CMS; they generally have a defined network of participating hospitals, doctors and other medical providers. They often cover services not covered by traditional Medicare (including vision or dental care), but may also have more restrictive coverage on some services as compared to traditional Medicare. Many Advantage plans also have prescription drug coverage built in. These plans can change from year to year as well, and open enrollment is the time to make a change if you wish to.
  • Medicare Supplement Plans. Many consumers who use traditional Medicare Part A and B also enroll in a supplemental insurance plan, sometimes referred to as Medigap insurance (because it covers gaps – including deductibles and co-pays – that Medicare does not cover). These plans are offered by private insurance companies. Open enrollment is also a time to evaluate your supplement coverage.

Health insurance is complicated for people of any age. Fortunately, excellent help and information is available through the Senior Health Insurance Information Program (SHIIP). SHIIP is an office within the Iowa Insurance Division, so it is completely non-commercial and not sales-oriented. Note: similar agencies are available in other states too. The SHIIP website offers a wealth of information. In addition, they have a helpline during business hours at 800-351-4664 (TTY 800-735-2942). Most valuable of all, however, is the corps of highly-trained volunteers located in counties across the state. Find SHIIP volunteers near you! These SHIIP volunteers kick into high gear during fall open enrollment, typically offering appointments to help consumers understand their options for Part D (Prescription coverage) and other coverage.

If you, or someone you care about, need help during Medicare Open Enrollment, I urge you to connect with your local SHIIP resource today! For general information about Medicare, the annual “Medicare and You” handbook is the best starting point.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Weighing the Cost

Airplane and Tornado

Last week a tornado ran for a half-mile through one of our fields, flattening a 200-yard wide strip of corn. What are the chances of that happening? It is a first for us in the 45 years we have farmed. This week, aerial applicators are spraying for aphids and white mold that are threatening north central Iowa soybeans. What are the chances of that happening?  Almost every year that it is wet.

Nearly every day, my husband is inspecting crops or livestock or grain in a bin, to ensure his investment of time, labor and money is insured or protected against accidents, extreme temperatures, weather, disease, mold or pests. The decision to spray, plant, vaccinate, buy, sell or insure is not made once and forgotten about.  He is always weighing the cost of action or inaction against the return on his investment.

The same is true for me on the home front. We purchased a used camper three years ago with the expectation we would use it for five year. Our decision to NOT insure the camper was based on how much five years of insurance would cost compared to the amount we paid for the camper.  The amount we saved in NOT purchasing insurance could easily replace the camper should something happen to it.  Basically, we SELF-INSURED the camper.

The same thought process is used for our vehicles. The nice, fully insured, used car we purchase for me to drive for work will eventually becomes the “farm” vehicle which we carry minimal insurance on. There is a very little chance of my husband having an accident driving down gravel roads between fields, whereas the number of miles I drive on highways for work greatly increases the chances I may have an accident and need to replace my car.

The Money Talk workbook discusses financial basics, insurance, investing, retirement planning, and planning for life events. This practical, clearly written guidebook is available through Iowa State University Extension should you like to learn more about financial basics including Insurance.

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Affordable Health Insurance: ARPA Expansions

The American Rescue Plan Act of 2021 (ARPA) has put into place several temporary expansions to the Affordable Care Act (ACA) provisions that can help Americans access health coverage at affordable prices. In general, these benefits apply to people who purchase health insurance in the Marketplace (created by the ACA) because they do not have an affordable option available through employment. The expansion has two dimensions: 1) more people are eligible for help paying the health insurance premiums for plans purchased in the Marketplace, AND 2) those who are eligible for help are now eligible for MORE help, so that their share of the monthly premium can be reduced.  People who are unemployed will especially benefit.

The Health Insurance Marketplace is now open for enrollment through August 15, so if this information makes you want to enroll in a plan OR change the plan you chose, you should be able to do so in the next few weeks. NOTE: The law took effect March 11. The agency in charge of the Health Insurance Marketplace expects to be ready to implement many of the changes on April 1. Suggestion: if you call or log in to the Marketplace in early April, ASK if the new rules are yet in place. It might be worth waiting a week or two in order to be sure the changes have been built into the system.

