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Health Insurance Information

If you're without health insurance and missed the open enrollment deadline don't wait until November 1 to purchase health insurance.


MKG Insurance Agency is pleased to offer Short Term Medical insurance to bridge the gap.

California Short Term Medical Insurance Plans

Click HERE to apply for California  Short Term Medical 

 

Serving all of Fresno/ Clovis  Metropolitan Areas

Quick Facts: October is the month to change or renew your existing health insurance.


Open enrollment for Covered California health insurance plans happens once a year. For coverage that begins on Jan. 1st open enrollment begins on Nov. 1st, and lasts until January 31st (Medi-Cal enrollees are not limited to this period, and do not need to renew their enrollment in Medi-Cal during this time, because Medi-Cal enrollment is year-round.)


Purchasing health insurance through Covered California has many advantages. Covered California is the only place where an individual can learn about and use federal financial assistance that can help reduce health care costs. Consumers can also learn if they are eligible for low-cost or no-cost Medi-Cal. This also includes the ability to make true "apples to apples" comparisons of health insurance plans.


Avoid Obama Care Penalties"

 

Don't have health insurance? Enroll now to start coverage in January 1 on your 2017 taxes.

The fee for not having health coverage is calculated one of 2 ways. If you or your dependents don't have insurance that qualifies as minimum essential coverage you'll pay either a percentage of your household income or a flat fee -- whichever is higher.

 

Who's at risk for a tax penalty? 


Anyone who does not have a plan that meets Minimum Essential Coverage requirements may be subject to the tax penalty. A few examples of those who may be subject to the tax penalty are:

Those that choose to be uninsured.

Anyone who buys a health insurance plan that does not qualify as Minimum Essential Coverage.

Consumers that have a gap in coverage of more than three months between health insurance plans.

Who's exempt from the tax penalty for individuals and families? 

 

Find out if the individual mandate applies to your situation 
Use our subsidy estimator to figure out how the individual mandate applies to you


To pay your premium and answer any questions pleased use this link

 

Whether or not you are exempt from the individual mandate.

 

 

If you are not exempt - the annual tax penalty you would be subject to if you don't buy or maintain a plan that meets Minimum Essential Coverage requirements.

 

 

Whether or not you're eligible for a premium subsidy and the estimated amount.

 

 

What is the tax penalty? 

The tax penalty will continue to increase from 2014 to 2016. After 2016, it will increase in relation to the cost of living. Also, the tax penalty is the greater of the specified percent of income or the flat dollar amount.

 

Tax Penalties by Year


Year Tax as a % of income Minimum flat dollar amount per adult Minimum flat dollar amount per child Maximum flat dollar amount per family
2014 1.0% $95.00 $47.50 $285.00
2015 2.0% $325.00 $162.50 $975.00
2016 2.5% $695.00 $347.50 $2,085.00


Note: The flat dollar amount (tax penalty) is the lesser of the maximum flat dollar amount per family (noted in the table above) or the sum of the minimum flat dollar amounts applicable to each individual in the family (noted in the table above).


2016 tax penalty examples - See how it applies to your family  


Example 1: A family of three

If a family of three (two adults, one child) has a household modified adjusted gross income of $100,000, and does not have major medical insurance and does not otherwise qualify for a penalty exemption, the 2016 penalty for this family would be calculated as follows:

  1. Figure out the total flat dollar amount:
    1. Flat dollar amount per adult = $695 (multiply this by 2 because there are two adults)
    2. Flat dollar amount per child = $347.50
    3. Add the flat dollar amount together from above = $2085.00
  2. Figure out the 2.5% of income: 2.5% multiplied by $100,000 = $2,500.00
  3. Use the greater of the two to find out what your 2016 penalty is: $2,500.00

 

MKG Tax Consultants- Leading Tax Preparation Provider & ACA Tax Experts 
 
We are your ACA Tax Experts when it comes to tax time and filing your taxes. We make it easy and affordable in assisting you in completing your ACA 1095 and 8962 tax form

For assistance in completing and filing your ACA form click here: 
www.mkgtax.com/home

To learn more about Affordable Care Act tax provisions, visit the Internal Revenue Service (IRS) Affordable Care Act Tax Provision website                                                     

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

 

Under certain circumstances, an individual may be exempt from the individual responsibility requirement. These circumstances include the following:

 

 

The individual is uninsured for less than three months of the year

 

 

The lowest-priced coverage available to the consumer would cost more than 8% of the consumer's household income

 

 

The individual does not have to file a tax return because his or her income is too low

 

 

The individual is a member of a federally recognized tribe or eligible for services through an Indian health care provider

 

 

The individual is a member of a health care sharing ministry

 

 

The individual is a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare

 

 

The individual is incarcerated, and is not awaiting the disposition of charges

 

 

The individual is not lawfully present in the United States

 

