Insurance Frequently Asked Questions in Marion, NC

Protect Your Legacy- Protect Those You Love

Q: What are Subsides?
A: To help make health insurance more affordable and effective, the federal government offers financial assistance, to individuals and families who qualify base on their income and household size. These subsidies reduce the monthly coast of a health insurance plan for those who qualify.
Q: How do I qualify for a Subsidy?
Income is between 100% and 400% of the Federal Poverty Level (FPL)
Not be eligible for public coverage, such as Medicaid, the Children's Health Insurance Program (CHIP), Medicare or coverage through the armed services.
Not have access to insurance through an employer. (An exception can be made if the employer's plan does not provide required minimum benefits (also known as minimum essential coverage) or if the plan is considered unaffordable – the premium is more that 9.5% of the employee's income.)

Note: Many families have access to health insurance through a job. If that coverage is not affordable, families may be eligible for tax credits (other words called “subsidies) to lower the cost of coverage under the Affordable Care Act. Because employer coverage affordability is based on the cost of coverage for the employee only, not the typically higher cost of coverage for the entire family, some working families face a “Family Glitch” that prohibits them from eligibility for tax credits (subsidies) and lowering their costs.
Q: What is a qualified income?
A: Federal Taxable Wages, Self-employment income, Unemployment compensation, Social Security and Social Security Disability Income, Retirement/pension Income, Alimony, Capital gains, Investment income, Rental and royalty income.
Q: What if my income below 100% of the FPL or above 400% of the FPL?
A: People with income below or above the FPL for their household size, is ineligible for subsides.
Q: Can I still purchase health coverage if I am not eligible for a subsidy?
A: Yes, you will pay the entire cost of the monthly premium.
Q: When can I purchase health insurance?
A: Open Enrollment Period begins November 1 and ends December 15. After December 15, only if you have a “life event” that qualifies you for a Special Enrollment Period.


Initial Enrollment Period – the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

This period also includes those who are newly eligible due to receiving disability benefits from Social Security or certain disability benefits from the RRB for 24 months.

General Enrollment Period – the time that you sign up for Part A and/or Part B if you did not during your Initial Enrollment Period. Coverage will start July 1 of that year (a penalty maybe assigned).

Special Enrollment Period – the time when you can sign up for Part B (or Part A if you have to buy it) and did not during your Initial Enrollment Period, because you were covered under a group health plan.

Open Enrollment Period – Anyone with Medicare can join, switch, or drop a Medicare Advantage Plan or Prescription Drug Plan between October 15 – December 7. Coverage will begin on January 1, as long as the plan gets your request by December 7.
Q: What is the Part D late enrollment penalty?
A: The late enrollment penalty is an amount that is added to your Part D premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there is a period of 63 or more days in a row when you do not have Part D or other creditable prescription drug coverage. You will generally have to pay the penalty for as long as you have Part D coverage.
Q: How much more will I pay?
A: The cost of the late enrollment penalty depends on how long you did not have creditable prescription drug coverage. Currently, the late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” by the number of full, uncovered months that you were eligible but did not join a Medicare drug plan or without other creditable prescription drug coverage.
Call us today at 828-652-1553 for more clarification regarding your insurance questions.