More Help. The ACA created a maximum cost people would have to pay for health insurance premiums, stated as a % of your income. The ARPA dramatically reduced that percentage of income for 2021 and 2022.  For example, suppose you are a 2-person household with income of $43,000/year (which is just under 250% of the poverty level); under the ACA your share of the premium for a benchmark silver plan would have been 8% of your income; under the new ARPA guidelines, your share of the premium cost for that same silver plan is just 4% of your income. Implications:

  • Some people who previously decided health insurance was too expensive will NOW decide it is affordable under the new rules.
  • People who chose a less-expensive bronze plan despite its higher deductible and copays may NOW decide a silver plan is worthwhile.
    This is of special value to those who are at or below 250% of the federal poverty mark, because these folks are eligible for plans that sell for a “silver” price but have smaller deductibles and copays so that they are more like a gold or platinum plan. In other words, folks under the 250% level can get a premiere plan for a budget price.
    It’s sort of like getting a brand-new luxury SUV for the price of a 2014 compact sedan!
  • If you are already enrolled in a Marketplace plan, there is a good chance that your share of the monthly premium is reduced under the new rules. Consider contacting the Marketplace (800-318-2596) sometime later in April.

More People Eligible.  Under the original ACA rules, if your income was over 4 times the poverty level, you were not eligible for help paying for health insurance. Under the ARPA expansion, people of any income level are eligible if the cost of the Marketplace plan would exceed 8.5% of their income. This will be especially valuable for those in their 50’s and 60’s, since health insurance premiums rise with age. This provision is also in effect for 2021 and 2022. 
Implication: some people with incomes above the 400% threshold may have compromised to save money by purchasing health coverage that was poorer quality (that is, it does not meet the ACA standards related to broad coverage and value). With the new cap of 8.5% of income regardless of income level, these folks might now be able to purchase a high-quality plan for an affordable price.

Huge Benefit for Those Unemployed at ANY time during 2021.  Note: this benefit is ONLY in effect in 2021.  If you receive(d) Unemployment Income at ANY time during the 2021 calendar year, special rules apply for your eligibility. With regard to eligibility for help paying for health insurance in the Marketplace, any income above 133% of the poverty level will be disregarded. That means these households will be eligible for the “platinum-like” silver plans for FREE – the premiums will be entirely covered by the subsidy.  Note: all other qualifications must also be met. For example, if you have workplace coverage available that is considered affordable, then you will not be eligible for the free silver plan.  However, if you are unemployed now, take advantage of the free silver plan. If you get a new job in a couple months that provides insurance, you can then drop the silver plan.
For those whose incomes are below 100-133% of poverty, they will be eligible for Medicaid coverage (also free), even in states where Medicaid was not expanded.

COBRA Subsidy. For people who lost health coverage due to being laid off or having their work hours reduced, the government will cover the cost of their COBRA premiums for up to six months, from April 1 – September 30, 2021. Check with your employer about how this might help you. Even if you lost your job months ago and did not sign up for COBRA at that time, you should now be able to sign up for COBRA.
Note: if you are in this group, you might also benefit from Marketplace insurance or Medicaid, so be sure to evaluate all your options.

Primary Source: Kaiser Health News Details for the % of income (paragraph 3) from Kitces.com
For more information see: https://www.healthcare.gov/more-savings/

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Health Insurance Marketplace Reopens

Normally the health insurance marketplace is open just once a year in the fall (Nov 1 – Dec 15). This year, however, the government is opening the federally-run Marketplace today (February 15) for three months. Since Iowa uses the federal marketplace (www.healthcare.gov), this opportunity is available to Iowans. For readers in other states: many of the state-run health insurance marketplaces are also opening for the same three-month period.

Are you worried about choosing a health insurance policy? ISU Extension is offering a one-hour online workshop called “Smart Choice Basics” to help you understand key factors to consider when choosing a policy. The workshop is free, but pre-registration is required. Two options are available – choose the one that fits your schedule, and preregister today!

In the health insurance marketplace, Americans who do not have quality coverage available on the job can enroll in insurance plans that cover the ten essential benefits (including prescriptions, mental health care, rehabilitation, and more). In addition, you may qualify to get help paying the premiums, through the Premium Tax Credit. You may be eligible for a Premium Tax Credit if your income is below: $51,000 (single); $68,900 (couple); or $104,800 (family of four). Find out more at www.healthcare.gov. NOTE: if you are very near the income limit, you are eligible for only a small amount of help, but it does cap the percentage of your income you’ll need to pay for health insurance.

