Individual Health Insurance
The old way of health insurance has gone and the new way, brought on by the passage of the Affordable Care Act (ACA), has come. To some, these changes may seem intimidating, while others may find it exciting. Either way, we are here to help you navigate through the process. As a licensed health insurance agent, we do not charge you a fee, and you do not pay more for your insurance to have an agent help you. The insurance companies pay insurance agents directly when an agent sells one of their policies. You will pay the same premium whether you let an agent help you or not. We are available to answer any questions you may have before you decide on, and enroll in, a plan.
The biggest change as a result of the passage of the ACA came in 2014 when the state and federal marketplaces (Exchanges) opened up for business. These marketplaces are designed to provide health insurance for individuals who are not covered by an employer-sponsored health insurance policy, or by Medicaid, or by a Medicare plan.
Idaho chose to create its own State Exchange (Your Health Idaho). Your Health Idaho is an online price comparison website where consumers can shop and purchase a qualified health plan (QHP) and determine their eligibility for an Advanced Tax Credit and subsidies.
An Advanced Tax Credit (APTC) is a tax credit that you receive in advance to help pay your health insurance premiums. APTC is calculated by your household size and household income. For example, a household size of 4, with a modified adjusted gross income in 2015 of $60,000, could qualify for a $321 APTC every month. When you file your taxes, the IRS will reconcile with you regarding this tax credit amount. If you received an APTC for the previous year that was too high, you will owe in taxes when you file, and in order to receive the APTC, you have to enroll through Your Health Idaho.
If you do not qualify for an APTC because your income is too high, or you are eligible for other coverage from a job, Medicaid, or Medicare, then you can purchase coverage directly from a carrier. It is important to note that the plans available on the Exchange are the same ones available off the Exchange.
Currently, Dirks Insurance Group is contracted to sell policies from Blue Cross of Idaho, Regence Blue Shield of Idaho, Pacific Source and Mountain Health Co-op. We are also open to contracting with any other reputable health insurance carriers that may enter the North Idaho market in the future. We contract and sell with the above-mentioned carriers because they have a large, established network of providers.
Below are a few of the other noteworthy health insurance changes that have occurred.
- The preexisting condition clause has been removed. As of 2014, no person can be charged more or dropped from coverage due to a preexisting condition. You also cannot be charged more because of your health status.
- The lifetime and unreasonable annual limits on benefits have been eliminated.
- Essential health benefits must be included in all new health insurance plans.
- Required coverage of preventive services and immunizations on all health insurance plans beginning after 2014, and all non-grandfathered health plans will have to provide many A and B rated preventive services at no out-of-pocket cost.
- Dependents can stay on their parent’s plan until they are age 26.
Small Group Health Insurance
Small group health insurance is designed for small businesses with 2-50 employees. To qualify as a small group, you must have at least two full-time employees, and at least 50 percent of those employees need to live and work in Idaho. Other conditions apply, so please call if you have questions about whether your business would qualify as a small group.
We know how important it is for small business owners to get the best coverage at competitive rates. To offer the best plan for your small group needs, we shop three different insurance carriers: Blue Cross of Idaho, Pacific Source and Regence Blue Shield of Idaho.
For a quote or more information, please contact
our office at info@dirksinsurance.com or (208) 664-9272.
Health Insurance Coeur d’Alene ID Hayden Idaho