Going to 2015 Open Enrollment

As 2014 comes to a close, the open enrollment for 2015 will start again in just a few weeks. Open Enrollment will be November 15th through February 15th.


Let’s take a step back into 2014 for starters, were you able to be part of a Health Care Plan (group or individual) You will need to add that policy number to your tax return for this year.  If you were not able to get into the health care plan and have a record of you trying to obtain coverage, you will need to have that as supporting documents to send in with the tax return.

On the flip side you did not want to or did not sign up for any health care plans and want to know what your tax penalty will be for you and your family. The annual individual shared responsibility payment is the GREATER OF:


                        1% of the tax payer’s household income that is above the tax return filing thus holds for the tax payers filing status.





                        The tax payer’s flat dollar amount which is $95.00 per adult and $47.50 per child, limit to a family maximum $285.00



For those people who took the tax subsidies or credits, you will receive an IRS 1099 form to claim as income on your tax return and, yes, you will be paying tax on the credits. This section did not change going forward.


Let’s move forward to 2015 and look at the Annual Individual Shared Responsibility of the payments for NOT having coverage in 2015.



2% of the tax payer’s household income that is above the tax return filing thus holds for the tax payers filing status.





                        The tax payer’s flat dollar amount which is $325.00 per adult and $162.50 per child, limit to a family maximum $975.00



Exemptions from the Individual Responsibility Requirement

Under certain circumstances, an individual may be exempt from the individual responsibility requirement. These circumstances include the following:


  • The individual is uninsured for less than three months of the year
  • The lowest-priced coverage available to the consumer would cost more than 8% of the consumer’s household income
  • The individual does not have to file a tax return because his or her income is too low
  • The individual is a member of a federally recognized tribe or eligible for services through an Indian health care provider
  • The individual is a member of a health care sharing ministry
  • The individual is a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • The individual is incarcerated, and is not awaiting the disposition of charges
  • The individual is not lawfully present in the United States
  • The individual has experienced a hardship (hardship exemptions will be covered later in this topic)

Some types of exemptions are available only through the tax filing process; some are only available through a Marketplace.


Hardship Exemptions

There are certain circumstances that affect an individual’s ability to purchase health insurance coverage and which may qualify an individual for a hardship exemption. To make the determination, the Marketplace considers whether an individual has experienced one of the following events:

  1. Becomes homeless
  2. Has been evicted in the past six months, or is facing eviction or foreclosure
  3. Has received a shut-off notice from a utility company
  4. Recently experienced domestic violence
  5. Recently experienced the death of a close family member
  6. Recently experienced a fire, flood, or other natural or human-caused disaster resulting in substantial damage to individual property
  7. Filed for bankruptcy in the last six months
  8. Incurred medical expenses in the last 24 months that resulted in substantial debt
  9. Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member
  10. Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child
  11. As a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through a Marketplace, the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through a Marketplace
  12. Was determined ineligible for Medicaid because his or her state did not expand eligibility for Medicaid under the Affordable Care Act
  13. Lost insurance coverage because his or her individual plan was cancelled and believes other available coverage options are unaffordable
  14. Experiences another hardship in obtaining health insurance

Only individuals under age 30 and individuals with hardship exemptions may purchase a catastrophic plan. Catastrophic plans typically have high deductibles, and mainly protect individuals from very high medical costs.




2014 Federal Poverty Level Chart*

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The Department of Health & Human Services (HHS) issues poverty guidelines that are often referred to as the “federal poverty level” (FPL). Federally-facilitated Marketplaces will use the 2014 guidelines when making calculations for the insurance affordability programs starting November 15, 2014.

Household Size 100% 138%** 150%** 200%** 250%** 300%** 400%**
1 $11,670 $16,105 $17,505 $23,340 $29,175 $35,010 $46,680
2 15,730 21,707 23,595 31,460 39,325 47,190 62,920
3 19,790 27,310 29,685 39,580 49,475 59,370 79,160
4 23,850 32,913 35,775 47,700 59,625 71,550 95,400
5 27,910 38,516 41,865 55,820 69,775 83,730 111,640
6 31,970 44,119 47,955 63,940 79,925 95,910 127,880
7 36,030 49,721 54,045 72,060 90,075 108,090 144,120
8 40,090 55,324 60,135 80,180 100,225 120,270 160,360

*Chart is for 48 contiguous states and the District of Columbia

The amount of the premium tax credit depends on the QHP that the individual or family selects. If the monthly premium for the selected QHP is greater than the monthly advance payments of the maximum premium tax credit, the individual or family will pay the difference in the monthly premium cost. If the premium for the selected QHP is less than the maximum advance payments, the individual or family may elect to receive the maximum advance payments of the premium tax credit, and have no additional monthly premium cost.

