Thoughts on health and wellness

Healthcare Updates for 2017 – Review of What you Need to Know

Open Enrollment for 2017 Plans – For coverage starting in 2017, the Open Enrollment Period will be November 1, 2016 through January 31, 2017. Individuals may be eligible for Special Enrollment Periods (SEP’s) outside of Open Enrollment if they experience a qualifying event. If individuals do NOT have a SEP, they CANNOT buy health insurance outside of open enrollment. Cancellation for non-pay is not a SEP.

2017 Penalty – The penalty for not having any insurance in 2017 is the same as in 2016. That penalty is $695 per adult ($347.50 per child under 18) or 2.5% of household income, whichever is greater. This is the maximum penalty but it can rise each year based on inflation.

Review of Healthcare Reform Plans:

  • “On Exchange” is primarily for individuals that would be eligible for a subsidy from the government to help pay their insurance premiums. The amount of the subsidy depends on household size and how many are enrolling in the plan. There are fewer insurance companies that offer plans On Exchange and the networks used are “narrow networks” (mainly HMO’s).
  • “Off Exchange” would be very similar to how an individual bought health insurance prior to healthcare reform except that all of the plans offered are healthcare reform compliant (cover the Essential Health Benefits) and they are more expensive. You have more insurance companies and more plans to choose from Off Exchange.
  • Individual plans are guarantee issue, no health questions asked, and there are no waiting periods for pre-existing conditions. Rates are solely based on age, where you live, and tobacco use.

Michelle Cole & Associates, Inc. represents many health insurance companies in Georgia, including: Blue Cross Blue Shield of GA, Aetna, Coventry, Humana, Alliant, and United Healthcare. This allows us to provide the best coverage for each individual member. Below are key notes regarding the primary players for this year’s upcoming open enrollment.

  • United Healthcare will NOT be selling individual plans on or off exchange (in GA) in 2017. Anticipated financial losses for the year are currently around $650 MILLION (nationwide). They are also currently planning to pull out of the exchanges for at least 15 other states.
  • Aetna is projecting over $300 million in losses for the year (nationwide) and will continue to opt-out of participating on the exchange.

The staff at Michelle Cole & Associates, Inc. is here to help you with your health insurance needs. No matter what your family situation or income may be, we can help you find the right coverage for you and your family. Call or email us for help!

Health Insurance Open Enrollment 2016

Open enrollment for 2016 individual & family health plans

Nov. 1, 2015

Jan. 31, 2016

Under the Affordable Care Act — more commonly known as “Obamacare” — you can only sign up for health insurance during an annual open enrollment period, unless you have a “qualifying life event,” such as loss of employer coverage, getting married, getting divorced, moving out of area, having a baby, etc.Due to ACA, you must have health insurance or pay a penalty at tax time.

That annual open enrollment period is fast approaching!!

If you do not have coverage through your employer and you are buying health insurance on your own, here are some things you need to know.

1. Open enrollment starts Nov. 1, 2015, and continues through Jan. 31, 2016.  Your effective date depends on when you enroll.

  • If you sign up between Nov. 1, 2015, and Dec. 15, 2015, your coverage will start Jan. 1, 2016.
  • If you sign up between Dec. 16, 2015, and Jan. 15, 2016, your coverage will start Feb. 1, 2016.
  • If you sign up between Jan. 16 and Jan. 31, 2016, your coverage will start March 1, 2016.

This will be the last year open enrollment extends into January. Starting for 2017 health plans and beyond, open enrollment will be from Oct. 15 to Dec. 7 with Jan.1st effective dates.

2. If you don’t have health insurance from another source, open enrollment is the time to enroll in coverage.  It is also the time to make changes to your current plan.

If you signed up for health insurance during open enrollment in 2015, your plan will automatically renew. However, the plan may make changes to its premiums, provider network, copays, co-insurance, and drug coverage. Your insurance company will send you a notice of any changes it will make for 2016.  Open it. Read the mail, and see what it means for you!  Check to see if your provider network is still what you want and make sure that the doctors and hospitals that you prefer to use are in network.  Your prescription drug coverage could also change. The plan may no longer cover the drugs you take to manage your chronic conditions. It’s important that you check your plan’s drug benefits for 2016 before you allow it to renew. You may need to find a different plan for your needs and now’s the time to do it.

3. Penalties for not having health insurance have increased for 2016.

If you go without health insurance in 2016, the penalty is 2.5 percent of your income or $695 per adult (whichever is more) and the penalty for each child in the family without coverage will be up to $347.50. (In 2015, it was the greater of $325 or 2 percent of your income.).

4. You can buy coverage in Georgia on the Federal Marketplace or directly from a private insurance company.  If your family size and household income determines that you are eligible for tax credits, you would buy coverage on the Federal Marketplace.

You may qualify for a premium tax credit which is based on income and family size. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL).

That means, for example, a family of four with an income between $24,250 and $97,000 in coverage year 2016 would qualify for these credits. If you qualify, the credits can be applied to your monthly insurance premiums. If your income changes during the year and you no longer qualify for the credits then you may have to repay the subsidy when you file your taxes.


