What’s the “individual mandate”?

Our consumer advocates have been getting a lot of questions about the individual mandate, which is the penalty for failing to obtain health insurance under the Affordable Care Act (ACA), which is a federal law. In Washington, the last day to enroll in a health plan is March 31, only four days away.

If you qualify for free or subsidized health care, enroll through Washington Healthplanfinder at www.wahealthplanfinder.org.  People qualify for help if their income is less than 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013). If your income exceeds that threshold, you may wish to contact an insurance broker or agent directly.

Those who qualify for Washington Apple Health (Medicaid) may continue to enroll throughout the year. There are also certain events that allow you to enroll or change your enrollment throughout the year. Read more about qualifying events.

With a few exceptions, people who do not purchase an ACA-compliant health insurance plan will pay a penalty when they file their 2014 federal income taxes. The penalty is 1 percent of your income or $95, whichever is greater. The penalty increases yearly through 2016, when the penalty will be the greater of 2.5 percent of your household income or $695 per adult and $347 per child. If you lacked coverage for part of the year, your penalty will be prorated.

There are exemptions to the penalty:

• People who cannot afford coverage because the cost of premiums exceed 8 percent of their household income.
• People whose household income is below the minimum threshold for filing a tax return.
• People who are incarcerated.
• Members of federally recognized tribes.
• People who are eligible for care through the Indian Health Service.
• People who live in the United States illegally.
• People whose religious beliefs prohibit having health insurance and are recognized as such by the Social Security Administration.
• People who belong to a health care sharing ministry.
• People who experienced a health insurance coverage gap of fewer than three months.
• U.S. citizens who live outside of the country for at least 330 days during a 12-month period. However, once they return to the U.S., they need to purchase health insurance within three months.

People must apply for an exemption to the individual mandate through the IRS. The IRS created a section on its website about the mandate, exemptions to it, and how to file.

Balancing consumer protection, innovation is focus of new health insurance rules

Balancing consumer protection with innovation is the focus of the new rules under consideration for new health insurance plans that will be available in 2015.

The Insurance Commissioner’s office has been working on the health insurance network rules for more than four months. The process began soon after the emergence of what are called “narrow networks.” That’s the common reference now to health plans that don’t always include the doctors and hospitals that insurance companies typically contracted with in the past before the Patient Protection and Affordable Care Act took effect this year.

While still providing access to a full range of medical providers, health insurers have said they have not contracted with some traditional doctors and hospitals because of the higher rates they charge for some services. It’s a key way that insurers have said they can keep premiums lower for consumers and still maintain comparable quality care – especially considering the often wide discrepancies in what providers charge for the same service.

Insurance Commissioner Mike Kreidler saw early on that consumers and providers needed more guidance in developing health plans for 2015. The new rules under consideration are heavily focused on providing more transparency – answering the common question: “Is my doctor and hospital in the network of the health plan I might buy?”

“Consumers have a right to know,” Commissioner Kreidler told the members of the Health Benefit Exchange at its monthly public meeting March 27. “It’s my job to ensure that consumers can access the care they need and that insurers live up to their promises.”

That hasn’t been as clear as it should have been through plans offered this year. The new rules are designed to give consumers more information on which to make choices in 2015.
The commissioner has heard from a wide range of interested parties, including insurance companies, doctors, consumer advocates, Indian tribes and more.

A public hearing on the rules is scheduled for April 22 in Olympia. They are set to take effect May 1, about the same time that insurers will begin proposing new plans. Considerable flexibility is built into the new rules to make sure that health plans for 2015 are given time to comply. The fact is, health insurers have been involved in the process for months. And much of what’s being asked for in the rules is already required.

The new rules are simply providing a formal and clearer roadmap for all to follow on behalf of consumers.

If I have a child care business in my home, can my insurer cancel my homeowner policy?

An insurer cannot decline to issue a homeowner policy, cancel or fail to renew a homeowner policy for the sole reason that the customer operates a home-based child care, in accordance with state rules (WAC 284-30-700). However, insurers may exclude liability coverage for any liability that arises related to the child care business. People in Washington who operate home-based child care businesses should talk to an insurance agent or broker about seeking a separate business liability policy to insure themselves and their business in the event of a liability issue. Find a licensed agent or broker.

People who care for children in their homes typically require a license from the Department of Early Learning. Read more on DEL’s website.

People who run other home-based businesses should contact their insurance agent to find out what types of coverage they may need.

Read more about insurance and home-based businesses.

