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Health Insurance & ObamaCare: 10 Facts You Should Know

Posted by David Ross on Thu, Feb 27, 2014

10 health insurance facts you need to know about ObamaCare - The Affordable Care ActThere is a lot of uncertainty these days regarding what is required under the Affordable Care Act, also known as ObamaCare. Businesses and individuals alike are concerned they may be penalized or miss out on important information needed to keep their health insurance in tact and affordable.  

With that in mind, here are 10 things you should know:

  1. As of January 1st 2014, every person must be insured under a Qualified Health Insurance Plan.
  2. If Employer Coverage is not offered, it is the responsibility of the Individual to purchase insurance independent of their Employer.
  3. If a person is not insured in 2014, they will be faced with an Individual Tax penalty equal to $95/person or 1% of your taxable income…whichever is greater!
  4. The Initial Open Enrollment period ends March 31st, 2014.
  5. Health plans sold after January 1, 2014 must include a list of 10 Essential Health Benefits such as Maternity coverage, Mental Health coverage, Prescription coverage, Pediatric Dental coverage, etc.
  6. Health Plans will fall into 4 Metal Levels (Platinum, Gold, Silver, Bronze) and also include a catastrophic coverage option for those under 30 or for those meeting specific hardship guidelines.
  7. There is premium assistance for people making between 100-400% of the Federal Poverty Level.
  8. In addition to premium assistance, there are cost sharing subsidies (reduction in deductibles and out-of-pocket expenses) for those between 100-250% of the Federal Poverty Level.
  9. The only way to claim the Premium Subsidy (Advance Premium Tax Credit) and the Cost Sharing Subsidies is to apply with the Federally Facilitated Marketplace (FFM).
  10. Because the FFM is temperamental, the best way to apply and evaluate your coverage options is to contact a CERTIFIED Licensed Producer for assistance.
Please note: There is not an increase in cost if you choose to use a Certified Licensed Producer.
Here is a handy chart to help you determine if you are eligible to receive a premium subsidy.
Summary of health insurance premium assistance under ObamaCare Affordable Care Act


Contact us to obtain affordable, high quality health insurance for your employees or family. We supply health insurance coverage for Reading, PA, Berks County, Philadelphia, Lancaster, Lebanon, Allentown, York, Harrisburg, Pittsburgh, Bethlehem, Erie, and all of Pennsylvania and beyond. Contact us for a free quote.Looking for help in obtaining the right health insurance coverage for your employees or family?

Contact us today at American Insuring Group or request a free health insurance quote.

Tags: Health Insurance Reading PA, Health Insurance Allentown, Health Insurance Harrisburg, Health Insurance, Health Insurance Berks County, Health Insurance Philadelphia, Health Insurance Lancaster

Is Long Term Care Insurance Right for You?

Posted by David Ross on Sat, Jan 11, 2014

Tips for considering long-term care insurance. We serve Reading, Lancaster, Philadelphia, Allentown, Harrisburg and beyond with health insurance protection. Contact us for a free consultation.Do you want to become a burden to your family? Of course not.

Do you have homeowner’s insurance to protect your home in case of a fire?  Chances are you do.  It’s a very scary thought and – wisely - very few people think twice about protecting themselves against such a possibility. 

Less Than 8% of Adults Have Long Term Care Insurance: Why?

OK, next question… Do you have long term care insurance (LTCI)?  There’s a good chance that your answer is no.  Recent statistics show that less than 8% of U.S. adults and about 10% of seniors have long-term care insurance.  And yet, nearly 10 million people in the U.S. (37% under age 65 and 63% over age 65) needed some form of long-term care in 2000 (see for more information).  It’s estimated that almost 70% of people turning age 65 will need long-term care at some point in their lives. 

Bottom line… Your chances of needing to make a claim for long-term care are considerably higher than making a claim for a fire.

What Exactly is Long Term Care Insurance?