The staff at Michelle Cole & Associates, Inc. is here to help you with your health insurance needs.  No matter what your family situation or income may be, we can help you find the right coverage for you and your family.  Call or email us for help!

Eligible consumers have from March 15 through April 30 to enroll in coverage

The Centers for Medicare & Medicaid Services (CMS) announced Friday, February 20th, that there will be a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30.  If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace (which includes Georgia) and:

  • Currently are not enrolled in coverage through the FFM for 2015,
  • Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special enrollment period will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015.  If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

Americans who do not qualify for an exemption and went without health coverage in 2014 will have to pay a fee – $95 per adult or 1 percent of their income, whichever is greater – when they file their taxes this year.  The fee increases to $325 per adult or 2% of income for 2015.  Individuals taking advantage of this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015.  This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.

Open Enrollment for 2016 Plans:  The administration announced Monday, February 23rd that Open Enrollment for the 2016 plan year would be changing yet again from the original proposed dates. The new open enrollment date begins November 1st, 2015 and will run through January 31st, 2016. Be sure to mark your calendars and call us for assistance with your individual healthcare policies during this timeframe.   Thank you for choosing Michelle Cole & Associates to be your trusted advisor in the individual healthcare marketplace.

Open Enrollment for 2015 Health Insurance Plans is Almost Here!

The 2015 open enrollment period is coming. It starts November 15, 2014 and will end February 15, 2015. This open enrollment will affect just about everyone that has an individual/family health insurance plan. We know you and your family will have a lot of questions. Our goal is to work with you to ensure a smooth transition through this year’s open enrollment period. Michelle Cole & Associates, Inc. is committed to making sure you have the support you need.

Despite assurances from State and Federal authorities, there are concerns that the newly-implemented automatic re-enrollment of exchange health plans may cause confusion. Not all health plans will continue to be offered, and changing circumstances could change both costs and benefits. In addition, some who receive subsidy payments now could get much less if they stay in their current plans. We strongly encourage recipients of coverage to review plan details before automatic renewal!

Besides new plans being offered and potential changes in subsidy amounts, you also need to pay close attention to provider networks available. Each insurance company obviously has their own network of doctors and hospitals but you can also see different networks associated with different plans. For example, you may use one network for a plan that is “on” the Federal Exchange and a different network for plans that are “off” the Federal Exchange.

As you can see, there is still a lot of confusion surrounding the healthcare reform law. Michelle Cole & Associates, Inc. is here to help you make the best decision possible for you and your family. Please call or email us any time. We are here for you!!

Healthcare Reform: What are your options?

Healthcare Reform: What are your options?

We want to make sure that you know Michelle Cole and Associates can still help you with Healthcare Reform and your health insurance options!!  Even though open enrollment just ended, there is still so much confusion out there.  One of the key components of the health reform package was a Federal website,, and that site aimed to be a one-stop shop for health care information, briefing Americans on the public and private insurance options available to them — as well as the benefits offered by the new law. But it didn’t always meet that goal and it also neglects to inform consumers that they could still receive guidance on selecting and enrolling in a plan by using a licensed health insurance agent. Therefore it left most consumers under the impression that health insurance agents cannot help you with “Obamacare” at all.

The health insurance marketplace has always been very complicated and the new law, with its mandates, exchanges, and etc, has only made it more complex and confusing.

At Michelle Cole and Associates, we are not only licensed health insurance agents, we also did the certifications required to help you select plans “on and off” the Federal exchanges. We can help you navigate the dizzying array of options and find the health plan that best suits your needs. And…we don’t disappear when you purchase a policy, either. We often help patients file claims and take full advantage of all the benefits offered by their plans.

A survey conducted by Assurant Health, found that 64 percent of consumers who purchased individual medical insurance through a professional agent found their experiences “helpful,” while only 36 percent of those who purchased online said the same. Those who bought through an agent were also significantly more satisfied with the health plans they purchased. Some critics have argued that the government could provide these services more effectively and at a lower-cost. But the federal government has a very poor track record when it comes to helping consumers navigate the insurance market. Consider the federal 1-800-MEDICARE call center. A U.S. Senate Special Committee on Aging investigation found that consumers waited up to an hour to speak with someone during peak call times. Calls were often dropped. Customer service representatives spoke from scripts littered with errors and hard-to-understand jargon. Worst of all, callers often received incorrect information.

You deserve the best information available when shopping for something as important as health insurance and we just wanted to make sure you knew that Michelle Cole and Associates is still here to help!! If you have an individual plan and need to evaluate your options, call or email us. If you have a group plan through your employer and there are changes coming and you are unsure of what to do, call or email us, we can help. If you are a business owner and need to evaluate your small group options, we can help.  Please see our frequently asked questions and answers regarding healthcare reform.  Hopefully you will find this helpful.

Thank you for trusting us to help you and your family!


Michelle and Team