Some types of exemptions are available only through the tax filing process; some are only available through a Marketplace; and some are available through either channel Hardship Exemptions

 

There are certain circumstances that affect an individual’s ability to purchase health insurance coverage and which may qualify an individual for a hardship exemption. To make the determination, the Marketplace considers whether an individual has experienced one of the following events:

 

 

Becomes homeless

 

 

Has been evicted in the past six months, or is facing eviction or foreclosure

 

 

Has received a shut-off notice from a utility company

 

 

Recently experienced domestic violence

 

 

Recently experienced the death of a close family member

 

 

Recently experienced a fire, flood, or other natural or human-caused disaster  resulting in substantial damage to individual property

 

 

Filed for bankruptcy in the last six months

 

 

Incurred medical expenses in the last 24 months that resulted in substantial debt

 

 

Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

 

 

Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child

 

 

As a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through a Marketplace, the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through a Marketplace

 

 

Was determined ineligible for Medicaid because his or her state did not expand eligibility for Medicaid under the Affordable Care Act

 

Lost insurance coverage because his or her individual plan was cancelled and believes other available coverage options are un-affordable

 

Only individuals under age 30 and individuals with hardship exemptions may purchase a catastrophic plan. Catastrophic plans typically have high deductibles, and mainly protect individuals from very high medical costs.





    Covered California Shop & Compare Tool   
     Click here   


    Plans Providers 

    You can apply for Covered 

    California's carriers marketplace during open enrollment choose

    For plans comparisons click on links below
     

    To receive a personalized quote, product information or to apply online, simply click on the link below or copy and paste it into the address bar of your browser.

    Kaiser Permente, dedicated to helping you thrive


    Anthem Blue Shield of California


    Blue Shield of California


    United Health One Dental, Vision, Critical Illness

    UnitedHealth Short Term Medical


    National General STM supplemental plans, exclusion residents of CA

    National General Accidental Medical Expense, Critical Illness, Accident, Dental, PPO Dental,Vision

    Dental for everyone PPO plans



     

     

     

    What kinds of health insurance are there?
    There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.

    1. Fee-for-Service
      These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
       
    2. Managed Care
      More than half of all Americans have some kind of managed-care plan1. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.

    What is 'long-term care'?
    Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, toileting or continence, and/or transferring (e.g., getting out of a chair or out of bed). These six actions are called Activities of Daily Living–sometimes referred to as ADLs. In general, if you can’t do two or more of these activities, or if you have a cognitive impairment, you are said to need “long-term care.”

    Long-term care isn’t a very helpful name for this type of situation because, for one thing, it might not last for a long time. Some people who need ADL services might need them only for a few months or less.

    Many people think that long-term care is provided exclusively in a nursing home. It can be, but it can also be provided in an adult day care center, an assisted living facility, or at home.

    Assistance with ADLs, called “custodial care,” may be provided in the same place as (and therefore is sometimes confused with) “skilled care.” Skilled care means medical, nursing, or rehabilitative services, including help taking medicine, undergoing testing (e.g. blood pressure), or other similar services. This distinction is important because generally Medicare and most private health insurance pays only for skilled care–not custodial care.

    What are the types of disability insurance?
    There are two types of disability policies: Short-Term Disability (STD) and Long-Term Disability (LTD):

    1. Short-Term Disability policies (STD) have a waiting period of 0 to 14 days with a maximum benefit period of no longer than two years.
       
    2. Long-Term Disability policies (LTD) have a waiting period of several weeks to several months with a maximum benefit period ranging from a few years to the rest of your life.

    Disability policies have two different protection features that are important to understand.

    1. Non-cancelable means the policy cannot be canceled by the insurance company, except for nonpayment of premiums. This gives you the right to renew the policy every year without an increase in the premium or a reduction in benefits.
       
    2. Guaranteed renewable gives you the right to renew the policy with the same benefits and not have the policy canceled by the company. However, your insurer has the right to increase your premiums as long as it does so for all other policyholders in the same rating class as you.

    In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:

    • Additional purchase options
      Your insurance company gives you the right to buy additional insurance at a later time for an additional cost.
       
    • Coordination of benefits
      The amount of benefits you receive from your insurance company is dependent on other benefits you receive because of your disability. Your policy specifies a target amount you will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
       
    • Cost of living adjustment (COLA)
      The COLA increases your disability benefits over time based on the increased cost of living measured by the Consumer Price Index. You will pay a higher premium if you select the COLA.
       
    • Residual or partial disability rider
      This provision allows you to return to work part-time, collect part of your salary and receive a partial disability payment if you are still partially disabled.
       
    • Return of premium
      This provision requires the insurance company to refund part of your premium if no claims are made for a specific period of time declared in the policy.
       
    • Waiver of premium provision
      This clause means that you do not have to pay premiums on the policy after you’re disabled for 90 days.

       

    1 - Source : MANAGED CARE AND THE STATES