LTCI helps pay the cost of care for seniors or individuals with disabilities if they should ever need it over a long period of time.  It helps pay for the cost of care for individuals unable to perform the basic activities of daily living (ADLs) -- such as bathing, eating, getting in and out of bed, dressing, and going to the bathroom – over a long period of time. 

Depending on the policy, LTCI may cover home care, assisted living, adult daycare, respite care, hospice care, nursing home, and Alzheimer's facilities. Certain policies will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse.

The cost of an LTCI policy is based on:

  • Your age when you purchase the policy
  • The maximum amount that a policy will pay per day
  • The maximum number of days/years that a policy will pay
  • Any optional benefits you choose, such as benefits that are adjusted for inflation

What is the Cost of Long-Term Care and Who Pays for it if You Don’t Have LTCI?

According to the U.S. Department of Health and Human Services, in 2010 the average cost for long-term care was more than $6,000 per month in a nursing home, more than $3,000 per month in an assisted living facility, or $19-$21 per hour for a homemaker or home health aide. 

One of the biggest misconceptions about long-term care is that it’s covered by Medicare.  Medicare only pays for a maximum of 100 days if you need skilled services or rehabilitative care in a nursing home.  It does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services. 

Medicaid pays the largest share of long-term care services, but only applies if your income is below a certain level and you meet minimum state eligibility requirements.

Other federal programs such as the Older Americans Act and the Department of Veterans Affairs pay for long-term care services, but only for specific populations and in certain circumstances

Benefits of Long-Term Care Insurance

More and more people are purchasing LTCI to protect themselves in the event that they need long-term care.  Some of the benefits include:

  • Ensuring that you will be taken care of should you need long-term care
  • Allowing you to live as independently as possible without burdening your family 
  • Allowing you to spend family time with your children rather than caregiver time
  • Protecting your savings
  • Premiums paid on a long-term care insurance product may be eligible for an income tax deduction

Learn More about LTCI

Contact us to learn more about long-term care insurance for you or your loved ones.If you want to ensure that you can live independently and not become a burden to your family and friends in the event that you need care over a long period of time, give us a call at (800) 947-1270 or (610) 775-3848 or contact us by email.  The sooner the better!

Tags: Health Insurance Reading PA, Health Insurance Allentown, Health Insurance Harrisburg, Long Term Care Insurance, Health Insurance, Health Insurance Berks County, Health Insurance Philadelphia, Health Insurance Lancaster

Disability Insurance: What You Don’t Know CAN Hurt You

Posted by David Ross on Tue, May 28, 2013

Are you rolling the dice on disability insurance? Get the facts and get protected. Contact us for help. Serving Reading PA, Berks County, Philadelphia, Harrisburg, Allentown, Lancaster, and beyond.According to a May 2013 report by the non-profit Council for Disability Awareness (CDA), there is a sharp mismatch between the high value employees place on their ability to earn a living vs. their financial preparedness to handle a disability that would threaten their income as evidenced by having adequate levels of disability insurance.

Most are Ignorant of the Real Need for Disability Insurance

The report titled “Disability Divide: Employer Study” is based on a 2012 survey of over 500 human resources professionals. The key findings, as reported by the Insurance Word Blog, are as follows: 

    • ¾ of HR professionals surveyed said employees viewed their income-earning ability as their most valuable financial resource, ahead of medical insurance, their homes, and retirement savings. However, only ¼ said employees considered it “very important” to prepare for potential disability, and a similar portion felt their employees were prepared to handle the financial hardships of the loss of income due to illness or injury.
    • A prior CDA survey of over 1,000 wage earners yielded similar results, with most respondents stating they are most likely to agree with the statement, “I never really thought about” preparing for a potential disability.
    • The HR experts surveyed generally felt that employees should begin planning for disability early in their careers even though most don’t begin until age 40 or older, if ever. According to statistics, approximately 100 million members of the US civilian workforce have no private disability insurance.
    • Most of the HR experts as well as the wage earners dramatically underestimated the likelihood of incurring a disability during their careers.


