Understanding Halbig v. Burwell – Can I Still Collect a Health Insurance Subsidy?

We recently learned the outcome of an important legal case with potential implications for health insurance reform.

At issue in Halbig v. Burwell was whether or not the language in the Affordable Care Act (in the law itself) gives the IRS and the federal health insurance exchange the authority to distribute premium tax credits to individual policyholders.

The argument is that the law states subsidies are available for policies purchased in state-based — not federal — exchanges.

On July 22, the U.S. Court of Appeals for the D.C. Circuit ruled that, in fact, the IRS and the federal marketplace do NOT have the authority to distribute subsidies.  (Click here to read the full ruling.)

However, because the decision is certain to be appealed, and because a similar case was decided in Richmond on the same day, in which the court ruled the IRS did act correctly in allowing subsidies on the federal exchange, no action will be taken; the Circuit Court ruling will not be enforced — for the time being.  We can expect to see this issue come up again, perhaps even appearing on the 2015 Supreme Court docket.

What does Halbig v. Burwell Mean Right Now?

In essence, there will be no changes, at least for the time being, in how anyone — in any state — buys, pays for, uses, selects, or accesses health insurance.  Specifically:

• The federal health insurance exchange (through which Virginia residents can get coverage) remains fully operational, and we can continue to help our clients obtain coverage in the marketplace.  (Note, the Maryland and DC exchanges were also not impacted by this ruling.)
• No changes are planned for the calculation or distribution of premium subsidies or other cost-sharing relief.  If you are receiving subsidized coverage, you will continue to do so for as long as you remain eligible.
• If a future ruling does strike down subsidies, it is unlikely you will need to repay any subsidy amount you received, provided you were legally eligible for the subsidy when you received it.
• Open enrollment for 2015 plans is on schedule to begin on November 15, 2014.
• Special enrollment period rules are still in place.
• There has been no change to either the individual mandate or the employer mandate.

Business as Usual for Virginia Medical Plans

It is business as usual for us!  We will continue to stay abreast of any new rulings or changes.  And, as always, contact us if we can be of assistance.  Reach us by phone 1-800-867-0800 or email jkatz@vamedicalplans.com.

How to Apply for Insurance on Healthcare.gov

⇒NOTE: This post is about applying for 2014 coverage.  For information about applying for 2015 coverage, click here.

If you live in Virginia and are eligible for a health insurance subsidy, you must purchase your coverage on the federal health insurance marketplace in order to receive the subsidy.

Not sure if you are eligible?  Use this chart to find out.  You may qualify for a subsidy if, based on the number of people in your household, your yearly household income is between:

# People in Your Household
	1	2	3	4	5	6
Yearly Income	$11,490 -$45,960	$15,510 – $62,040	$19,530 -$78,120	$23,550 – $94,200	$27,570 – $110,280	$31,590 – $126,360

(Note: if you are not subsidy-eligible, you should apply directly with the carrier.  Click for specific instructions for enrolling with:  Anthem BC/BS, Innovation Health/Aetna, CareFirst BC/BS, Humana.)

Getting Assistance from us AT NO CHARGE

If you may be eligible for a subsidy, we can assist you with your application for coverage if you select us as your broker — at no charge to you!  This means we can help you choose the right plan now, and assist with administrative and claims issues for as long as you own your policy — for FREE.  Here is our broker information that should be entered into the appropriate screen (below) or on a paper application should you choose to apply that way:

• First name: Jonathan
• Last name: Katz
• FFM User ID: JONKATZAGENT
• NPN Number: 1585616

Applying for Coverage Online

If applying online, your first step will be to sign up for an account on the online federal marketplace — healthcare.gov.   Below are detailed instructions, along with some screen shots, to streamline your application process.  (Note, all images were captured on January 16, 2014.)

This is the home page of healthcare.gov:

You can browse available plans by clicking on the “SEE PLANS” button.

When you are ready to apply, click on the orange “APPLY NOW” button.

---

On the next screen, specify your state, and then choose APPLY ONLINE.

When you click APPLY NOW, you can either CREATE a Marketplace Account, or LOG IN if you already have an account.  Here is the log in screen:

(If you have not created an account, then click on the blue “CREATE ACCOUNT” button.)  If you already have an account, enter your Username and Password and click the green “LOG IN” box.  If you have forgotten your Username or Password, you can get assistance by clicking on the appropriate link.

Once you have logged in successfully, the next screen will ask you what you would like to do.  If this is your first time applying, you will see this screen.  (Note that if you had already started an application(s) at another time, you will also have the option here to return to it.):

Click on “Apply for new coverage”.

You will be taken through several screens on which you will (1) verify your state of residence and (2) for whom you are purchasing health insurance.  You must (3) agree to the Privacy Policy, and then (4) confirm your contact information.

(1)	(2)
(3)	(4)

Getting Help from Agent or Broker

The next screen is where you will be asked if you are getting help applying for coverage.  This is where you should fill in our broker information so that we can be of assistance with plan selection, administrative issues, claims issues etc.  Remember, there is no charge to you for getting help from a broker.

Select “Agent or Broker” and then enter our broker information:

• First name: Jonathan
• Last name: Katz
• FFM User ID: JONKATZAGENT
• NPN Number: 1585616

Getting Help Paying for Coverage — Subsidy

From there, you will be asked if you want to find out if you can get help paying for coverage:

You can double-check your subsidy eligibility by selecting the “I’m not sure” button, or simply choose “Yes” to move to the next step.  Be prepared to answer income questions for all members of your household.

Entering Family and Household Information

In subsequent screens you will enter information for each person who will be covered on the policy.  You should be prepared with the following for each person:

• name
• date of birth
• social security number
• document numbers for anybody with eligible immigration status

Verifying Eligibility to Purchase Health Insurance

After entering data on who needs coverage, you will be taken through several more screens on which you will answer additional questions to verify your eligibility to purchase insurance.

Note, you may stop your session on healthcare.gov at any time and return later by signing back in with your Username and Password.   But make sure you have entered all of your Family and Household information, or you may need to re-enter it the next time you sign in.  Family and Household data must be completed all in one sitting!

Selecting the Best Coverage

Once your eligibility has been verified, you can see the various plans from which you can choose.   Look closely at the available options — paying particular attention to deductibles, co-pays, provider networks, etc.  And — of course — premiums.  Then give us a call at 800-867-0800, or email us at jkatz@vamedicalplans.com so we can help you decide which is the best for you.

Once we have identified the best plan for you, you can sign back in to healthcare.gov to complete your application.

Confirming Coverage with Carrier

After submitting your application, you will need to await confirmation (and a bill) from the carrier to confirm your coverage.  We recommend you contact your carrier to make sure they have received your information.  However, since the data is transmitted to the carriers at the end of each day, you should wait at least 1-2 days before trying to call.  The wait times to reach the carriers by phone have been very long, so you may want to set up your speakerphone and have something else to do while you are on hold!

Contact us for Help!

We are available to assist you at any step of the way, so let us know if we can be of service.  Please also understand that we are experiencing an extraordinarily high volume of calls and emails and that we must endure the same wait times with the carriers as you!

Thank you for your patience!  Reach us by phone:  800-867-0800, or email: jkatz@vamedicalplans.com.

For your convenience, here is our Broker Information once again.  Remember there is NO CHARGE TO YOU for using our services:

• First name: Jonathan
• Last name: Katz
• FFM User ID: JONKATZAGENT
• NPN Number: 1585616