Individual Health Insurance 2015

What to know for 2015: Michigan

DISCLAIMER: Information provided below is for illustrative purposes only.  For tax related questions, please consult with a certified financial consultant.  Key points and resources are not intended to be a comprehensive guide to Health Care Reform and may change pending further guidance.  For additional information, please speak with a Market Certified Agent at Blue Sky Insurance Agency or visit

Individual Mandate

Effective January 1st 2014, the Individual Mandate requires individuals need either to enroll and maintain qualified health insurance benefits on their own direct with a Medical Carrier,  through the Public Marketplace, through state run Medicaid if eligible or through an employer.

It is very important to note – those individuals who cannot demonstrate qualified coverage in 2014 may incur a tax penalty.

  • 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
  • $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.

whichever is GREATER. Some exceptions apply, please speak to an agent for further details on those not subject to Individual Mandate. Please refer to  for further information.

Significant Reform Changes

– Carriers will no longer be able to medically underwrite.  An individuals premium will be based on their age, their area (or zone) and whether they use tobaccoTobacco surcharge up to 50%.

– Plans will need to fit in one of 5 tiers based on Actuarial Value (AC): Catastrophic, Bronze (60%), Silver (70%) , Gold (80%) or Platinum (90%).  – Plans sold will need to include Essential Health Benefits (EHB’s).  Please refer to EHB link below under tools

– Individuals will need to secure coverage during an OPEN ENROLLMENT PERIOD.  Those who miss the enrollment period may only obtain/enroll in individual health coverage direct with a medical carrier OR on the Public Marketplace if they have a Special Qualifying Event. For more information, please call and speak with an agent or visit

Coverage Availability

Individuals may chose to purchase their coverage either direct with a carrier as they do now or on the Public Marketplace.  Individuals can continue to work with Licensed, Certified Agent  to help evaluate what route makes the most sense.  Not all carriers that sell direct will offer plans on the Marketplace, nor will all plans sold off the Marketplace be available on the Marketplace by carriers who participate. Plans sold mutually on and off the Marketplace will reflect same premium.

Why choose a Marketplace Certified Agent

Whether an Individual chooses to purchase direct with a carrier or on the Public Marketplace, using an agent is an added value that will not effect the premium, our service is no cost to you, so take advantage and let us help! You need to make sure to include your agent’s FFM ID at time of application: bluesky1980

Only Federally Facilitated Marketplace Certified Agents can work with clients both on and off, make sure you choose a Certified Agent to ensure the greatest selection in coverage options. Only State Licensed Agents can help individuals enroll in medical plans.

When to apply

Each year, individuals will need to select and enroll in their proceeding year medical coverage during the OPEN ENROLLMENT PERIOD held November 15th to December 15th  for a January 1st effective date.  Those who miss this period will have until February 15th to secure the last effective date of March 1st 2015.

IMPORTANT: Individuals who miss the open enrollment period will need to wait to the next open enrollment period with the exception of those who have a Special Qualifying Event.  Please speak with an agent for details.


Will I qualify for a Advance Credit Premium Subsidy? If so, how much?

Individuals who’s income falls between 138- 400%* Federal Poverty Level (FPL) may qualify for tax subsidies to offset their cost of medical premiums.  *Effective April 2014, those individuals who fall between 100-138% may qualify for Medicaid. Please contact our office to speak with a Marketplace Certified Agent to review your options and help you determine:

1. Do I qualify for tax subsidies, if so, how much and how do I claim

2. What is the difference between applying direct with a health carrier and purchasing on the Public Marketplace

3. What plans are available and would make the most sense for me and/or my family?

4. How will Health Care Reform impact my current coverage, do I need to make a change now?


Individual Marketplace Enrollment Link (Quote & Apply Here!)

Federal Poverty Level’s and Income

Kaiser Foundation Illustrative Tax Subsidy Calculator

What income is considered when certifying for Advance Tax Subsidies- MAGI

What are the 10 Essential Health Benefits