  • Example 1: Family A is eligible for a maximum of $800/month for advance payments of the premium tax credit. Family A selects a QHP that costs $1,000/month. If they elect to receive the full amount of the premium tax credit as advance payments, $800/month will be paid directly to the QHP issuer, and Family A will pay the issuer the remaining $200/month premium.
  • Example 2: Individual B is eligible for a maximum of $400/month for advance payments of the premium tax credit. Individual B selects a QHP that costs $350/month. If he or she elects to receive the full amount of the premium tax credit as advance payments, $350/month will be paid directly to the QHP issuer, and Individual B will not have a monthly premium payment.
  • Calculating Cost-sharing Reductions
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  • Cost-sharing reductions limit the out-of-pocket costsfor essential health benefits (EHB) for individuals and families with MAGI between 100-250% of the FPL, and certain American Indians/Alaska Natives enrolled in a Silver level QHP through the Individual Marketplaces. Federal regulations set the reduced maximum annual limitation on cost sharing for individuals and families eligible for cost-sharing reductions based on income, however, reductions on cost-sharing for specific benefits and services may vary based on a QHP issuer’s specific plan design.
  • Under federal regulations, a family can only enroll in the most generous plan for which all members of the family are eligible. For families that want to maximize each family member’s ability to access cost-sharing reductions, the Marketplace provides separate initial enrollment groups for each family member(s) eligible for different levels of cost-sharing reduction.





Calculating Cost-sharing Reductions, continued

  • 9 of 15

Reduction in Maximum Annual Limitation on Cost Sharing for 2015

Plan Variation
(from 70% AV Silver Plan)
Income Range for Individual* Individual Out-of-Pocket Maximum
(standard 2015 limit: $6,600)
Income Range for Family of Three* Family Out-of-Pocket Maximum
(standard 2015 limit: $13,200)
94% AV Silver Plan Variation
(for households with a MAGI between 100-150% of FPL  )
$11,670- $17,505 $2,250 $19,790- $29,685 $4,500
87% AV Silver Plan Variation (for households with a MAGI between 150-200% of FPL) $17,505- $23,340 $2,250 $29,685- $39,580 $4,500
73% AV Silver Plan Variation (for households with a MAGI between 200-250% of FPL) $23,340- $29,175 $5,200 $39,580- $49,475 $10,400

American Indians/Alaska Natives with MAGI below 300% of FPL enrolled in a zero cost sharing plan variation have all cost sharing eliminated for EHB. American Indians/Alaska Natives with MAGI above 300% of FPL enrolled in a limited cost sharing plan variation have cost sharing eliminated for any EHB item or service that is furnished directly by the Indian Health Service, an Indian Tribe, Tribal Organization, Urban Indian Organization, or through referral under contract health services.

*Please review the 2014 Federal Poverty Chart in the Resources tab to find dollar ranges for the different percentages of FPL.

To determine eligibility, the Marketplace verifies applicant information using data from key federal agencies and other sources.

Depending on an individual’s specific circumstances, the Marketplace may verify information from the following sources to conduct the verification process:

  • Social Security Number (SSN) (Social Security Administration [SSA]) (An individual does not have to provide an SSN if he or she does not have one.)
  • Citizenship status (SSA and Department of Homeland Security [DHS])
  • Immigration status (DHS)
  • Household size (IRS)
  • Household income (IRS, SSA, consumer reporting agency, potentially other sources)
  • Access to other coverage (Medicaid, CHIP, Medicare, TRICARE, Department of Veterans Affairs, Peace Corps, other State-based Marketplaces, Small Business Health Options Program (SHOP), and potentially other sources)


If a Marketplace needs additional information regarding SSN, citizenship, or immigration status, it establishes eligibility based on the individual’s attestation in those areas for a period of 90 days, during which it will use the individual’s attestation to establish eligibility. If the consumer is otherwise eligible for a QHP, the premium tax credit, cost-sharing reductions, Medicaid, or CHIP, during this time, he or she can enroll and obtain coverage. The individual just needs to resolve the issue by the close of the period to continue his or her eligibility for health care coverage.

