Navigating the Financial Assistance Maze - Obamacare Subsidies

Get Help Navigating the Financial Assistance Process in Obamacare - Get Subsidies

Confusion Reigns                                                                                                                            NPN #7644850

The Affordable Care Act continues to be a source of confusion and consternation for many of our clients and readers.  Many of the questions we are receiving are centered on financial assistance and the need for clarification from shoppers if they qualify for government help in paying for the high price of health insurance.


The Tone Has Changed

We still continue to get phone calls from shoppers that start the conversation with "I don't want any of that Obamacare stuff", and frankly that sentiment is one we all share.  The problem is now that the entire industry IS that Obamacare stuff and every policy whether OFF EXCHANGE or ON EXCHANGE is ruled by the Affordable Care Act....or Obamacare.  Effectively what these callers are saying is that they don't want an HMO because they've heard that the doctor selection for Obamacare plans is really poor (which is true) and these people are really fiercely independent and don't want or need a government handout.  I fundamentally understand where they are coming from as these folks feel strongly that the ACA has been thrust upon them and it is surely a doomed system.  I agree in many respects and in future posts I'll elaborate on some of the main issues, but the focus of today's post is to highlight that there is starting to be a change in tone brought on by the unfortunate reality that the larger and growing presence of the government in healthcare and health insurance has done the one thing it does in every industry, distort prices....much higher.

Because health insurance prices are now almost 100% greater than they were just 15 months ago, previously independent health insurance purchasers are scrambling to try to afford the policies in this new "Affordable Care Act" world.  Our team will quote shoppers only to get the response, "There is no way I can afford this".  Frankly, even if you can afford the policies (from a financial resources standpoint) they are still extremely expensive.  In fact, I've said in the last couple of days that the system is now broken.  A great example is a 60 year old couple I sent quotes to yesterday.  Their cheapest option was $900 a month for a policy that offered a $6,000 per person deductible and no office visits!  Doesn't sound like great access to healthcare now does it?

The point of this discussion is that rates are now so high that the conversation swiftly turns to clarifying the income limits for purchasers to see if there is some sort of available help to purchase this unaffordable coverage.  Those shoppers that were very against Obamacare are probably still of the mindset that it isn't a good thing, but certainly they are positioned in a place where they have little choice but to rely on the Obamacare subsidies to help pay for the out of control premium costs.  So, when they ask, "How can we afford this?", we turn to the financial assistance available under Obamacare and I've found a pretty nice graphic here that gives us a good overview of the income bands and limits to receive help.


Marketplace Qualification Eligibility


As you can see here, a couple earning less than $63,000 can probably obtain assistance, and a family of four earning below $94,000 will also qualify.   If an applicant makes too little money, they may qualify for Medicaid, but unless there are small children involved or a pregnant mother, they won't get Medicaid here in Texas.

Things You Need To Know

Qualifying for financial assistance is getting easier this year from a process standpoint.  You may log into the website, you may call the Marketplace 800 #, or even better, you can call us direct at 713-422-2935.  We purchased a quoting software system that integrates directly with the Marketplace so we at Texas Health Design can actually provide quotes, give guidance regarding your plan choice, and now we can also help you answer the questions and navigate you through the qualification process on our platform!  Let us help you get quick decisions and make excellent plan choices. 

Calling the Marketplace - 1-800-318-2596

If you call the Marketplace directly, simply tell them you are working with us and give them our NPN # (National Producer Number - # 7644850) and then once you have your subsidy information ask them to save the application and call us.  We can talk and help you find the best plan for your needs and then we can conference call them and make our selection.

Online -

If you choose to use the online system, simple log into and create an account (yes, there are still online web issues!).  There are several sections that ask if you are receiving assistance in the purchase process, please say yes and you'll be prompted to enter in our NPN # 7644850.  Once you know your subsidy amount, call us and we'll help provide quotes and review the plan options now that we know the amount you'll receive.

I Have A Subsidy- Do I Need To Reapply?

YES!  Why would you call back to the Marketplace is your income hasn't changed from last year?  The reason you'd call back is EXACTLY that!  You income hasn't changed, but premiums have gone up 10%, 15%, or even 25%!  Since subsidies are calculated based on targeting how much your health insurance premiums are as a percentage of your total income, we know that your health premiums have gone up and your income hasn't!  As a result, you probably could get more assistance in 2015.

If I Want To Change Plans And I Receive Financial Assistance - What Do I Need To Do?

You guessed it, you need to call the Marketplace.  Even though you've made a plan decision with our help and we've selected a newer, better plan, we've got to call the Marketplace.  We are happy to conference call with you and walk you through that call.  Please remember to tell them that you're working with us and like our help and to add NPN # 7644850 on that new plan!  The system is frankly set up to drop us off of your policy.  If you choose a new plan and don't actively tell them you are working with us, they won't copy over the data to the new plan and we won't be able to service your policy and keep you from calling the health insurers with their long hold times!  We're happy to call with you, just call us at 713-422-2935 and we'll conference them in and make the plan switch today!

Call Us For A Quote and to Discuss Your Qualification Today

The health insurance shopping process is confusing enough with more than 70 plans to choose from here in Texas.  When you add the government financial subsidy process too, it can be overwhelming.  When you call or log into the Marketplace you can get good information, but you don't get expert plan advice and tools that help you compare plans against each other in an easy to read format.  Contact Us Today by clicking this link or simply call us at 713-422-2935.  You can also get a quote directly from our website!  Click Get A Quote Now to get started.  We are looking forward to serving your family.


Jason Bohmann
NPN# 7644850
Texas Health Design