To my clients on Medicare,
The annual Medicare Open Enrollments started October 15th and will continue until December 7th. Inevitably, every year there are countless Medicare scams where criminals pretend to be from Medicare or an organization representing Medicare. This year is no different. They will use terms such as “I’m with the Medicare Enrollment Center.” they will claim “new Medicare cards are being issued, because of this your old one is invalid. ” They will insist that they need you to verify your Medicare claim number or Social Security number to receive your new card. The caller may even tell you your “benefits will be cancelled” if you don’t immediately provide your personal information. They may tell you that you “qualify for a refund due to a change in your plan,” and ask for your personal information. These are most usually scams. Medicare does not call you on the phone and ask for personal information. You will usually get a written request from Medicare stating what information they need.
If you get one of these types of calls, you are welcome to tell them you will get with your agent about any changes, and hang up. Do not give your personal information over the phone to anyone claiming to be from Medicare.

Please feel free to call with any concerns.
Thanks, Jim

If you have a medical plan through the Federal Marketplace, and are going to be eligible for Medicare in the near future, you must drop your Marketplace Plan before your birth month. This is especially important if you have a subsidy. You are not eligible for a subsidy if you are eligible for another government plan. If you have a medical plan, for example with Blue Cross, you must contact the Marketplace, to drop your plan. You do not contact your insurance carrier.

An important message to my clients receiving a premium subsidy through the Marketplace:

A very important message to my clients:

On June 30, 2020, state question 802 passed expanding Medicaid coverage to adults whose income is 138% of the federal poverty level or lower. A chart with those income levels which is also based on family size, is included in this message. Starting July 1^st these benefits will begin. If you and your family are receiving a subsidy from the Federal Marketplace and fall within the expanded Medicaid guidelines, you are no longer eligible for a marketplace plan which is subsidized. You will be responsible for the full unsubsidized premium.
Documents should be going out from the Federal Marketplace or the Oklahoma Healthcare Authority concerning this matter. Even if you do NOT receive the aforementioned documents, it is your responsibility to ascertain if you qualify for the expanded Medicare. If you do qualify, you should immediately end your subsidized marketplace coverage.
To help determine your eligibility for the expanded Medicaid, you can call the Sooner Care helpline at 1-800-987-7767. Tell them your taxable income and your family size, and they should determine your eligibility at that time.
It is important that you do this immediately, or within 30 days of any notice you receive from the Marketplace or Healthcare Authority.
If you continue to receive a Marketplace subsidy and are also eligible for Medicaid, you could be compelled to pay back the Federal subsidy.
Remember, make sure you qualify for Medicaid before ending your Marketplace plan!
If you have any other questions, feel free to call me at 405-720-0094.
-Jim

With the economic impact payments (federal stimulus payments/checks) to taxpayers, who are also receiving subsidies to help pay for their Marketplace insurance, I am asked if the economic impact payments are taxable income?
The answer is no. The IRS stated that the economic impact payments are not considered taxable income. Thus, they should not affect your Marketplace subsidy.
If you have any other questions, contact your tax advisor, or feel free to call me anytime at 405.720.0094.
Again, do not hesitate to call me with any questions.
Thanks, Jim

A very important message to ALL my clients:
Recently the Federal Government created a “Special Enrollment Period” (SEP) from February 15th through May 15th for people who needed to enroll in a Marketplace Health Insurance plan and could not wait until next year for coverage to begin. That SEP has now been extended to August 15th. In addition, in the past, if you made over 400% of the federal poverty level (for example: $55,000 for an individual, $104,800 for a family of 4) you were not eligible for a subsidy to help pay your premiums. Under the new law, it does not matter how much you make, you will never have to pay over 8.5% of your adjusted gross income. In addition, other income level subsidies are somewhat higher. We can either re-enroll you, or you can receive the additional premium tax credit (if any) when you reconcile your 2021 federal income taxes, which I recommend.
Finally, if you or anyone you know has collected unemployment for as little as one week in 2021, you will be eligible for a more generous subsidy.
There are other changes in this law. Please call me with any and all questions.
Call me anytime.
Thanks, Jim

405.720.0094

Here’s hoping you and your family had a happy and safe Thanksgiving!

An important message to my clients who are members of a recognized Native American Tribe:

The federal government has recently created a “Special Enrollment Period” from February 15th through May 15th for people who need to enroll in the Marketplace and can’t wait until next year for coverage to begin. However, if you are a card carrying member of a recognized Native American Tribe, you can enroll into the Marketplace at any point in the year. Also, any subsidies you get are many times greater than the general non-Native population. For example, if a Native American buys a Marketplace plan, and their income is between 100% and 300% of that federal poverty level, they won’t have to pay any out of pocket costs. If they fall into that category, the subsidies available will cover most, if not all the cost of your monthly premium. Call me with any questions about this subject.
I appreciate all of you.
Call me anytime.
405.720.0094

Here’s hoping you and your family had a happy and safe Thanksgiving!