If a Marketplace needs additional information regarding a criterion of eligibility other than SSN, citizenship, or immigration status, whether it establishes eligibility for health insurance coverage while the inconsistency is resolved depends on what the information that the applicant provided indicates that he or she is eligible for. If the applicant’s income and other eligibility information are consistent with eligibility for enrollment in a QHP with or without the premium tax credit, a Marketplace establishes eligibility for enrollment in a QHP, the premium tax credit, and cost-sharing reductions, as applicable, based on the applicant’s attestation during the 90-day inconsistency period, as long as the applicant attests that he or she understands that advance payments of the premium tax credit are subject to tax reconciliation. If the applicant’s income and other eligibility information are consistent with eligibility for Medicaid or CHIP, the applicant will not be able to access Medicaid or CHIP until the open verification items are resolved.

The 90-day inconsistency period may be extended if the applicant demonstrates that he or she has made a good faith effort to obtain the required documentation. This can be done through the Marketplace call center. After the inconsistency period expires, the Marketplace issues a final eligibility determination.

When Enrollments Take Effect During the Initial Open Enrollment Period

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The date that an individual’s QHP health insurance coverage takes effect is based on the date the Marketplace receives his or her enrollment selection. The effectuation standards for the open enrollment period are as follows:

November 15- December 15               Effective Date January 1, 2015

December 16- January 15                   February 1, 2015

January 16 – February 16                    March 1, 2015


Individual Health Insurance Cost Less than Group Health Insurance … WHY….

For most employees, individual health insurance costs less than group health insurance.

And, as of  2014, individual health plans have new advantages.

To understand why individual health insurance is more affordable than group health

insurance, you need to understand how each type of insurance works.

Group Health Insurance: 

Group health insurance is a type of policy purchased by an employer and offered to eligible

employees of the company, and to eligible dependents of employees. The premium cost is

typically split between the employer and employee, and there is a minimum percentage

rate the employer must contribute to the premiums. The premiums typically increase every

year based on the previous year’s healthcare costs of the employee group. 

“With group health insurance, the risk is spread over the company –

the number of employees you’re covering.”

Individual Health Insurance:

Individual health insurance is a type of policy an individual purchases for himself and/or

his family. Starting in 2014, all individual health plans must cover employees regardless

of health. For example, a healthy non-smoking 40-year old employee will pay the same

as a non-smoking 40-year employee with a medical condition. Premiums cannot be

increased because of health conditions.

“With individual health insurance, the risk is spread over a large group of people

– hundreds of thousands, even millions depending on the plan and carrier.”

If you’ve never heard of individual health insurance before, you’re not alone. Prior to health

care reform, less than 10% of the US population had this type of insurance.

Most people purchased insurance through their employer. However, with the rise of

defined contribution health benefits and the Affordable Care Act, the number of

people with individual health insurance is expected to grow exponentially.

Now, it’s becoming normal for employees to purchase a plan on their own –

just like car insurance.

On Average, Individual Health Insurance Costs Less Than Group Health Insurance:

Individual health insurance costs less, on average, than group health insurance. Let’s look at

the numbers. In 2012, employers paid on average $3,335 more a year for group health

insurance than employees would pay if they purchased a plan on their own. For family

coverage, employers paid over $10,800 more a year.

The cost of group health insurance is not sustainable – especially for small businesses. In

2012, 61% of small businesses said “cost” was the primary reason they did not offer

traditional group health insurance.

Why Would You Pay So Much More for the Same Coverage? Prior to 2014 …

Before health care reform, individual health insurance plans and group health insurance

plans were different. Individual health insurance plans could deny coverage or charge

more for coverage based on health conditions. One reason employers offered group health

insurance (despite the higher price tag) was because they worried about sick employees not

being able to find coverage with an individual health plan. With group health insurance,

everyone is covered – no questions asked.

But as of 2014…
The playing field is leveled. Individual health insurance plans are guaranteed-issue so all

employees can find coverage regardless of health. In fact, many of the new health care

reform provisions greatly favor individual health insurance. Individual health insurance is

now just as good (and in most cases better) than group health insurance. Employers can

continue to contribute by using a defined contribution plan. In this scenario, which would

you choose?

How Much Will Health Insurance Cost in 2014?

  • On average, individual health insurance will cost employees less than group health insurance in 2014.
  • Most employees will be eligible for discounts on individual health plans, decreasing the cost significantly.
  • Nationwide, individual and small group health insurance plans in 2014 will receive federal tax subsidies through the federally-run health insurance exchanges.
  • Income level examples are shown on charts at http://www.healthcare.gov

How Do the Discounts (“Health Insurance Tax Credits”) Work?

