It’s Open Enrollment Season for Obamacare

If you have an inadequate health insurance plan or you have changed your situation and need new insurance, now’s the time to go out on the exchange and look around. Open enrollment is from November 1st to December 15th. Today’s NY Times has an in-depth discussion of what’s out there. Take a look also at this very recent NY Daily News article.

The American health insurance system is a frustrating  tangle which is hard to navigate and requires a lot of time to deal with, from selecting policies to figuring out how to afford insurance to changing prescription plans based on their formularies to coping with absurd denials of coverage for drugs or treatment that the patient’s doctor recommends. Unbelievable amounts of hours are spent by patients and their advocates every year, often during their workday when those hours might be better spent getting the work done. Before the affordable care act, our small-company plan’s premiums were rising by double digits every year. The ACA was designed to greatly broaden the pool of healthy, premium-paying plan participants as a way to bring those premiums down. With the rollbacks of certain protections that were built into the Affordable Care Act (“Obamacare”), in the free-market economy, that critical aspect of the program has been removed, and companies are allowed to offer policies that provide minimal coverage and are still costly to pay for. People are spending as much on their insurance as they are on housing. It’s absurd.

I’d like to see a system where coverage isn’t linked to employment and instead is just based on something simple, like geography … for example, everyone who resides in a county which has population in excess of X people enrolls in that county’s plan, and very small counties just combine into a regional plan of an adequate and defined size. You’d only have to change plans if you moved out of county. No more worries that your smaller employer won’t have an insurance plan.  Let the insurance companies compete behind the scenes to be the plan administrator. Have all practitioners in a given county accept that insurance plan as well as others. Let the plans negotiate drug prices or treatment prices like the Veterans Administration does (for drugs) or Medicare (treatment). Control the price of premiums and subsidize premiums through tax returns (as is done under the ACA) so that no participant has to pay more than a certain nation-wide percentage of their modified adjusted gross income. It’s absurd that an employee in a company which has a health plan should have to pay $12,000 a year for their share of the premium to have coverage for their family. The cost of insurance may not make too big of a dent in the budget of someone earning $180,000 a year, but the premium cost is the same for the person earning $60,000 a year.

By the way, if you are at that age to enroll in Medicare (65), keep an eye on your deadlines as well, and be sure to be mindful of the potential lifetime penalties for failure to enroll in Part B when you sign up, even if you are still employed.

For advice and representation on senior care legal planning, call us at 732-382-6070


Affordable Care Act (Obamacare) Coverage – Automatic Renewal Available

More than 5.4 million people enrolled in health insurance plans through the federally subsidized health insurance exchanges that were established by the Affordable Care Act (ACA), and 86% of them were eligible for subsidies, according to the NY Times on June 27th. The Department of Health and Human Services has issued regulations that enable most ACA enrollees to have their policies automatically renewed without a need to reapply. If there has been a material change in income or the person wants their premium and subsidy to be recalculated, they would need to re-apply through

The next open enrollment period begins November 15th, and anyone who isn’t presently insured should certainly make plans to enroll in either an ACA insurance plan or the expanded Medicaid plan if their state is participating. This is especially useful if you are awaiting a decision on your Social Security Disability claim or have been approved  but cannot yet receive Medicare benefits (because there is a 2-year waiting period from the start date of your disability benefit). ACA Subsidies are based on the Modified Adjusted Gross Income (MAGI) reported on the most recent federal income tax return, and are available if household income is up to 4x the poverty level — i.e., if your income is up to $45,960 in 2014 you may qualify for a subsidy to keep your premiums affordable. The Times reports that “The Congressional Budget Office estimates that subsidies this year will average $4,400 for each person who receives a subsidy.” This may amount to 50% of the cost of the insurance, depending on where you live.

In keeping with my recent comments about the need to continue treatment or health care monitoring to maintain documentation of your ongoing disabling conditions, it is critically important to do whatever you can to maintain some kind of health insurance coverage.

For representation on Social Security Disability Appeals, contact us at 732-382-6070

Lauren Marinaro Will Talk Obamacare at the Y on October 23rd

I will be at the YMCA of Scotch Plains at 12 pm and 7 pm on October 23rd to discuss the Affordable Care Act and answer questions about the Medicaid expansion, access to health insurance subsidies and the ins and outs of the health insurance mandate.  At noon we will also be talking about Obamacare’s impact on Medicare.  Come one come all!!

Affordable Care Act – Important Dates and Deadlines

By now you know that you can start shopping for affordable health insurance at, where you will learn about the insurance policies available on the New Jersey exchange as well as whether you qualify for government subsidies to offset the cost of insurance, and if you qualify for the Medicaid expansion. Considering the catastrophic cost of even one uninsured trip to an emergency room for medical treatment, getting insurance now through the exchange or through the Medicaid expansion should be a real lifesaver for your family. Whether you are employed without insurance, or receiving unemployment or Disability Income benefits, such as Social Security Disability — or your case is pending — get started with this enrollment process and find a plan that works for you.

1.       We are in a six-month open enrollment period that began October 1, 2013 and runs to March 31, 2014, to get insurance that will start in 2014.

2.        If you want to have coverage effective Jan. 1st, 2014, be sure to enroll and pay your first premium by Dec. 15, 2013. If you do so after Dec. 15,  your start date for coverage will be delayed by as much as 6 weeks.

3.         Most people who don’t have insurance coverage by Jan. 1, 2014 will face a tax penalty of $95 for individual adults or 1 percent of their income, whichever is higher.

4.         After Mar. 31, 2014, you can only enroll in the exchange’s insurance if you have a “qualifying life event,” such as losing your job, having a child, or getting divorced.

5.          Each year there is another 6-month opportunity to enroll, from October 15 to March 31, but if you haven’t enrolled by December 7th, there will be tax penalties that go up each year as of the upcoming Jan. 1.

6.          The tax penalties will be $325 for individual adults or 2 percent of income, whichever is higher, if you’re not enrolled by Jan. 1, 2015. They will be $695 or 2.5 percent of income, whichever is higher, if you’re not enrolled by Jan. 1, 2016.


Affordable Care Act Insurance Plans – Start Investigating online today

Applications for new government -supported health insurance plans are online today. Some people refer to the Affordable Care Act as “Obamacare.” If you have no health insurance or you cannot afford the premiums on insurance offered by your employer, go to   to start your investigation. You will set up an account and a password. You’ll be asked to enter your basic household information, select your State (New Jersey, for instance) , and provide information concerning  household income, legal status, and present access to insurance. and see what plans are available for you. The insurance will become available to you January 1, 2014. Premiums will be subsidized through tax credits, which in turn will be based on your  income. Premiums would be reduced for individuals with income up to $45,960 and $94,200 for a family of four (400 x the Federal Poverty rate). There will also be a cap on your annual out-of-pocket expense for premiums and deductibles

The ACA can be a lifeline for people with pending Social Security Disability claims:  If you are no longer able to work due to severe, medically-determinable impairments that prevent you from performing the kinds of work you have done in the last 15 years and which prevent you from performing any other kind of full-time work, you may be filing a claim for Social Security Disability (Title II) benefits. If your claim is eventually approved, you will receive Medicare as your health insurance once two years have gone by since the start of your SS benefits (the “start” is 5 months after the “onset date” of the disability, which is when you are disabled and no longer gainfully employed). However, while your claim is pending, you may need health insurance, and it would be smart to investigate what the Affordable Care Act can do for yourself and your family.