Surprising Disability Insurance Statistics

The post goes on to quote some surprising statistics from the CDA’s Personal Disability Quotient calculator:

    • An average 35-year old male office worker who is a non-smoker and has no health history issues has a 13% risk of incurring a long-term disability prior to retirement.

    • For women with the same profile the risk is higher: 18% or nearly 1 in 5. Those surveyed had estimated their risk at only 1-2%.
    • The 35-year olds noted above, if earning an average of $50,000 per year, are likely to earn approximately $2.4 million on average by the end of their careers.

    • Clearly, the contrast between the risk of losing millions in income and the lack of disability insurance is striking!


Key Takeaways

Americans are much less protected against income loss than in the past due to several factors, including:

    • The relative lack of solid pension plans
    • Much lower savings rates
    • Home mortgages with higher balances
    • Rising college education costs
    • Given the poor economy, the much greater likelihood of the need to continue to support children beyond their college years

What to do About Disability Insurance

Given these facts, the only wise course of action is to acquire the proper level of disability insurance to cover the gap between your current savings and the funding that would be needed to cover your financial needs during a long-term disability. If you are a business owner, the risks of inadequate disability insurance may be even greater due to the financial consequences of being unable to work.

We’re Here to Help if Needed

If you have questions on how to determine the right level of disability insurance you need to protect both you and your loved ones, then please contact us at 610-947-1270, or Contact Us online.

Tags: Health Insurance Reading PA, Health Insurance Allentown, Health Insurance Harrisburg, Small Business Insurance, Disability Insurance, Health Insurance, Health Insurance Berks County, Health Insurance Philadelphia, Health Insurance Lancaster

Health Insurance Pitfalls to Avoid During Open Enrollment

Posted by David Ross on Sat, Dec 01, 2012

Get the Most from Your Employer Health Care Program

Health Insurance Tips - Problems to Avoid During Open EnrollmentWith the end of the year fast approaching, many employees are starting to become anxious. It’s that time of year again, the time when they get to tweak their health insurance benefits. While this may be exciting to some, the responsibility to choose the right health insurance plan can be a source of tension for others.

There are many reasons for this. Personal circumstance comes into play, including additions to family. Since the days when employers offered either a low-cost HMO or an expensive PPO, the maze of health insurance options has increased significantly. With health insurance costs on the rise, it’s more important than ever to make sure you are getting the most coverage for your money. 

Here are 5 mistakes to avoid in an open enrollment benefit session: 

Mistake #1- Saying No to Health Savings Accounts

Less than 20% of those given the option of opening a Health Savings Account choose to take advantage of this potentially valuable opportunity. If you break it down, these turn out to be the equivalent of free money, and can really give you a leg up towards paying for medical expenses. 

Mistake #2- Picking the Cheapest Health Insurance Premium

It’s easy to look at a low cost and choose the cheapest health insurance plan because we may think it's all we can afford. What many fail to realize, however, is that low-cost health insurance premiums often offer significantly less coverage. This could lead to big trouble in the long run if your health care needs outweigh the coverage available. 

Mistake #3- Not Doing Your Health Insurance Research 

Nine out of ten people renew their old health insurance plans for the upcoming year. This isn’t always a bad thing, such as when your needs haven’t changed and you’ve researched the available options. However, even if your health insurance needs are the same as they were last year, review the plans available to make sure that nothing has been changed on their end. Benefits and premiums may not be the same as last year, so make sure that you know exactly what you’re signing up for. 

Mistake #4- Under-Buying

Under-insuring is one of the worst mistakes you can make, as once you’ve signed into a health insurance plan, you’re locked into it either until there is a change in family demographics or open enrollment comes up again. That’s it. There’s no in between. It would be nice to think that by the time you need it, you’ll have thrown enough money into your Health Savings Account to cover the cost of the premium, but there’s no guarantee. You could find yourself paying a large sum out of pocket.