As of 2014, the federal government is providing discounts for health insurance to eligible

individuals and families. The discounts, called “health insurance tax credits”, help many

employees buy affordable individual or family health insurance coverage through the

new state health insurance exchanges (“marketplaces”).

Who is Eligible?
Employees who meet certain income requirements and who do not have access to

affordable health insurance through an employer or another government program

are eligible for a discount. Eligibility is based on a standard called the “federal

poverty level” (FPL). The tax credits cap the cost of health insurance

between 2% and 9.5% of annual household income, on a sliding scale

based on income. Individuals and families who earn up to 400% of FPL may be

eligible. This translates to an individual earning up to $45,960 in 2013 and a

family of four earning up to $94,200 in 2013.

                                                          FPL (2013)

   100%            133%             150%           200%         300%         400%

 Premium as % of income

0% – 2%           0% – 3%             4%              6.3%               9.5%            9.5%

                                                            Family Size
1.  $11,490      $15,282            $17,235       $22,980       $ 34,470      $45,960
2.  $15,510      $20,628            $23,265       $31,020        $46,530       $62,040
3.  $19,530      $25,975             $29,295       $39,060       $58,590        $78,120
4.  $23,550      $31,322             $35,325       $47,100       $70,650       $94,200

On average, individual health insurance is more affordable than group health insurance.

Using individual health insurance as the foundation of employee health benefits is less

financially risky for small businesses.  With group health insurance, if one employee has a

baby, a surgery, or is diagnosed with a chronic illness, you are likely to see a large premium

rate increase at renewal time. This is not the case with individual health insurance. By

using a pure defined contribution approach (where employees purchase individual

health insurance and the business reimburses them), the business has total

cost predictability. 



The Future of Employee Health Benefits is Defined Contribution Paired with Individual

Health Insurance

Because of the affordability of individual health insurance, compared with group health

insurance, most (if not all) small businesses are offering employee health benefits with a

pure defined contribution approach. With this type of strategy, the business offers

employees a healthcare allowance that employees can spend on purchasing individual

health insurance. With health care reform, all employees are guaranteed coverage and

many will have access to the health insurance tax credits. Employees purchase the plan

that best fits their personal health needs. Employers have complete cost predictability and

there are no minimum or maximum contribution amounts.

With the new advantages and affordability of individual health insurance, why would

a small business offer group health insurance?

Questions- email to megins@att.net

Quote – Health, Gap Plans and Dental- http://www.WorkingWithMary.com


Health Care Facts

Health Care Facts

An educated person can make a INFORMED decisions.

Mary E. Granberry

 Certified Market Place and SHOP


We have been hearing for the last couple of months about this Affordable HealthCare Act. This became a law back in 2010, and was upheld for the most part in June of 2012. There are states that did not expand the Medicare Act, and The Supreme Court, stated that individual states did not have to participate in State run Exchange Plans. Texas and 25 other states will all have to use the www.healthcare.gov web site to enroll members of their state to the FEDERAL EXCHANGE PLANS.


This is article is not to take sides about the plan, but to explain what some of your options are.




  • Based on your household income, note that if you live with roommates or with family the whole household income will determine what your credit can be.
  • Should you be granted any subsidies or credits, you will receive an IRS 1099 form to claim as income on your tax return and, yes, you will pay tax on the credits.
  • With any of the credits that you receive from premiums and co-pay you will still have to pay the annual deductible $6,350 for single or $12,700 for a family.
  • For the Bronze plan that will only cover you at 70%, the deductible is $5,000.00 on MEDICAL AND DRUGS, before the plan kicks in  starting January 1st. (or the first of the month).
  •  On The Bronze Plan- Primary Care Doctor Visits are limited to 3 with a co pay of $60.00 each, the other visits will not have a co pay. You will pay out of pocket.
  • Should your income level change and you have applied for subsidies and credits, you have 30 days to report to the Exchange. This could change the plan that you started in, thus could have you sliding between the Bronze and Silver Plans throughout the year.
  • Exchange Plans will not be open after April 1st, 2014.
  • You have to be current with your taxes, student loans, to be eligible for any subsidies.





  • You do not have to worry about your income level, the plan you select you can have for the year.
  • You do not go to www.healthcare.gov,  Homeland Security, IRS, and Social Security Administration to find out that you are who you say you are.
  • The prices are generally found to be less expensive compared to the Exchange.
  • Plans need to be purchased by the 15th of each month to be effective the first day of the following month.
  • Prices can increase if you do not purchase before April 1st, 2014.