Keep in mind: You can always have a “special enrollment period” in the marketplace if you lose your insurance (e.g. leave your job, get divorced, or other reason). This new opportunity can be helpful for people who didn’t sign up when they could have, but have now decided that they need insurance after all.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Understanding Health Insurance

This time of year many Americans make health insurance decisions. If your health insurance comes through your employer, you may be making plan choices in the next month or so, and if you purchase insurance individually, open enrollment is November 1 through December 15. Are you equipped to make informed choices about your health insurance?

ISU Extension and Outreach offers two free on-line workshops on health insurance topics:

  • Smart Choice Basics focuses on the key things to know before you sign up for a specific health plan. It’s useful to people who get their insurance through their employer as well as to people who need to purchase insurance on their own. It also addresses questions about how to get help paying for health insurance via the HealthCare.gov Marketplace. It is being offered November 19 and December 1 (6 p.m. each day).
  • Smart Use: Smart Actions for Using your Health Insurance Wisely. This workshop focuses on seven key actions for consumers to take, including keeping track of the health care they receive, reviewing their bills carefully and disputing errors, understanding deductibles and co-pays, and more. It is being offered November 2 and December 8 (6 p.m. each day).

Understanding key health insurance principles can save you money year-round. It also gives you the confidence to ask useful questions about health costs and bills, and to make informed choices about when and where you receive the health care you need.

Pre-registration for the health insurance workshops is required.
Questions? Contact Barb Wollan or Brenda Schmitt. The flier is attached below if you’d like to share it with others.

These two workshops were developed by a team of experts from across the nation led by University of Maryland Extension. They are conducted locally by trained Iowa State University Extension and Outreach specialists.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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October Dates to Remember

Around this time of the year, I get a surge of individuals wanting me to prepare the previous year’s taxes. Then I remember…October 1 is the first day to file the FAFSA for college financial aid. Some colleges award scholarships and financial assistance on a first-come, first-served basis.

October Dates to Remember

October 15 is the new deadline to file your return if an extension was filed earlier this year.  If you filed for an extension on your taxes, October 15 is also the last day to contribute to a SEP IRA for self-employed people and small business owners.

Sometime in the fall, usually beginning in October or November, most employers hold their open enrollment period so you can change your employee benefits for the upcoming year. Review your health election, 401(k), and other employee benefits like life and disability insurance to see if they’re still meeting your needs. Do you have a flexible spending account (FSA)? Use those funds for qualified medical expenses or child care expenses by the end of the year. That money generally won’t roll over into next year. If you have a health savings account (HSA), that money will roll over and is tax-deferred, so consider maxing it.

November 1 is just around the corner and is the opening day of the federal health insurance marketplace enrollment for 2021 coverage. Iowa State University Extension has online class scheduled to help individuals choose wisely, the kind of health insurance they need.  The Smart Choice Basics class is intended for individuals that are 65 or younger and helps you select the right plan. Smart Choice Actions teaches individuals how to make wise use of the health insurance plan and intended for adults of any age.  Both workshops are 1 hour long at begin at 6:00 PM.  For dates and registration information, go to…

10/26/20  Smart Choice Basics

11/2/20  Smart Use

11/19/20 Smart Choice Basics

12/1/20  Smart Choice Basics   

12/8/20  Smart Use

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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Laid Off? Health Insurance Options

It’s tough to live on reduced income after a reduction in hours or a job loss, but unemployment benefits can help to bridge that gap, at least for a while. The expanded eligibility and expanded benefit amount provided through federal legislation in response to COVID-19 has helped thousands of Iowans.

Losing employment (or even reduction in hours) often means that workers also lose their health insurance coverage. Depending on the situation, that loss may be even more disruptive than the loss of income. Fortunately, there are some good options available for obtaining affordable health insurance outside of your workplace.

Free Insurance. If your income is below a certain threshold, you may be eligible for free health coverage through the state, and you can apply at any time during the year. This coverage is available to everyone, regardless of whether they are disabled or have children in the home, thanks to the fact that Iowa signed on to the expanded Medicaid portion of the Affordable Care Act.  The income guidelines for this option depend on family size:  for a single individual, the 2020 income limit is nearly $17,000; for a family of four, it is nearly $35,000. There are some nuances in the recording of income, so even if your income is a little above the limit, it is worth applying – you may be eligible. ALSO – even if your income for the first six months of the year puts you over the limit, it is still worth applying if your situation has changed, because the income limits are considered on a month-by-month basis. To apply, contact the Department of Human Services at 855-889-7985.