Mistake #5- Over-Buying Health Insurance Coverage 

Throwing a high premium at the possibility of a life altering health-related disaster may provide you with quite a safety net, but financially it could turn out to be an unwise move. This is not to say that choosing the cheapest health insurance plan is always the best option for an individual with a clean bill of health, as we are all at risk for accident or unexpected illness. Finding something in the middle is ofen sufficient. Consider a high deductible with a limited network to keep premium costs low while providing coverage against a major health care expense.

Yes, open enrollment can be a source of tension, but if you play it right, as most people don’t, you’ll find that next year’s open enrollment isn’t the confusing maze that some make it out to be. Open enrollment for health insurance coverage is there to give you options that can help you. Don’t pass up a good opportunity to make a smart move. 

Do you need personal health insurance, or better health insurance for your employees?

We can help. Please contact us today: 800-947-1270

Click to save on high-quality, affordable health insurance in Reading, PA, Berks County, and beyond

Tags: Health Insurance Reading PA, Health Insurance Allentown, Health Insurance Harrisburg, Health Insurance, Health Insurance Berks County, Health Insurance Philadelphia, Health Insurance Lancaster, Business Insurance

Health Insurance Costs May Rise With ObamaCare Rebates

Posted by David Ross on Tue, Oct 23, 2012

Is Affordable Care Affordable, or an Incentive to Raise Health Insurance Premiums?

Health care prices under Affordable Care Act. Insights for Berks County, Reading, PA, Philadelphia, Lancaster, York, Harrisburg, Lebanon, Erie, Pittsburgh, Allentown, Lehigh Valley, and beyond.A section of The Affordable Care Act requires health insurance providers to spend at least 80 percent of dollars they receive from premiums on patient care, or be forced to send a rebate to patients. This may seem like a good deal for patients, but health economists say the provision can only lead to more expensive insurance.

Economists reason that the provision merely provides an incentive to raise premiums, instead of encouraging companies to control costs. While patients may be thrilled to receive a rebate in the mail, this rebate will be a small consolation for the inflated premiums patients will have to pay as insurers let spending balloon.

Health Insurance Rebates Lead to Higher Premiums

According to Peter Suderman's Hit and Run blogpost "ObamaCare's Health Insurance Rebates May Make Insurance More Expensive," insurers rebated slightly over $1 billion this year, at an average of $151 per customer, in letters that clearly stated the rebates were coming as a result of reforms made under the Obama administration. This politically sound move lets patients know exactly where their rebates are coming from. What it doesn't tell them is that the rebates might cause premiums to rise.

"It's easier to cover someone's health costs on 80 percent of $1,000 than it is on 80 percent of $100," Suderman writes, "and because insurer profits and other administrative costs must come from the remaining 20 percent, there's a larger pool from which to draw profits and business expenses." In other words, insurers will be motivated to raise their premiums in an attempt to cover expenses.

Economists Doubtful of Benefits

NPR's Planet Money reported on the likely outcomes of the insurance rebates provision. Reporter David Kestenbaum interviewed six health economists. "No one thought the provision would do much good," he said, "and several thought it could be harmful." Among the economists interviewed by Kestenbaum was Jonathan Gruber, an ObamaCare architect and supporter.

Skewed Coverage? NPR Story Differs from ABC, CBS, USA Today

The press has widely lauded the health insurance rebates. ABC News reported that the law is "aimed at holding health insurance companies accountable for how they spend the money collected through premiums." CBS and USA Today ran similar stories, equally positive about the program that would force insurance companies to spend more on patient care or send out rebates. None of the articles mentioned that premiums would likely rise as a result of the provision. NPR's Planet Money was the first news platform to explore the potential pitfalls of the rebate program, and stumbled on a major flaw: more money spent on patient care will logically result in higher premiums.

Need help in acquiring a sensible health insurance plan for yourself, your family, or your employees? Click below to learn more about your health insurance policy options.

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