GAP Plans, started almost 50 years ago when seniors received Medicare, and found that it does not cover every expense.

  • $1,000 or $2,000 per day in the hospital
  • $50.00 Doctor Office Reimbursement
  • Lab
  • X-Ray
  • Prescription Coverage
  • $5,000 Accident Plan

There are a lot more benefits that can be added to this list, this would be a small monthly premium that will have the funds to cover the gaps in Major Medical, or to have when something bad happens.



In a wrap-


You have the choice to have coverage from your Job/ Affordable Health Care Act Exchange / Off the Exchange by Private Medical Insurance Companies / or be placed in Medicaid.


For those that choose not to purchase a plan, the block on your IRS tax form 2014 will ask you to place your policy number and company. When you leave this blank, you will be fined $95.00 or 1% of your gross income whichever is greater. For example you have 2 adults on the tax return and you have a gross income of $50,000 your fine will be $1,000.00.


For Texas Residents, you are welcome to call (832) 851-5466 or email megins@att.net to set up an appointment and receive a quote for you and your family.

Web site www.MaryGranberry.Info  MEG Insurance Services Tab

Business Owners Need to know-

 So many people are telling you now that you HAVE TO MAKE A DECISION, by submitting the personal household information you have only had to share with the IRS and or your CPA.

Understanding that there is a very wide variety of feelings mixed with this emotion. This is a primary factor into determining what plans that you will be eligible to receive Tax Subsidy Credits on the personal side. A Business Owner can receive larger tax credits by offering coverage to the smaller company size (less than 25 full time employees). Even though the law is written that business owners with less than 50 employees are not required to offer health care, the employees will have to find it on their own.

 For business owners, you have another set of plans to be educated on. If you only own a single business and you have less than 50 full time (2 part time equals 1 full time) you are not required to offer medical benefits. However if you do offer medical benefits there will be some tax subsidy credits assigned to you. The fewer the employee count the more the credits will be.

For business’ and owners of multiple business’ you will need to add up all of your employees from all FIEN, DBA’s, LLC, etc ; with more than 50 full time (2 part time equals 1 full time). You must offer them coverage or pay a $3,000 per employee fine (after the first 30 employees). There is also another penalty that will be assigned and that is if your employee, pays more than 9.5% of their income for their own medical benefit plan, this will result a fine of $2,000.00 per employee.

 Even so, if you are a company with less than 20 employees you are hit with the fine of $2,000 per employee.  This is a fine of $40,000.00. This is could be a salary for 1 of your employees.

Keeping with the same thought, if you were a business that had 50 employees and took both fines you are looking at (20 X $3,000.00 = $60,000 + 50X$2,000 = $100,000) $160,000.00, Just in FINES.

For businesses over the 100 count of employees, the Federal Government has pushed your participation in this plan to 2017.

 The Federal Poverty Level is still going to play a factor whether or not you will have coverage in the 4 Market Place Plans- Bronze, Silver, Gold and Platinum, being if you are above 400% of the FPL, (48 Contiguous States and DC, Family of 4 is $94,200) you will need to purchase and pay for Health Care on your own.

 To follow my blog – www.marketplaceplans.wordpress.com

Free Medical Benefit – www.meg.awisfreerx.com 

News Article

This article is not to take sides in the Affordable Health Care Act 2010, just to give you the facts in simple language. The Affordable Health Care Act was passed into law in 2010, the law goes in to effect on January 1, 2014. The open enrollment times will start on October 1st and go through March 31,2014, there will be special election dates that you will be able to enroll; those are getting married, adding a dependent, change of job, and moving out of the service area.


The fines that can be assets on your 2014 IRS tax form if you leave the block on the form to insert your Health Care Policy Number, failure to do this will result in a penalty of 1% or $95.00 whichever is greater. This means if you $50,000 in gross income you will have a $500.00 fine for not having a qualified health care policy.


What makes up the Essential Benefits of the Affordable Health Care Act is

  1. Ambulatory Patient Services
  2. Emergency Services
  3. Hospitalization
  4. Maternity and Newborn Care
  5. Mental Health and Substance Use Disorder, Behavioral Health Treatment
  6. Prescription Drugs
  7. Rehabilitative and Habilitative Services and Devices
  8. Laboratory Services
  9. Preventive and Wellness Services and Chronic Disease Management
  10. Pediatric Services, including oral and vision care.


There will be 5 different levels of the plans that will be offered

  1. Bronze (60%)
  2. Silver (70%)
  3. Gold (80%)
  4. Platinum (90%)
  5. Catastrophic Plan for people under the age of 30.


