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In this article written by the New York Times 03/26/2019, Trump asks the federal appeals court to invalidate the Affordable Care Act. What does this mean to those of us with re-existing conditions, and those who rely on premium assistance from the government, to be able to afford health care coverage? More and more each day, health share ministries are coming up to fill the need where traditional health insurance falls short. Aliera is one company that is leading the way. Click here to view more: Aliera Health Care

Q & A about the HSA

- My understanding of the HSA is that it is a financial tool, that I use to pay for medical expenses, and that it's not directly tied to my insurance policy, is that correct?

Correct. You would open a special "Health Savings Account" and deposits up to $3,000 per year are tax deferred. Check with your bank to see if they offer this type of account, or you can go to Bank of America, or these online institutions www.livelyme.com www.thriventcu.com

- If it's not tied directly to my insurance policy, does that mean I can take it with me when I end my California coverage and move to Idaho next year?

Correct. Any funds you deposit are yours to keep and use exclusively for medical expenses (including, dental, vision, pharmacy, etc). This account can bear interest, and rolls over year after year.

- Looking at the Bronze 60 HDHP PPO pdf document, I see mostly $0 payments for covered services, that $0 is only true after meeting the deductible, correct?

Unfortunately yes. You would get a free physical and pay cash for all services until you reach the out of pocket maximum which is $6,900 (2020 policy year).

- Looking at the 2020 Health Benefits pdf document, I see that an urgent care visit under the Bronze plan is $65. Is that also true for the Bronze 60 HDHP PPO? Or would that only be true after the deductible is met?

On the HDHP HSA you would pay $0 for services after the deductible of $6,900 is met.

Sorry that the decision for health insurance is so confusing. But we're happy to spend as much time as you need to help you make the right decision. Just let me know when you have some time to discuss.

Here is the conversation I had with a 59 year old living in the San Fernando Valley:

I don't mean to be too persuasive, but I honestly can't justify the Silver plan to be a better choice over the Bronze HSA.

I recommend Oscar, but would be much happier seeing you with any Bronze HSA over any Silver.

If you add up the cost of the HSA and Out of Pocket maximum, then deduct the tax savings, and increased premium assistance, the HSA including the out of pocket, is the same as just the insurance cost of the silver.

Let's have a look...

$538 Oscar Bronze HSA, plus out of pocket maximum $6,650, Total: $13,106

Health Savings Account: You can deposit up to $4,000 a year to come off your gross adjusted income, a savings of about $1,500 in taxes. Also, the $4,000 you deposit reduces your gross adjusted saving you another $33 per month by way of increasing your premium assistance. A grand total of: $11,210

The HSA account is quite simple. You open this special health savings account and deposit however much you need, when you need it for medical services (dental, vision, pharmacy, etc). Get an debit card with this account and always use it. When you file your taxes, let your accountant know how much you deposited, and that amount will come off your gross adjusted income.

$921 a month for the Oscar Silver. $11,052

Plus the out of Pocket Maximum: $7,550. plus copays that do not go towards the deductible: Total $18,602

Still confused? Give us a call and we'll walk you through it step by step

Hayek Insurance

3205 Old Conejo Rd, 2nd Floor

Newbury Park, CA 91320

(805) 496-8835

Fax (805) 496-8572

info @ hayekinsurance.com

California Department of Insurance 0F09609

As certified agents with Covered CA, we are licensed and educated in the ways of health insurance. There are so many changes happening, who can keep up? Contact us now to arrange a free consultation!

The 2018 Health Insurance Rates and Coverage Options have been released! Call now to get your quotes!

Scroll down for recent news and Frequently Asked Questions

Group Health Insurance Costs are now lower than individual!

If you own a business, and your gross adjusted income is over 400% of the Federal Poverty Level. (see chart below), then Group Health Insurance may be a better option. The network of providers is much larger, and you are able to pay 100% of it through your business account for maximum deductions! Call now to get a quote! There's no cost or obligation.

(800) 860-8835

Not happy with your health plan? You still have until 01/31/18 to make changes. Premium assistance is available. Plans cost as little as $1 per month in some cases.

Open enrollment ends 01/31/2018. Call now to secure your coverage for 2018! After this date, you will need a qualifying event to enroll in coverage: View Qualifying Events

We found a great resource for the lowest cost prescriptions: www.goodrx.com . If you have the Bronze Plan with no prescription benefits until you meet your deductible, you'll need to pay cash for your medications, and that means shopping for the lowest cost. Please give us a call anytime for help!

What happens when Covered CA cancels my coverage and I get placed in Medi-Cal?

