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Bob Hopper: Health Insurance Guide for 2015

Read this if you buy your own health insurance. Open enrollment runs through Feb. 15.

If you are covered by an employer-sponsored health plan, open enrollment does not apply to you. If, however, you work for an employer who does not offer coverage, are part-time and not eligible for employer coverage, or you are self-employed, read on.

Health Insurance Can Be Affordable

Where you get health insurance is based on your estimated annual household income for 2015 (use adjusted gross income or line 37 of your Federal 1040 form).

Low income: Individuals earning less than $16,105 a year, a couple earning less than $21,707 or a family of four making less than $32,913.

Recommendation: You may qualify for free coverage through the expanded Medi-Cal program. Call the Department of Social Services at 805.681.4401.

Low to moderate income: Singles earning $16,105 to $46,680, couples earning $21,706 to $62,920 and a family of four earning $32,913 to $95,400.

Recommendation: You may be eligible for a Premium Subsidy via the Exchange, significantly reducing the cost of insurance. Call an exchange-certified insurance agent to find the plan that offers the best value for you and your family.

Moderate to higher income: Individual income greater than $46,680, for couples $62,920 or more and a family of four earning $95,400-plus.

Recommendation: Avoid the frustration of using the Exchange website. Contact a local agent to find the plan that offers the best value for you and your family.

So, What Is the Best Value in Health Plans?

If you have a grandfathered plan …

President Barack Obama said that if you like your plan, you can keep it. It’s important to note that he said this prior to the passing of health-care reform on March 23, 2010. If you had your plan prior to that date you have a grandfathered plan with a large physician network, a lower out-of-pocket maximum and, most likely, lower premiums.

Recommendation: Keep you grandfathered plan. One of the main benefits of a grandfathered plan is the significantly larger network of doctors compared to the new, smaller Affordable Care Act plan networks. Consider a change only if you are eligible for a premium subsidy, making your plan more affordable.

If you have an “off Exchange” plan from an insurance company …

If you bought a plan after March 23, 2010, you have a new ACA health plan.

Recommendation: If you like your plan, keep it. If you don’t like your plan, talk with your insurance agent to find a better plan.

If you have a subsidized plan on the California Exchange …

The main reason for buying insurance on the exchange is to get a premium subsidy.

Recommendation: If you like your plan, keep it and try to avoid making plan changes this year. The Covered California system remains dysfunctional. Expect phone wait times of two to three hours during open enrollment. A better alternative is to contact your agent to make any changes. If you previously enrolled by yourself, it’s not too late to contact an exchange-certified agent who will provide a much higher level of customer service and guidance, at no extra cost to you.

If you don’t know an agent, simply log onto the national professional organization for agents, click on choose an agent and enter your ZIP code.

Remember, open enrollment ends Feb. 15. If you don’t secure health insurance by this date, the IRS will assess a fine equivalent to 1 percent of income or $350, whichever is higher.

Bob Hopper owns Hopper Insurance Services in Santa Barbara, providing individual and group health insurance for more than 30 years.

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