The age bands for the pricing will be

            0-20                 21-63               64- and older


Pricing will also take into consideration of how the family is made up.

            1 or 2 parents

            Up to 3 children under the age of 21


The maximum out of pocket for 2014 is $6,350.00 for an individual and $12,700.00 for a family.

With this being said as long as you are above The Federal Poverty Level, for this example we are going to use a family of 4 and income of $47,100 (this is 200% of FPL) you will qualify for a Bronze Plan, and you will qualify for Federal Government Subsidy for about $11,000.00.

Knowing that most people will just want to have the least expensive monthly premiums, will want to purchase the Bronze Plan. The chart shows the Silver and Bronze Plans:

Key Benefits

Silver Plan

Bronze Plan


$2,000 Medical

$5,000 Medical & Drugs

Preventative Care Co Pay

No Cost 1 per year

No Cost 1 per year

Primary Care Visit Co Pay


$60.00 3 visits per year

Specialty Care Visit Co Pay



Urgent Care Visit Co Pay



Generic Medication Co Pay



Lab Testing Co Pay



X- Ray Co Pay



Emergency Room Co Pay



Hospital Care/ Outpatient Surgical



Imaging  (MRI, CT, PET)



Brand Medication

$250.00 deductible then you pay the co pay amount

$50-$75 AFTER meeting your deductible

Preferred Brand Co pay

$50.00 after drug deductible

$50.00 After meeting your deductible

Maximum out of pocket for ONE



Maximum out of pocket for  FAMILY




This mark means you have to meet your deductible before these co pays will start.


The Gold and Platinum Plans will both have co pays and no deductibles.


States will have their own Market Place websites to visit, 22 states including Texas did not expand the Medicaid Plans. The availability to purchase across state lines will be open on October 1st.  If you find a plan that you would like to have in another state you will be able to purchase that plan, stay tuned into to your states Department of Insurance to find out what the web site will be.


Seniors in America have been purchasing 2 plans for the last several decades, the first one is the Part A & Part B from Medicare and a Medicare Supplement (or GAP) Plan. The market for these gap plans will expand into another trillion dollar industry.

Silver and Bronze Plans

Silver Plan                                                                               Bronze Plan

Deductible                                                        $2,000. Medical Deductible                               $5,000. Medical Deductible & Drugs

Preventive Care Co- Pay                                NO COST 1 per year                                            NO COST 1 per year

Primary Care Visit Co- Pay                             $45.00                                                                    $60.00 (LIMIT 3 Visits per year)

Specialty Care Visit Co-Pay                             $65.00                                                                    $70.00

Urgent Care Visit Co-Pay                                $60.00                                                                   $120.00

Generic Medication Co – Pay                         $25.00                                                                    $25.00

Lab Testing Co-Pay                                          $45.00                                                                    30%

X-Ray Co- Pay                                                    $65.00                                                                    30%

Emergency Room Co – Pay                             $250.00                                                                   $300.00

Hospital Care and Outpatient Surgery         $250.00                                                                  30%

Imaging (MRI,CR, PET Scans)                          $250.00                                                                   40%

Brand Medications                                           $250.00 Deductible then Co Pay                        $50-$75 AFTER DEDUCTIBLE

Preferred Brand Co-Pay                                  $50.00                                                                     $50.00

Maximum Out of Pocket for ONE                 $6,350.00                                                                $6,350.00

Maximum Out of Pocket for FAMILY            $12,700.00                                                              $12,700.00

This is the Federal Guide Lines for the Silver and Bronze Plans. Most Americans will pick the Bronze Plan based on premium cost. However, you need to know what your out of pocket is going to be.

If you take medications now, you will have to pay for them in full starting January 1st, because you will have a $5,000 deductible.

Free Medical Benefit – Email – megawis@gmail.com

Essential Benefits must Include services with in the following 10 Catagories

All of the Health Care Plans must contain each one of these parts:

1. Ambulatory Patient Services

2. Emergency Services

3. Hospitalization

4. Maternity and Newborn Care

5. Mental Health and Substance Use Disorder services, Behavioral Health Treatment

6. Prescription Drugs

7. Rehabilitates and Habitability Services and devices

8. Laboratory Services

9. Preventive and Wellness Services and Chronic Disease Management

10. Pediatric Services, including Oral and Vision Care


Bronze, Silver, Gold and Platinum Plans will have each of these components in the plans. However, the coverage is going to depend on which level you qualify for and purchase.