Affordable Care Act - AKA "Obamacare"
Costs can vary depending on your age, income, household size, location, and the type of plan you choose (Bronze, Silver, Gold). But many Idahoans qualify for tax credits that significantly lower monthly premiums—some plans even start as low as $0 per month after credits are applied. The best way to get an accurate quote is to give us a call or click this link to go to Your Health Idaho's quoting tool. https://www.yourhealthidaho.org/pre-eligibility
I can help you review your options at no cost to you.
Yes—but you may not qualify for tax credits if your employer’s health plan is considered affordable and meets minimum coverage standards under the law. If your employer coverage is too expensive (typically more than 9.12% of your household income) or doesn’t meet minimum value, you might be eligible for subsidized coverage through Your Health Idaho. Even if you're offered employer coverage, it's worth checking with us here at Longwill Insurance to see if the exchange is a better option for your situation. I can help you run the numbers and explore your eligibility. If you feel your insurance through your employer is "unaffordable", click this link to check out Your Health Idaho's affordability calculator. https://affordability.yourhealthidaho.org/
There’s no minimum income required to apply for a health plan through Your Health Idaho—but to qualify for tax credits that lower your monthly premium, your estimated household income generally needs to fall between 138% and 400% of the Federal Poverty Level (FPL). Give us a call and we can help you check your eligibility based on your household size and income.
Any Idaho resident who is a U.S. citizen or lawfully present, not incarcerated, and not eligible for other qualifying coverage like Medicaid, Medicare, or employer-sponsored insurance.
You typically can’t enroll in health insurance at just any time. Instead, enrollment is limited to specific periods. The main opportunity is the Open Enrollment Period, which runs each year from October 15 to December 15. During this time, you can apply for coverage or make changes to your existing plan without needing a special reason.
Outside of this window, you must experience a Qualifying Life Event—such as moving, getting married, having a baby, losing other coverage, or similar changes—to be eligible for a Special Enrollment Period. These special windows usually last 60 days from the date of the event.
Advanced Premium Tax Credits (APTC) are subsidies provided in advance to help lower the cost of your health insurance right away. Unlike other tax credits that you typically claim when you file your taxes, APTCs are applied upfront to reduce your monthly premium payments. This can make your health insurance much more affordable on a month-to-month basis, easing the financial burden of maintaining coverage.
When you apply for the Advanced Premium Tax Credit (APTC), the amount you receive is based on the income you estimate for the year. For example, if you report that you expect to earn $50,000 but end up making $75,000, you’ll likely need to repay part of the tax credit when you file your taxes. On the other hand, if you earn less than you estimated, you may qualify for additional credit and receive a refund when you file your return.
When you work with us at Longwill Insurance, our top priority before recommending any health plan is to narrow down options that include your current doctors and prescriptions. We understand how frustrating it can be to have an established relationship with a provider, only to find out your new plan doesn’t cover them. Our goal is to help you choose coverage that works seamlessly with your existing care, so you don’t have to disrupt what’s already working well for you.
Under the Affordable Care Act (ACA), health plans on the exchange cannot deny you coverage or charge you more because of pre-existing conditions. In fact, one of the main goals of the ACA was to eliminate this issue, which was common before the law was enacted. You can feel confident that no matter which plan you choose, your pre-existing conditions will be covered.
Am I stuck in a contract once I enroll?
On the exchange, you can only enroll in a health plan during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period due to certain life events (like moving, losing other coverage, or having a baby). However, you can cancel your plan at any time. Just keep in mind that if you cancel, you won’t be able to enroll again until the next Open Enrollment Period or unless you experience another qualifying event.
Some dental or vision plans may require a contract commitment, but health plans through the exchange do not.
That’s exactly where Longwill Insurance comes in. You don’t have to be the expert—we are! Rely on our experience to help you choose a plan that truly fits your needs. Many people try to navigate the process alone, only to discover after enrolling that their plan doesn’t work for them. Unfortunately, in many cases, that mistake can’t be fixed until the next Open Enrollment Period or a qualifying event, which could be months away. Our guidance comes at no cost to you, so let us help you get it right the first time.