This message is for my clients on short-term major medical policies. While these are extremely attractive and effective policies that can save you literally thousands of dollars a year in premiums, they are finite policies. They have a limited lifetime. For example, if you have a one year policy that ends January 9th, and you become injured or very ill on January 7th, you only have two days of coverage. The short term carrier does not have to sell you another policy to cover whatever illness or injury you have incurred. That means you could be forced to go without coverage for virtually an entire year.
That is why I always tell my clients to renew their policies each December, for at least a year, no matter the end date of your policy/contract.
If at that time you have a pre-existing illness or injury, we need to consider moving you to the guaranteed issued government policy that would cover the pre-existing condition.
We have attempted to contact some of our clients about the importance of renewing their contracts by December 15th, and still have had no response from five or six families. 
It is imperative we renew your contracts. The contract can be with your current carrier, or a different one, depending on premiums and coverage. If this is not done in a timely manner, those families are in danger of losing coverage for up to a year.
Please call right away so we can look at renewing your coverage in time to switch you to a government plan if needed. Open enrollment ends the 15th of December. After that you will not be covered for any pre-existing conditions.
Thanks and God bless you and your family.
-Jim

I have had a number of my Blue Cross clients call me and ask if they need to do anything to continue their coverage in 2021. Blue Cross will, again, have every policy available in 2021 as they did in 2020. Because of that, Blue Cross says if you like the plan you are on in 2020, you can keep it in 2021 with no action on your part. This is what they call a “passive enrollment.”
If you want to change the policy you need to contact me.
A word of caution to Blue Cross members getting a federal subsidy on the Marketplace: If you have filed an extension on your 2019 taxes and have not reconciled them, you will lose your subsidy. If you have any outstanding documentation that the marketplace has required you could lose your subsidy. 
One more thing: If you are on the exchange, receiving a subsidy, and you have a “life changing event” (birth, death, marriage, divorce, move, different income, loss of a job, etc.) you need to call me so we can contact the Marketplace. This is VERY IMPORTANT. If you have any questions in this regard, don’t hesitate to call me. A phone call to my office is more effective and reliable than an email. Rates for next year have not been released, but we are told there will be very little change.

Call me anytime.

405.720.0094
Thanks, Jim

I have discovered a number of my clients who receive a subsidy through the Marketplace are scheduled to lose their subsidy in January. This most commonly is caused by not submitting an 8962 form. This form is submitted by your tax preparer. That form can only be submitted once you give your tax preparer the 1095-A form you recieved from the Marketplace. Also, if you filed an extension and have not paid your 2019 taxes, you will lose your subsidy. We have left messages with those clients who we have discovered are losing their subsidy. This does not guarantee we have discovered and notified everyone in this situation. It is incumbent on my clients to call me if you have received a message from my office warning you that you are in danger of losing your subsidy. It is imperative you contact me as soon as possible. If you have ANY questions concerning your subsidy, please give me a call anytime. 405.720.0094

An important message to my clients:
Recently Oklahomans voted to approve State Question 802 which expanded Medicaid coverage for low income adults between ages 18 and 65 with incomes at or below 133% of the federal poverty level. Because the affordable Care Act includes a 5% income disregard, this expanded Medicaid to those with incomes at or below 138% of the federal poverty level. If you fall in this group and you are currently receiving a subsidy to help pay your premiums, this could affect you. To receive a subsidy, you must make a minimum amount of household income. Under the new guidelines the minimum amount is as follows:
Individual: $17,236
Family of 2: $23,335
Family of 3: $29,435
Family of 4: $35,535
The Oklahoma Healthcare Authority has until July 1st, 2021 to submit an effective Medicaid plan to the Centers for Medicare and Medicaid Service for approval.These Federal poverty levels will probably change in 2021. If you are in these income levels listed above, it will more than likely affect your subsidy eligibility when the plan is approved.
Thanks, and call with any questions.
-JIm

See below email from Mike Rhoads, the Deputy Commissioner of Consumer Services for the Oklahoma Insurance Department.

Jim:  I will make this as brief as possible acknowledging that there are still many unanswered questions on what happens when the Medicaid expansion happens in Oklahoma on July 1, 2021.  All of the implementation will be the responsibility of the Ok Health Care Authority.

For people that have a marketplace plan and are at or below the 138% FPL for PY 2021 the following is going to happen:

• Individuals that have Marketplace coverage at 138% level will not be eligible for subsidies (premium tax credits, CSR’s) after Medicaid expansion comes on line –July 1, 2021.
• These people will get a letter from CMS 30-60 days before their eligible date (7/1/2021) explaining the change in their policy.  It will say that the individual can keep their Marketplace coverage but will pay the full price of the plan.
• The notice will inform them that they should not cancel their Marketplace policy until they have been accepted by Medicaid.  The notice will give them instructions on how to enroll in Medicaid.
•  The bottom line here is that if the individual does qualify for Medicaid they are not eligible for any savings on an ACA policy.  For people above the 138% threshold nothing changes as far as their ACA policy goes.
• Since this policy change occurs at mid- year in Oklahoma everyone on a Marketplace plan should ‘re-up” for coverage during the upcoming Open Enrollment (Oct 1-Dec 15).

You can do further research on this topic by accessing www.healthcare.gov/medicaid-chip .

Hope this helps with your communication to your clients.

Michael Rhoads
Deputy Commissioner of Consumer Service
Oklahoma Insurance Department
7645 East 63^Rd Street, Ste 102
Tulsa, Oklahoma 74133
918.295.3702 office
oid.ok.gov

A message for my clients:

If someone in your family has lost their job and their group health insurance, they have 60 days to apply for health insurance through the Federal Marketplace. This 60 day period is called a special enrollment period (SEP). During this SEP they could qualify for federal subsidies that would pay for most, if not all their premium. I help people every week who are in this situation.

Page 1 of 1