If your income falls below 138% of the federal poverty level, your health insurance coverage may be cancelled, and you may be enrolled in Medi-Cal. In order to have your traditional health insurance coverage reinstated, you will need to contact Medi-Cal (or the local social services office) and ask for the Covered CA Liaison. Be sure to bring 2 forms of identification, and as much proof of income as you can. If you need help with this situation, please give us a call and we'd be glad to help you out.

What is a mixed household?

If you have coverage with Covered CA and they have told you you have a mixed household, it means that members of your family under 19 are enrolled in Medi-Cal, while adults may have selected traditional health insurance. This poses certain challenges with regards to your estimated income. In a mixed household, you must communicate directly with Medi-Cal about adjusting your income. We can help! Call now and a certified agent will assist you! 805 496 8835

10/13/2017 Trump to Halt Subsidies For Health Insurers- Expected To Drive Up Costs For Middle Class. Click here for details

Anthem Blue Cross is canceling all individual health insurance policies effective 12/31/17, with the exception of grandfathered plans. Yours may be one of them! Contact Hayek Insurance today, so you can plan and prepare for your new health coverage in 2018.

How do I Enroll in Health Coverage?

You can attempt to enroll on your own by visiting www.coveredca.com. However, there is no cost to have Hayek Insurance process the enrollment for you! Costs of coverage and benefits are the same, whether you enroll on your own, or contact us to help you.

Group Health Insurance is required to be offered if you have more than 50 employees. The good news is that employers may qualify for substantial tax credits if the average income is less than $50,000 per year. Please contact us to discuss.

Case Study, 2018 Health Insurance, Covered CA

A family of four living in 91320 (ages 46, 43, 18 and 16) with income of $97,000 a year. Total monthly amount of federal tax credits: $918. That's over $11,000 a year in assistance! It may be tough to secure these dollars without our help! Call Now! (800) 860-8835

What is an HSA Account?

HSA stands for Health Savings Account. Choosing an HSA compatible insurance plan means that you may deposit funds into a special health savings account, to be used for medical services. Contact your tax professional to find out how funding this special account may reduce your tax liability

What is Premium Assistance, and how do I get it?

Premium Assistance, also know as Federal Tax Credits may be awarded to those that fall within the right income bracket. When we enroll you for coverage, we'll discuss where you fit in, and how you can optimize your assistance, for the lowest costs.

What is a PPO?

A PPO stands for Preferred Provider Organization. It means that you have better benefits when you use a Preferred Provider (In Network), than when you use one that is out of network with your insurance company.

What is an EPO?

An EPO stands for Exclusive Provider Organization. Coverage applies only when you use providers that are in your insurance company network. No out of network benefits apply.

What is an HMO?

An HMO stands for Health Maintenance Organization. Benefits apply only when you use network providers. The insurance company has more control over covered services, and you must have your primary care provider refer you, in order to see a specialist.

What is a Co-Pay?

A co-pay refers to the amount you might pay for a specific medical service, before you have to satisfy your deductible. As an example, the Silver 70 PPO has a $35 co-pay, to see a primary care physician, and a $15 do-pay to fill a generic prescription

What's the difference between a deductible and an out of pocket maximum?

With some health insurance policies, once you satisfy your deductible, you'll be paying a percentage of the remaining balance, until you reach your out of pocket maximum. See the example below:

Suppose you have the Silver 70 plan, and undergo a surgery. The hospital bill is $14,000. The Silver 70 Plan has a deductible of $2,500, and a 20% Co-Insurance. In this situation, you would pay the $2,500 deductible, then 20% of the remaining $11,500 balance, or $2,250. Added together, your responsibility for this surgery would be $4,750.

What is an Out of Pocket Maximum?

In a given year, this is the maximum amount you would have to pay for all medical services. The Gold plan has an out of pocket maximum of $6,750. Even if you have a $1,000,000 hospital bill, your cost will be $6,750.

What are Essential Benefits?

Affordable Care Act Compliant plans must include the 10 essential health benefits:

  • Ambulatory patient services (outpatient services)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Will my brand name prescriptions be covered?

Yes. All plans will cover necessary brand name medications, but they will be subject to meeting the policy or pharmacy deductible, depending on the plan you choose. As an example, the Silver 87 plan has a $50 pharmacy deductible, then a minimum of $20 per prescription

When can I enroll in coverage for 2018?

Open enrollment starts on 11/01/2017. However, the 2018 coverage and rates will be released the second week of October 2017. Call us to review and discuss your options.

For any other coverage question, call: (800) 860-8835