That’s a great question—and a tricky one to answer. The main way to reduce your health insurance costs is to choose a plan with lower coverage, such as a Bronze plan, which typically has higher out-of-pocket costs but lower premiums. Some people also consider going without health insurance altogether, though this carries significant financial risk.
Outside of the exchange, there are options like health share programs. However, these alternatives don’t meet ACA requirements, often lack guarantees, and can leave you without coverage when you need it most. Additionally, there are many misleading or fraudulent plans in the market, so it’s important to be cautious.
If you’re exploring ways to lower your costs, we’re here to help you weigh the pros and cons and avoid potential pitfalls.
IRMAA, it's probably the sneakiest charge in the entire Medicare system. We expect copays at docs and pharmacies, but not extra cost for coverage that 93% of our others Medicare peers don't have an obligation to pay!
Introduction:
Medicare is a crucial healthcare program that provides coverage for millions of Americans aged 65 and older, as well as certain individuals with disabilities. While Medicare offers valuable benefits, it's essential to be aware of additional costs that can impact your coverage.
One such cost is the Income-Related Monthly Adjustment Amount (IRMAA). In this blog post, we will dive into the subject of IRMAA, how it affects Medicare beneficiaries, and provide insights to help you navigate this aspect of your insurance expenses.
With that said, here is some interesting thoughts to help you understand this confusing subject! 👍
IRMAA, short for Income-Related Monthly Adjustment Amount, is an additional premium that certain Medicare beneficiaries must pay for Part B (Medical Insurance) and Part D (Prescription Drug Coverage). It is based on the beneficiary's modified adjusted gross income (MAGI) and is calculated annually by the Social Security Administration (SSA). Essentially, IRMAA adjusts the standard premium amount based on income brackets.
Not all Medicare beneficiaries are subject to IRMAA. Instead, it only applies to individuals with higher incomes. Specifically, the SSA determines if you are subject to IRMAA based on your tax return from two years prior. If your income exceeds certain thresholds, you will be required to pay an additional amount on top of your regular Medicare premiums.
IRMAA is calculated largely based upon your tax return from two years prior to the current year. The SSA considers your modified adjusted gross income (MAGI), which includes various forms of income such as wages, self-employment earnings, dividends, and interest. The MAGI is then used to determine which income bracket you fall into and the corresponding IRMAA amount you must pay.
a. IRMAA and Medicare Part B: The standard Part B premium for Medicare beneficiaries is determined annually. However, if your income exceeds a certain threshold, you will be required to pay an additional amount. The higher your income, the higher your IRMAA will be.
b. IRMAA and Medicare Part D: Similarly, IRMAA can affect your Medicare Part D prescription drug coverage premiums. If you have a higher income, you may have to pay an IRMAA in addition to your regular Part D premium.
While IRMAA may seem like an additional financial burden, there are strategies to help mitigate its impact:
a. Tax planning: Consider utilizing tax planning strategies to manage your income and reduce your MAGI. Consult a tax professional to explore deductions, tax credits, and other methods to optimize your tax situation. This is a planning and proactive approach to strategizing around IRMAA. This only works prior to going on Medicare because otherwise if you are told you have to pay IRMAA, its probably too late. AND, some people may not have a choice because if you worked for a company collecting a large salary, I'm sure you wouldn't want to ask to be paid less just to save a couple bucks down the road right??
b. Appealing IRMAA: If your income has significantly changed since the two-year period used for IRMAA calculation, you can appeal to the SSA to request a new determination based on your current income. Visit this website on the Social Security site to learn more - https://www.ssa.gov/medicare/lower-irmaa
Conclusion
Understanding IRMAA is essential for Medicare beneficiaries, particularly those with higher incomes. By familiarizing yourself with how IRMAA is calculated and exploring strategies to reduce its impact, you can make informed decisions to manage your healthcare expenses effectively. While IRMAA may introduce additional costs, it is crucial to remember that Medicare continues to provide essential healthcare coverage for millions of Americans, ensuring access to quality care in their retirement years.
Author - Jackson Longwill - Agent/Broker - Longwill Insurance
Home | About us | Contact us | Medicare | Individual Insurance | Group Benefits | Vision/Dental | Life Insurance
Copyrights 2025 | Longwill Insurance | Terms & Conditions | Privacy Policy