Tag Archives: health insurance

Celebrating Our 2016 Content This Holiday Season

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The holiday season is one filled with laughter, songs, good food and even better company. As you celebrate with family and friends, we wish you happy holidays and hope that you create wonderful memories together.

The forthcoming new year also provides all of us an opportunity to reflect back upon the highlights of the past twelve months. As we do, join us in looking back at some of our favorite blogs and a special video from 2016. Once again, happy holidays from all of us at Petschauer Insurance.

  1. Travel Insurance for your Dream Vacation
  2. What You Need To Know When Choosing A Health Insurance Plan
  3. Certificate Of Insurance 101: What Business Owners Need to Know
  4. Key Man and Buy Sell Insurance Simplified
  5. How is your car insurance rate determined?

Understanding the ACA Obamacare Tax Penalty For the Uninsured

health-insuranceWhen filing your 2016 tax returns, you could face a sizeable fine if you and/or your family are without health insurance.

The Affordable Care Act mandates that anyone that has gone without health insurance for a span of three months or more is subject to paying a fine. The penalty this year has increased to equal the greater amount of $695.00 or 2.5% of an adult’s income. For every child under 18 without health insurance, the penalty is half that of an adult’s.

This penalty is deducted from any income tax refund you may be eligible for. It would be unfortunate to be burdened by such a penalty and have it get in the way of the potential tax refund you look forward to receiving every year.

There are, however, exceptions to the rule.

You may qualify for an exemption if you fall under any of the following categories:

  • Individuals and families who fall under the income-tax federal threshold would be exempt, or receive the necessary subsides to offset the costs of the health insurance.
  • If you are unemployed and are unable to find coverage costing less than 8% of your adjusted gross income, you would be exempt from penalties as well.
  • You may also qualify for a hardship if you are homeless or have been evicted in the last six months.

We encourage you to review this information carefully so that you can make good decisions for you and your family.

Please note, Open Enrollment for 2017 begins on November 1st  2016.  Feel free to contact us today to discuss the options that best fit the needs of you and your family, as the penalty will be the same for next year.

What You Need To Know When Choosing A Health Insurance Plan

What You Need To Know When Choosing A Health Insurance Plan

Is this the first time you are presented with the option to purchase your own health insurance?

Let us help you get started by defining some of the most misunderstood health insurance jargon along with 6 categories to pay close attention to when selecting a plan.

1) Network: This outlines the group of hospitals and doctors being offered to you by a particular insurance company; including primary care physicians and specialists.

2) Type of Plans:

    a) HMO (Health Maintenance Organization) plans cover medical care provided by doctors and hospitals inside a specific network. HMOs often require members to get a referral from their primary care doctor before going to see a specialist.

    b) EPO (Exclusive Provider Organization) plans allow you to access doctors that are only included in your specific network, and generally do not need referrals before going to see a specialist.

    c) PPO (Preferred Provider Organization) plans allow you access to doctors and hospitals inside and outside of your selected network and are typically the most expensive plan option.

3) What Tier to Select: Plans are categorized in four tiers.

    a) Platinum: Most expensive plan with little or no deductibles.

    b) Gold: Less expensive than Platinum plans with relatively low deductibles.

    c) Silver: Even less expensive premium with high deductibles.

    d) Bronze: These plans have the lowest premium and the highest deductibles.

4) Before benefits are paid, here is what you are responsible for:

    a) Your Deductible: The set dollar amount you have to pay before your insurance “kicks” in.

    b) Your Co-Pay: The set dollar amount you will have to pay Primary Care Physicians & Specialists at the time of your appointment.

    c) Your Co-Insurance: Set percentage for certain services you need.

5) Be aware of your out of pocket maximum.

This is the total dollar amount you will be responsible for in a given period, either a calendar year or contract year. This amount will include your deductibles, co-insurance, & co-pays. Once you have reached this amount in your given period, your medical expenses will be covered 100% until the end of that period. At that time, it will start all over again. Please note, you will always be responsible for your premium payments.

6) Prescription Drugs: they are generally broken down by 3 tiers

    a) Tier 1– generic drugs subject to the lowest co-pays

    b) Tier 2– brand name drugs subject to higher co-pays

    c) Tier 3– non-formulary drugs subject to the highest co-pays with some plans even having a deductible or limit within this

Hopefully, we have provided you with a basic understanding of health insurance so that you are able to make a more informed decision. Open enrollment for 2017 begins November 1st. Feel free to contact us today to help you make the choice that best fits the needs and budget of you and your family.