Join the Insurance Commissioner’s consumer protection team!

The Office of the Insurance Commissioner is recruiting to fill a Functional Program Analyst 3 position in the Consumer Protection Division at our Tumwater headquarters. This position supports our mission by advocating on behalf of consumers to ensure fair treatment by insurance companies and by educating the public on insurance matters.

The position researches and resolves consumer complaints involving health, life, annuity & disability (L&D) insurance and licensed carriers and responds to consumer inquiries regarding L&D insurance issues, including questions involving federal health care reform. This position staffs our consumer hotline four hours per day and spends the remaining time researching and resolving consumer complaints and then following up with consumers. Our consumer protection staff work with consumers and insurance professionals and also work heavily in our database, with some website content responsibilities.

In 2013, we received more than 5,000 consumer complaints and recovered more than $8 million related to insurance billings, refunds and various claim-handling issues.

Read more about this position or apply. This job closes on April 6.

Important information about landslide insurance

Gov. Jay Inslee has declared a state of emergency in Snohomish County after a large landslide hit the town of Oso on March 22. Tragically, at least eight lives were lost and several people were injured. Searches underway for more than 100 people who are still missing. The Office of the Insurance Commissioner’s thoughts are with the families, emergency responders and communities affected by the landslide.

In addition to the human toll, the slide destroyed at least 30 homes and 20 other structures, and caused a backup in the Stillaguamish River, sparking concerns about flooding. The landslide destroyed an area of at least one square mile, including Highway 230 and parts of neighboring Darrington. FEMA announced today it will assist with the landslide response.

People who lost or suffered damage to property as a result of the landslide can contact the Insurance Commissioner’s consumer advocates with questions about their options at 800-562-6900 or online.

In general, homeowner policies do not cover landslides or land movements caused by rain runoff. That type of coverage would be covered by a separate policy. If you think you purchased such a policy—or you would like to–contact your insurance agent or broker.

Read more information about homeowner insurance and landslides.

Gov. Inslee has a webpage with information about the landslide and the state Emergency Management Division has a page with updates and resources.

Be on the lookout for Medicare red flags

The Insurance Commissioner’s SHIBA program has received reports that some Washington Medicare subscribers are receiving calls from a person claiming they’re selling Medicare Supplement (Medigap) insurance. Medigap plans are sold by insurance companies and fill the gaps that Medicare parts A and B don’t cover, like copayments, coinsurance and deductibles.

The reports are that a solicitor is cold-calling consumers and setting up an appointment to come to consumers’ homes to talk about Medigap coverage and costs. When the solicitor schedules the appointment, they ask for personal information, including Social Security numbers and consumers’ home addresses. A company representative shows up for the appointment without any identification or proof they represent the insurance company; during the meeting they ask consumers for money to buy additional coverage.

Whenever a salesperson calls you unsolicited, you should proceed with caution. Consumers should never give personal information over the phone, including Social Security numbers, bank account numbers, credit card numbers, or anything that could be used to defraud you or steal your identity.

It’s also a good idea for consumers to find out if an agent is licensed to sell insurance in our state before meeting with them or giving them money. Consumers can also call the Insurance Commissioner’s consumer advocates at 1-800-562-6900 to verify someone is licensed to sell insurance in Washington or to report suspected Medicare or insurance fraud.

• Read more about Medicare
• Read more about SHIBA and how they help people navigate Medicare

Do you still need health insurance? Open enrollment ends March 31

Open enrollment for health insurance for this calendar year ends in less than two weeks. If you do not have a qualified health plan, you will be subject to a tax penalty when you file your 2014 taxes. The penalty for the first year is up to $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater.

• To be covered starting April 1, you must apply, select and pay for a health plan by 5 p.m. on March 23.
• To be covered starting May 1, you must apply, select and pay for a health plan by 11:59 p.m. on March 31.

Those who qualify for Washington Apple Health (Medicaid) may continue to enroll throughout the year. There are also certain events that allow you to enroll or change your enrollment throughout the year. Read more about qualifying events.

If you qualify for free or subsidized health care, enroll through Washington Healthplanfinder at www.wahealthplanfinder.org.  People qualify for help if their income is less than 400 percent of the federal poverty level ($45,960 for an individual and $94,200 for a family of four in 2013). If your income exceeds that threshold, you may wish to contact an insurance broker or agent directly.

Open enrollment for 2015 starts Nov. 15, 2014 and ends Feb. 15, 2015.