There is no cost to you for using any of our services. We do not make a commission, we receive a small policy fee from the company, which does not affect your premiums. This means your monthly premium is the same whether you do all of the work and research, or we do it for you.
We at Davies Insurance have worked diligently to understand how the new health care laws will impact you. We undergo annual training with Your Health Idaho (YHI), and all of the major companies here in Idaho. We are prepared and ready to answer any questions that you may have and to provide guidance as you need to make important decision about your health coverage.
An exchange is a public marketplace that allows you to compare insurance products, their pricing, and plan details from multiple insurance carriers in one place. Exchanges also provide enrollment options and subsidy verification.
If your household income is between 138% and 400% of the federal poverty level, you may qualify for a subsidy/APTC to help offset the cost of buying an individual health insurance policy. This subsidy is paid by the federal government and sent directly to the insurance carrier you choose. The premium you pay each month to the insurance carrier is the actual premium minus any subsidy/ATPC that you qualified for.
Any changes to estimated annual household income whether it be an increase or a decrease needs to be reported to Your Health Idaho (YHI) as soon as possible. That way your APTC can be adjusted accordingly, so it stays in line with the household income change. This is important because if you under estimated your annual household income it is possible you will have to pay some/all of the APTC your received for that year. Conversely, if you over estimated your annual household income you could possibly receive a tax credit /refund for that year. You will receive a 1095A tax form in the middle/end of January in order to calculate whether you would owe or get a refund.
Yes it is possible. There are several factors that would determine this. They would include: age, household size, estimated household income and where you live to name a few.
No. However, the only way to qualify for the subsidy/APTC is if you purchase your insurance through Your Health Idaho (YHI).
Open enrollment (usually October 15th - December 15th for a January 1st effective date) is a specified timeframe in which you can purchase health insurance plans and make changes to an existing plan without the need for a Qualifying Life Event (QLE). Examples of QLE that qualify you for an Special Enrollment Period (SEP) include but are not limited to: involuntary loss of group coverage, marriage, divorce, newborn child and adoption to name a few.
These are individuals that are there to provide assistance to individuals applying for medical premium assistance and/or enrolling on the exchange. They will primarily be regulated by Your Health Idaho (YHI). They are NOT licensed brokers and they cannot make product recommendations.
All plans are separated into 4 different categories: Bronze, Silver, Gold and Platinum. Platinum plans are the richest in benefits; Gold plans are the second richest and so on. The metal designation is used to help when comparing plans. As a general guideline, Platinum plans cover approximately 90% of actuarial value, Gold plans 80%, Silver plans 70% and Bronze 60%. Bronze plans are designed with the lowest monthly premium and highest out of pocket – such as deductibles, coinsurance and or copayments – when health care services are utilized. Platinum plans generally have the highest monthly premium and lowest out of pocket responsibility for the member.
CSR is a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through Your Health Idaho (YHI), your income is below a certain level, and you choose a health plan from the Silver plan category. If you’re a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.
Health plans offered both inside and outside of Your Health Idaho (YHI) must offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care. Insurance policies must cover these benefits in order to be certified or "ACA-compliant" and offered through Your Health Idaho (YHI).
Yes, but they may or may not qualify for any type of subsidy/ATPC. This is mainly determined if the group premium is deemed affordable/unaffordable for the household, better known as the "Family Glitch".
Group health insurance is insurance that is provided through an employer. Individual health insurance is personal health insurance that you purchase by yourself without the help of an employer. The rules are very different between these two types of health insurance programs, and we highly recommend contacting your insurance agent or your employer's HR person (if applicable) with any questions.
Yes, but only for fraud, deliberate misrepresentation, nonpayment of premiums or discontinuation of current product. No insurance carrier can cancel coverage for health insurance claims of any kind.
This is a very complicated question. In part because the answer varies so much depending upon your personal circumstances, how long you need coverage, your preferences and other relevant factors.
The professionally trained and licensed brokers at Davies Insurance will work closely with you, on a one on one basis, to ensure that we place you with the best health insurance company and plan that best suits your needs.
A “deductible” is a specific dollar amount that an insured member is responsible for before your health insurance plan begins to make payments for covered services. Most insurance plans offer what are called “pre-deductible”, “up front” or “first dollar” benefits. These are benefits that are available without having to meet the deductible. These benefits always include wellness services and may also include; doctor office co-pays, prescriptions, lab and x-ray.
A “co-pay” is a specific dollar amount that your health insurance plan might require you pay for covered services. For example, your health insurance plan may require a $30 co-payment for the physician charge or prescription drug, after which the insurance company pays the remainder of the charges.
At Davies Insurance Services, we take very seriously our responsibility to safeguard your personal information. We are continuously updating and doing all that we can to safeguard personal information.
Davies Insurance Services will NOT sell, trade, or give your personal information to anyone, anywhere, at any time for any reason, with the only exception of providing the insurance carrier you chose with your personal health information (PHI) for enrollment purposes.