Coverage for Children. Through Healthy and Well Kids in Iowa (Hawk-I), children and teens under age 19 are eligible for free or nearly-free health coverage up to much higher income levels, so if you are having trouble affording health insurance for your children use the same DHS phone number (855-889-7985) to inquire and apply.

Income too high for free coverage? There are still options! The high cost of health insurance often means that even those with average incomes may find it unaffordable. Through the Health Insurance Marketplace, you can find high-quality health insurance plans; you may be eligible for help in paying the premiums if you do not have access to an affordable employer plan and if your income is below a generous limit. The 2020 income limit here is $49,960 for a single individual, and $103,000 for a family of four. You will be expected to pay part of the premiums, based on your income, but the government will pay the rest. The Kaiser Family Foundation’s Health Insurance Subsidy Calculator will provide a good estimate of the help you might receive.  

To enroll mid-year in coverage through the Health Insurance Marketplace, you must be eligible for a special enrollment period; generally that ends 60 days after your previous coverage ends. Learn more or enroll at www.healthcare.gov or by calling 800-318-2596. Many community health centers offer assistance in considering options and enrolling, as well. 

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Nursing Home Residents: Keep your economic impact payment

If finances are tight, the federal economic impact payment being issued through the CARES Act for coronavirus relief may have a big impact on your well-being. Unfortunately, residents of care facilities in many states (including Iowa) are being told incorrectly that they must relinquish their payment.

This problem occurs when an individual is receiving Medicaid benefits to help cover the cost of their care. Nursing home administrators, acting on misinformation, believe they must recover the extra income to defray Medicaid costs. However, the CARES Act specifically labels the payments as “tax credits,” and tax credits are exempt from income and resource limits placed on those who are benefiting from certain government assistance programs.

Nearly every United States household should receive an economic impact payment, including households that receive Social Security, Supplemental Security Income (SSI), or Veterans Administration benefits. The payments should be deposited automatically to the same account where you receive either your tax refund or your SSA, SSI, or VA income. The IRS, which is responsible for issuing the payments, offers a lookup resource to help people track their payment. Note: the look-up link for those who do not file a tax return is separate from the link for tax filers; be sure to use the correct link.

If you have loved ones living in care facilities, especially if they are receiving Medicaid benefits to help cover the cost of care, be on the watch for any attempts to get them to turn over their economic impact payment to the facility. If this has already occurred, it should be refunded; contact the Iowa Attorney General’s office for help if needed. Note: it is important to keep in mind that nursing home administrators who try to claim the payment are not trying to steal; they are trying to do the right thing, but are simply misinformed about what the law requires.

Source: Federal Trade Commission

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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COVID-19 and Unemployment Insurance Benefits

This is a stressful time for individuals and communities across Iowa and we are dealing with many unknowns. Communities are impacted by the temporary closure of businesses, schools and other public facilities or events, and in some cases, quarantines. While these actions are necessary steps to help reduce exposures, it may bring financial uncertainty for many people who could experience a loss of income due to illness or workplace closures.

If you do experience unemployment, remember there are supports in place for you and your family. Iowa unemployment benefits are available to individuals who are unemployed through no fault of their own. If your employer needed to shut down operations and no work is available, you would be eligible to for unemployment benefits. Unemployment claims that are filed as a result of COVID-19 will not be charged to employers.

Many people wonder if they can receive unemployment benefits if they need to stay home from work to care for a dependent, family member or if their child has school cancellations. The answer is, “It depends”. A good approach is to contact your employer regarding potential telecommuting, sick leave, PTO, FMLA, Disability and other options they may be offering.  If those options are not available, you may file for unemployment insurance benefits to determine your eligibility.

Also note, an employer can require an employee to stay at home for the fourteen day isolation period if they have traveled out of state or had contact with someone who visited an area affected by COVID -19. Your employer should attempt to provide paid leave but if that is not available, employees might be eligible for unemployment insurance benefits.

To learn more about filing an unemployment claim, contact your local Iowa Workforce Development Center or apply online at:  https://www.iowaworkforcedevelopment.gov/file-claimunemployment-insurance-benefits.

Mary Weinand

Guest Blogger: Mary Weinand, Iowa State University Extension Family Finance Field Specialist.

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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