Individual and Family Plans
Our team of insurance professionals helps customers enroll in health insurance plans through federal and state health insurance online marketplaces that has been enacted by ACA. Affordable Care Act (also called Obamacare) is a comprehensive health care reform law enacted in March 2010.
The Official Health Plan Marketplace
ETRU Advisors agents are licensed and certified to use the federal and state online health plan marketplaces and can assist individuals and families, as well as small businesses to purchase health insurance. We will explain your health coverage options, compare your health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll you in coverage. Our agents will also provide information on programs that help people with low to moderate income and resources pay for coverage, including ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace.
When does enrollment begin?
Open Enrollment for QHP plans starts on November 15 and runs until February 15. After February 15, individuals and families can enroll in health insurance only if they experience a qualifying event such as marriage, divorce, birth of a child, or loss of job.
Here are more details about enrollment and coverage start dates:
- Members who enroll between 11/15 and 12/15 and pay their first premium by the due date will have coverage effective on 1/1 of the following year
- Members who enroll between 12/16 and 1/15 and pay their first premium by the due date will have coverage effective on 2/1
- Members who enroll between 1/16 and 2/15 and pay their first premium by the due date will have coverage effective on 3/1 etc.
Current members receive a notification regarding their eligibility for renewal:
- If a member qualifies to stay on their current insurance plan, they may be automatically re-enrolled in their current plan without action from the member.
- If a current member does not qualify for the same plan or the member wants to enroll in a different plan , the member can contact one of our agents to assist them.
What are the eligibility criteria to receive subsidies to assist in paying for the insurance?
An individual is eligible for subsidies if they:
- Earn between 138% and 400% of the Federal Poverty Level (FPL) ($18,755-$54.360, for an individual)
- Are uninsured
- Are underinsured. (People are considered underinsured if their insurance plan does not cover the essential health benefits outlined by the ACA, or if they spend more than 9.5% of their yearly income on health premiums.)
- Are not eligible for public options
Description of the state and federal subsidies
Depending on individual or family income and family size, consumers may qualify for financial assistance or subsidies to offset the cost of insurance. Two types of subsidies are available:
The Advanced Premium Tax Credit (APTC) is a subsidy that will pay a portion of an individual’s or a family’s monthly health insurance premium. It is available for people who make between 138% and 400% of the FPL. All Platinum, Gold, Silver, and Bronze Leaf members receiving APTC will receive a new tax form (Form 1095-A) from the NYSOH in early months of every year. This form will be used to help them reconcile the APTC they received in previous year on their federal income tax returns.
Cost-Sharing Reductions (CSRs) help reduce the out-of-pocket costs for individuals and families who make between 138% and 250% of the FPL and enroll in silver plan of the metal tiers and this subsidy lowers the member’s deductibles, copays, and coinsurance.
What are “essential health benefits,” according to the ACA?
As defined in Section 1302 of the ACA, essential health benefits include at least the following general categories:
- Ambulatory patient service
- Emergency services
- Hospitalization
- Maternity care
- Prescription drugs
- Laboratory services
- Pediatric services, including vision care
- Rehabilitative and habilitative services and devices
- Preventive and wellness and chronic-disease management
- Mental health and substance use disorder services, including behavioral health treatment
ETRU Advisors offers a comprehensive customer service. Our customers can always receive our help regarding various issues, such as: premium payment, reordering insurance member ID card, doctor selection, changing address, and explanation of benefits.
